Evaluating the appropriateness of fresh frozen plasma transfusions in two tertiary teaching hospitals

Despite efforts to standardise practice using evidence-based guidelines, fresh frozen plasma (FFP) remains the blood component most frequently prescribed inappropriately. This study assessed the appropriateness of FFP transfusion in two tertiary teaching hospitals and analysed the characteristics of appropriate and inappropriate transfusions.

Patients who had undergone FFP transfusion between October and December 2022 at two tertiary teaching hospitals were retrospectively analysed. Only the initial FFP transfusion data were analysed for each patient. Patient characteristics; laboratory test results, including prothrombin time, international normalised ratio, and activated partial thromboplastin time; and the association of FFP transfusion with various factors were examined. Sub-therapeutic dosing was defined as the transfusion of ≤2 units of FFP. FFP transfusions were classified into eight groups based on a classification algorithm to determine their appropriateness.

In total, 584 FFP transfusions (2301 units) were analysed, with 42.1% involving subtherapeutic dosing. FFP transfusions were performed in the intensive care unit (ICU; 30.5%), general ward (24.8%), operating room (21.1%), and emergency room (22.9%). Overall, 51.5% of FFP transfusions were deemed appropriate, with significant variations being observed between the hospitals (Hospital B vs. Hospital A: 73.2% vs. 35.3%). Inappropriate FFP transfusions were associated with a higher INR, with 73.4% of them being associated with severe bleeding and/or surgery.

In conclusion, 40.6% of FFP transfusions were deemed inappropriate in the present study owing to failure to meet laboratory criteria. The present study provides valuable insights into the optimisation of plasma transfusion practices and emphasises the requirement for institution-specific management.