Improvement in fresh frozen plasma transfusion practice: results of an outcome audit

Blood components have been in use in clinical practice for many decades now. In spite of fairly clear guidelines regarding their use, inappropriate prescriptions for components are still rampant. We undertook this work to assess the appropriateness of fresh frozen plasma (FFP) transfusions in our hospital. A prospective audit of 504 transfusion orders for 1761 FFP units was conducted over a 6-month period which was followed by a re-audit of 294 FFP prescriptions for 961 units. In the initial audit, we identified 304 (60.3%) prescriptions which were inappropriate according to the British Committee for Standardization in Hematology (BCSH) guidelines. The re-audit performed after an educational campaign among clinicians showed a reduction in inappropriate requests by 26.6%. The specific areas of misuse were FFP transfusions in patients with hypoproteinaemic states (40.5%), anaemia (36.5%), bleeding without coagulation factor deficiency (10.2%) and volume depletion (9.2%). A significant 50.3% of requests in the initial audit and 38.4% in the re-audit were for single- or two-unit transfusions, which were subtherapeutic. FFP transfusions carry the same risks to the patients as any other blood component. Prescribers of these transfusions need to be aware of the clinical setting where their use is appropriate. Local hospital transfusion committees can play a vital role in overseeing transfusion practices to ensure optimal use of blood/component therapy.