[Transfusion of plasma products: an update for anesthesiologists]

Historically, plasma was first used as volume replacement and later for coagulation substitution, although with limited effectiveness. As almost coagulation neutral volume replacement agents, plasma products are useful in treating patients suffering from traumatic hemorrhagic shock and seem to be superior to crystalloid infusion solutions for improving the outcome. Various plasma products are currently available on the market, each offering different advantages and disadvantages, which necessitates careful selection. The transfusion of plasma products should have the same AB0 group but in time critical emergencies AB0-compatible plasma can also be used. The previously feared risk of infection has been significantly reduced thanks to improved donor selection, testing and manufacturing processes, so that today other side effects are more prominent. Common side effects, such as iatrogenic hypocalcemia and transfusion-associated circulatory overload, must be considered. Careful evaluation of the correct indications for plasma transfusion can greatly reduce the occurrence of adverse events. For anesthesiologists the main indications for transfusion of plasma products are the treatment of hemorrhagic shock and, in exceptional cases, the substitution of rare individual factor deficiencies; however, in practice, there are often incorrect indications, which is why the administration should be critically reviewed before each plasma transfusion. The current literature no longer recommends the prophylactic use of plasma prior to procedures (e.g., tracheostomy, central venous catheter placement) in patients with abnormal coagulation tests but no evidence of bleeding. Patients with (chronic) liver dysfunction and abnormal coagulation parameters but without clinical correlates, should also not receive transfusions. Further research is still required to determine whether plasma plays a role in sepsis and in patients suffering from severe burns.