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Factors influencing plasma transfusion practices in paediatric intensive care units around the world
O Karam1,2, P Demaret2,3, A Duhamel2,4
1Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland.
Insights
Physician beliefs about plasma transfusions, not patient factors, influence transfusion practices. Targeting these beliefs through education is key to standardizing plasma transfusion protocols.
Area of Science:
- Hematology
- Transfusion Medicine
- Clinical Practice Research
Background:
- Plasma transfusions are common globally, yet indications vary widely.
- Paediatric studies reveal significant differences in plasma transfusion frequency across centers.
Purpose of the Study:
- To investigate factors driving diverse plasma transfusion practices.
- To understand the association between beliefs and transfusion rates.
Main Methods:
- An online survey was distributed to investigators at 101 centers in February 2016.
- The survey explored beliefs, patient case-mix, unit characteristics, and transfusion policies.
Main Results:
- A high response rate of 82% was achieved.
- 43% of respondents believed plasma transfusions stop bleeding, and 27% believed they prevent bleeding.
- Beliefs linking hypovolaemia and abnormal coagulation tests to plasma transfusion were associated with higher transfusion rates.
Conclusions:
- Plasma transfusion practices are primarily influenced by beliefs regarding efficacy in bleeding management and coagulation effects.
- Educational initiatives addressing these specific beliefs are recommended.
- Further research should focus on modifying these beliefs to improve transfusion consistency.
Background And Objectives:
Plasma transfusions are a frequent treatment worldwide, but many studies have reported a wide variation in the indications to transfuse. Recently, an international paediatric study also showed wide variation in frequency in the use of plasma transfusions: 25% of the centres transfused plasma to >5% of their patients, whereas another 25% transfused plasma to <1% of their patients. The objective of this study was to explore the factors associated with different plasma transfusion practices in these centres.
Materials And Methods:
Online survey sent to the local investigators of the 101 participating centres, in February 2016. Four areas were explored: beliefs regarding plasma transfusion, patients' case-mix in each unit, unit's characteristics, and local blood product transfusion policies and processes.
Results:
The response rate was 82% (83/101). 43% of the respondents believed that plasma transfusions can arrest bleeding, whereas 27% believe that plasma transfusion can prevent bleeding. Centres with the highest plasma transfusion rate were more likely to think that hypovolaemia and mildly abnormal coagulation tests are appropriate indications for plasma transfusions (P = 0·02 and P = 0·04, respectively). Case-mix, centre characteristics or local transfusion services were not identified as significant relevant factors.
Conclusion:
Factors influencing plasma transfusion practices reflect beliefs about indications and the efficacy of transfusion in the prevention and management of bleeding as well as effects on coagulation tests. Educational and other initiatives to target these beliefs should be the focus of research.
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