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Plasma is ineffective in correcting mildly elevated PT-INR in critically ill children: a retrospective observational
Esther Paula Soundar1, Ronald Besandre2, Sarah Kate Hartman3
1Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
Insights
Fresh frozen plasma transfusions are common for mild coagulopathy in children, but this study found they are ineffective. Plasma transfusion did not significantly correct elevated prothrombin time-international normalized ratio (PT-INR) levels in pediatric patients.
Area of Science:
- Pediatric Hematology
- Transfusion Medicine
- Critical Care Medicine
Background:
- Fresh frozen plasma (FFP) is frequently used in pediatric care to manage mild coagulopathy.
- Adult studies suggest FFP is ineffective for international normalized ratio (INR) ≤1.5, but pediatric applicability is debated due to different dosing.
- This study investigates the use and efficacy of FFP for mild coagulopathy in children.
Purpose of the Study:
- To determine the prevalence of FFP transfusions for mild coagulopathy (INR ≤1.5) in a pediatric setting.
- To evaluate the effectiveness of FFP in correcting mildly elevated prothrombin time-INR (PT-INR) in pediatric patients.
Main Methods:
- Retrospective review of electronic medical records at a tertiary referral hospital (April-October 2011).
- Included patients receiving plasma for PT-INR ≤1.5 with post-transfusion measurements; excluded intraoperative, ECMO, or plasma exchange-related transfusions.
- Collected demographic data and pre- and post-coagulation test results.
Main Results:
- 12.8% (60 of 468) of plasma transfusions were for PT-INR ≤1.5.
- 41 pediatric patients (median age 2.5 years) received single plasma transfusions (median dose 11 mL/Kg).
- No significant difference in PT-INR pre- and post-transfusion (p=0.34); only 15.4% achieved normalization.
Conclusions:
- Plasma transfusion for mild PT-INR elevation in critically ill children is prevalent (12.8%).
- FFP transfusion demonstrated no significant effect on correcting minor PT-INR prolongation in pediatric patients.
- Efficacy was not influenced by patient age, plasma dosage, or bleeding status.
Background:
Fresh frozen plasma transfusion is widely utilized in pediatric clinical practice to correct mild coagulopathy. Several studies on adult population have shown that transfusion of plasma cannot effectively correct mild coagulopathy when international normalized ratio (INR) is ≤1.5. Much controversy exists about the generalization of this finding for pediatric populations, especially since pediatric dosages often exceed those in adults. The aim of this study is to determine the prevalence of plasma transfusion with mild coagulopathy (INR ≤ 1.5) and its effectiveness in a pediatric setting.
Methods:
In our tertiary referral hospital, we retrospectively reviewed the electronic medical records of all patients who received plasma (April to October 2011) for mildly elevated prothrombin time (PT)-INR levels (≤1.5) and had post-transfusion PT-INR measurements; patients who received intraoperative, ECMO, or plasma exchange-related plasma transfusions were excluded from this study. We abstracted demographic data and pre- and post coagulation test results for the patients included in our study.
Results:
Among 468 plasma transfusions administered to 285 patients from April to June 2011, 60 plasma transfusions (12.8%) were given to patients with PT-INR ≤ 1.5 (range 1.3-1.5). Forty-one patients [median age 2.5 years (IQR, 0.14 to 13.75 years), median weight of 16.0 kg (IQR, 8.0 to 69.3 kg)] who received 41 single plasma transfusions [median dose 11 mL/Kg (IQR, 6-15)] had post-transfusion PT-INR measurements and were included in our study. There was no significant difference in their PT-INR values (p = 0.34) pre- and post-transfusion. Of our study, only 15.4% patients showed post-transfusion normalization [median change in PT-INR 0.15 (IQR, 0.1-0.2)] and were not different from the remaining 85% in age, plasma dose, and bleeding status.
Conclusions:
The prevalence of plasma transfusion for correction of mildly elevated PT-INR levels in critically ill children is high (12.8%). Plasma transfusion showed no significant effect in correcting minor prolongation of PT-INR in pediatric patients regardless of age, volume of plasma transfused per kilogram (dosage), or bleeding status.
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