FRESH FROZEN PLASMA

INAPPROPRIATE USE OF FRESH FROZEN PLASMA AN AUDIT OF A TERTIARY CARE HOSPITAL.

Abstract

Introduction: As the use of Fresh Frozen Plasma (FFP) is having established
complications including Allergic reactions, infectious complications, hemolysis, fluid over
load, transfusion related acute lung injury (TRALI) and immune suppression, therefore it must
be used cautiously. Objectives: To evaluate the inappropriate use of FFPs, to carry out an
audit of appropriateness of FFP transfusion with reference to international guidelines and set
foundations for blood bank and transfusion protocols. Study Design: Cross sectional study.
Setting: Khyber Teaching Hospital Peshawar. Period: 6 months, 1st January 2016 to 30th June
2016. Methods: During which FFP transfusion requests made to the blood bank by various units
of the hospital were studied including general surgery, surgical ICU, general medicine, medical
ICU, gynecology and obstetrics. Seventy Six requests were received that were judged using
6 variables: indication for FFP use, sampling errors, laboratory analysis errors, interpretation
errors, dosage of FFP (number of units being transfused) and timing of FFP transfusion. Score
of “1” was given for each correct variable. After matching data to the international protocols, a
score of 4-5 was taken as appropriate and <3 was classified as inappropriate. Results: Twenty
Seven (35.5%) FFP transfusions were done with a score of 4-5 and were considered appropriate
while 49(64.5%) FFP transfusions were given a score of 3 or less and were considered
inappropriate. Conclusions: Almost two third of FFP were used inappropriately in our hospital,
the commonest indication being acute Disseminated Intravascular Coagulation (DIC) and
mostly requested from surgical units. Maximum cases of inappropriate transfusions were due
to wrong sampling techniques and wrong dosage calculations. Most inappropriate transfusions
were done in MICU. It is recommended that annual clinical audit of all blood products usage
should be conducted. Local guidelines for physicians and training programs for nurses and
paramedics regarding proper use of blood products should be established.