Plasma: indications, controversies, and opportunities

Area of Science:

• Transfusional Medicine
• Hematology
• Critical Care Medicine

Background:

• Plasma, a vital blood product, is often overused globally.
• Current data supporting optimal plasma utilization is limited, leading to potential overuse.
• Common uses include treating coagulopathy in bleeding patients and pre-procedural coagulation optimization.

Purpose of the Study:

• To review and define appropriate indications for plasma transfusion.
• To highlight clinical situations where plasma is overutilized or not indicated.
• To discuss evidence-based guidelines for plasma use in various medical scenarios.

Main Methods:

• A comprehensive literature review was conducted on PubMed and Google Scholar from January 2000 to June 2023.
• Search terms included 'plasma,' 'fresh frozen plasma,' 'indications,' 'massive transfusion protocol,' 'liver disease,' 'warfarin reversal,' and 'INR < 2.'
• Articles were screened for relevance to transfusional medicine, with additional references sourced from citations.

Main Results:

• Key indications for appropriate plasma use include coagulation factor replacement, major hemorrhage protocols, and managing coagulopathy in liver disease or vitamin K antagonist use.
• The review discusses the relationship between coagulation factor levels, INR, and appropriate weight-based plasma dosing.
• Identified clinical situations where plasma is frequently overused or unnecessary were highlighted.

Conclusions:

• Appropriate plasma transfusion requires adherence to evidence-based guidelines to ensure patient safety and optimize resource utilization.
• A high-value healthcare approach necessitates careful consideration of plasma's benefits versus risks in specific clinical contexts.
• Novel plasma products may offer future advancements in transfusion therapy, warranting further investigation.