Background/Case Studies: Current guidelines recommend that plasma transfusions be restricted to patients with an abnormal coagulation profile in the context of active bleeding or an invasive procedure. Despite these recommendations, plasma is often transfused inappropriately, exposing patients to potential harms of plasma including transfusion associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI), allergic reaction, and alloimmunization. Inappropriate plasma transfusions also add unnecessary costs and resources. This study evaluated the frequency of inappropriate plasma transfusions over a 10-year period at a large academic hospital center.
Study
Design/Methods: This is a retrospective study. Adult inpatients (age ≥ 18) admitted to a large tertiary care hospital center between January 1, 2010, to December 31, 2019, and transfused at least 1 unit of plasma during admission to hospital were included. Patients treated with plasma exchange were excluded. Data collected included patient demographics, surgical interventions, laboratory investigations, blood product utilization, hospital length of stay, in-hospital mortality, and transfusion reactions. An inappropriate plasma transfusion was defined as 1) a dose that was too low (1- 2 units); 2) a plasma transfusion given in the context of an international normalized ratio (INR) < 1.5; 3) INR >1.5 with no bleeding or invasive procedure; 4) no INR drawn pre-or post-transfusion.
Results/Findings: A total of 9,588 hospital admissions with a plasma transfusion were identified, representing 9,313 unique patients. The mean age of plasma recipients was 64.9 (standard deviation [SD] 16.0) and 63.6% were male. Of 20,497 plasma transfusion events, 85.8% were considered inappropriate since they met one of the predefined criteria; 75.4% had an inappropriate plasma dose (1-2 units), and 44.8% were given outside of guideline recommendations (Table 1). Of the plasma transfusions administered outside of guideline recommendations, 16.0% were for an INR < 1.5, 76.1% were for INR>1.5 without bleeding or an invasive procedure, and 7.9% had no pre- or post- plasma transfusion INR assessed. Conclusions: This retrospective study demonstrated that plasma transfusions are often used inappropriately. Further education and quality improvement initiatives are required to enhance plasma stewardship.
Importance of research: This study highlights that plasma is often transfused inappropriately. In this study, the most common reason for inappropriate use of plasma outside of guideline recommendations was for an elevated INR without bleeding or an invasive procedure. Given the potential harms of plasma transfusion, including unnecessary costs and utilization of healthcare resources, this work illustrates the importance of additional education and quality improvement initiatives to enhance appropriate plasma use.
