Justifying the clinical use of fresh frozen plasma - an audit

To determine the appropriateness of fresh frozen plasma (FFP), uses in various haematological and clinical disorders, with reference to the British Committee for Standards in Haematology (BCSH) guidelines through an audit.

Descriptive study.

Department of Haematology and Transfusion Medicine, Shalamar Hospital, Lahore, from June 2001 to June 2004.

The data was collected from June 2001 to June 2004 from the request forms ordered by the clinicians for the transfusion of FFP at the Department of Haematology and Transfusion Medicine, Shlamar Hospital, Lahore. A total of 2075 healthy blood donors donated their whole blood for the preparation of fresh frozen plasma (FFP). All blood donors were screened for anti HCV, HBsAg, VDRL and HIV. Those 2075 FFP units were prepared on high-speed centrifuge and were rapidly stored at -30oC freezer. A total of 587 patients were transfused 2075 units of FFP for various clinical disorders. The percentage of FFP units, transfused appropriately and inappropriately, as defined by BCSH guidelines, was estimated.

Out of 2075 FFP units, 335 (24.41%) FFP units were transfused to patients suffering from bleeding due to disseminated intravascular coagulation (DIC), 306 (22.30%) units used for massive transfusion and surgical bleeding, 236 (17.20%) units for bleeding due to chronic liver disease, 202 (14.72%) units used to control bleeding due to coagulation factor deficiencies, 84(6.12%) units for thromobotic thrombocytopenic purpura (TTP), 75(5.46%) units prior to liver biopsy to correct prolonged prothrombin time (PT), 72(5.24%) units for haemorrhage due to haemolytic disease of newborn (HDN) and 62(4.51%) units to control bleeding due to warfarin overdosage, 425(60.45%) units used for nutritional support and hypovolaemia replacement, 131(18.63%) units for the reversal of prolonged INR in the absence of bleeding due to warfarin, 92 (13.08%) units used in ICU to correct prolonged PT without bleeding due to Vitamin K deficiency and 55(7.82%) units for chronic liver disease (CLD) to correct prolonged PT and APTT in the absence of bleeding. In summary, 1372 (66.12%) FFP units were appropriately and 703 (33. 88 %) were inappropriately used.

In conclusion, 33.88% FFP was inappropriately used mainly due to lack of awareness of international guidelines and ignorance of risks.