University of Alabama Birmingham, Alabama, United States
Background/Case Studies: Most fresh-frozen plasma (FFP) is transfused for the management of hypocoagulable states or liver disease as detected by the prothrombin time (PT) and its derivative the international normalized ratio (INR). With exception to therapeutic plasma exchange and massive transfusion, the typical dose of plasma to correct coagulopathy is 15ml/kg at 250ml per unit, making the total plasma for an average adult 4 units. In this study, we sought to quantify and describe single unit plasma use within a 3-month period in 2022 at a Level 1 Trauma center. We seek to intervene within the hospital services to decrease the incorrect and under-dosed plasma use.
Study
Design/Methods: A single-center, retrospective review of single unit plasma ordered for a patient within a month period use was conducted from January 2022 to April 2022. The emergency department was excluded, as their protocol is to use 1:1 pRBC: plasma in bleeding trauma cases. Pre and post transfusion values were recorded and the reason for transfusion was described. The patients were stratified by preINR: INR < 2, INR 2-3, INR >3 for further analysis.
Results/Findings: During the study period, 2669 units of plasma were transfused at the hospital. Of these, 159 (5.96%) were single units given within the three month period. After excluding the emergency department patients and patients < 18 years old, 136 (5.1%) were included in the analysis. Of the 136, 9 (6.6%) did not have a pre-transfusion INR value, 90 (66.2%) had an INR of < 2, 25(18.4%) had an INR ≥2 and ≤3, and 12(8.82%) had an INR >3. Of the 90 patients with a pre transfusion INR less than 2, 24 (26.7%) of the single units were dispensed from the CVOR and 22 (24.4%) were dispensed from the Trauma and Burn Intensive Care unit (TBIC). Paired t-tests performed to determine if there was a significant decrease in INR values following transfusion of a single unit of plasma demonstrated that patients with a preINR < 2 did not have a significant change in INR, but the other patients did (Figure 1). Conclusions: Single unit plasma use is outside of clinical guidelines, even more so in patients with INR < 2. This study helped us identify areas of interest for quality improvement to minimize unnecessary plasma use and for re-education of clinicians in ordering plasma. Future directions include providing education to all identified areas of the hospital with inappropriate plasma dosage.
Importance of research: The transfusion of a single unit of plasma is incorrect and insufficient per clinical guidelines. In a three month period at a Level 1 Trauma Center, the prevalence of the transfusion of 1 unit of FFP is around 6%. Addressing this incorrect dosage will not only improve patient care, but could be cost-effective for our hospital.
