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Indications and Effects of Plasma Transfusions in Critically Ill Children
Oliver Karam1,2, Pierre Demaret3, Alison Shefler4
11 Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland.
Insights
Plasma transfusions in critically ill children are often given without clear indications like bleeding or surgery. In most cases, these transfusions do not significantly improve coagulation tests, highlighting a need for better transfusion strategies.
Area of Science:
- Pediatric Critical Care Medicine
- Transfusion Medicine
- Hematology
Background:
- Plasma transfusions are common in critically ill children but lack strong evidence-based indications.
- Prescriptions are often based on physician judgment rather than documented need, especially in pediatric intensive care units.
Purpose of the Study:
- To identify patient characteristics and indications for plasma transfusions in critically ill children.
- To evaluate the impact of plasma transfusions on coagulation test results.
Main Methods:
- A point-prevalence study was conducted across 101 pediatric intensive care units in 21 countries.
- Data were collected during 6 predefined weeks, including 443 critically ill children who received at least one plasma transfusion.
Main Results:
- Indications included critical bleeding (22.3%), minor bleeding (21.2%), planned surgery (11.7%), and high risk of postoperative bleeding (10.6%).
- 34.1% of transfusions were given without documented bleeding or planned procedures.
- Plasma transfusion showed a significant improvement in international normalized ratio (INR) only for patients with a baseline INR > 2.5.
Conclusions:
- A significant proportion of plasma transfusions (one-third) were administered without clear indications like bleeding or planned procedures.
- Coagulation tests generally lack sensitivity to detect changes from plasma transfusions in most pediatric patients.
- Urgent research is needed to establish appropriate plasma transfusion strategies for critically ill children.
Rationale:
Plasma transfusions are frequently prescribed for critically ill children, although their indications lack a strong evidence base. Plasma transfusions are largely driven by physician conceptions of need, and these are poorly documented in pediatric intensive care patients.
Objectives:
To identify patient characteristics and to characterize indications leading to plasma transfusions in critically ill children, and to assess the effect of plasma transfusions on coagulation tests.
Methods:
Point-prevalence study in 101 pediatric intensive care units in 21 countries, on 6 predefined weeks. All critically ill children admitted to a participating unit were included if they received at least one plasma transfusion.
Measurements And Main Results:
During the 6 study weeks, 13,192 children were eligible. Among these, 443 (3.4%) received at least one plasma transfusion and were included. The primary indications for plasma transfusion were critical bleeding in 22.3%, minor bleeding in 21.2%, planned surgery or procedure in 11.7%, and high risk of postoperative bleeding in 10.6%. No bleeding or planned procedures were reported in 34.1%. Before plasma transfusion, the median international normalized ratio (INR) and activated partial thromboplastin time (aPTT) values were 1.5 and 48, respectively. After plasma transfusion, the median INR and aPTT changes were -0.2 and -5, respectively. Plasma transfusion significantly improved INR only in patients with a baseline INR greater than 2.5.
Conclusions:
One-third of transfused patients were not bleeding and had no planned procedure. In addition, in most patients, coagulation tests are not sensitive to increases in coagulation factors resulting from plasma transfusion. Studies assessing appropriate plasma transfusion strategies are urgently needed.
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