Neonatal Plasma Transfusion: An Evidence-Based Review

Area of Science:

• Neonatal Medicine
• Hematology
• Transfusion Medicine

Background:

• Audits reveal frequent plasma transfusions in neonates for various clinical scenarios.
• A significant portion of these transfusions are for abnormal coagulation values without active bleeding, despite limited supporting evidence.

Purpose of the Study:

• To review the appropriate clinical indications for plasma transfusion in neonates.
• To evaluate the evidence supporting current transfusion practices in neonatal care.

Main Methods:

• Analysis of clinical audit findings on plasma transfusion practices in neonates.
• Review of existing literature and evidence base for neonatal plasma transfusion indications.

Main Results:

• Plasma transfusions are commonly administered for bleeding, disseminated intravascular coagulation, and in critically ill neonates.
• Nearly half of neonatal plasma transfusions occur in the absence of active bleeding, for abnormal coagulation values.
• Evidence does not support prophylactic plasma for preventing intraventricular hemorrhage or as a volume expander.

Conclusions:

• Plasma transfusion in neonates should be reserved for documented bleeding (e.g., vitamin K dependent), disseminated intravascular coagulation, and specific inherited coagulation factor deficiencies.
• Routine or prophylactic use of plasma in neonates lacks strong evidence and should be reconsidered.