BACKGROUND Blood transfusions and fractionated products are not without risk and may lead to acute and long-term adverse events. The objective of this study was to evaluate the appropriateness of usage of frozen plasma (FP), cryoprecipitate (CRYO), and recombinant factor VIIa (rVIIa) in a pediatric setting. METHODS All orders for FP, CRYO, and rVIIa were prospectively audited over 6 weeks. Data collected included demographics, laboratory values, indication, and adverse reactions. The appropriateness of each order was independently evaluated using adjudication criteria rated by two hematologists. RESULTS Two hundred sixty-five products were ordered; 67% of the orders were issued to operating rooms or intensive care units. The most common indication for all products was cardiac surgery. FP was ordered as fluid replacement (15/215; 7%) to correct abnormal coagulation tests (23/215; 11%) and for patients with minor or no bleeding (111/242; 46%). FP was more likely to alter the international normalized ratio (INR) if the INR was over 2.0 (P < 0.0001). The rate of inappropriate products was judged as FP 19%, CRYO 21%, and rVIIa 91%. CONCLUSION FP, CRYO, and rVIIa are most commonly used in the operating room and intensive care units. FP was often used for fluid resuscitation and for patients with mild to no bleeding. FP was only effective in lowering the INR when the INR was over 2.0. Use of rVIIa was rarely ordered for an appropriate indication. Results of this study inform its readers where trials of pediatric transfusion should be performed to clarify how these products should be used in clinical practice.

Utilization of frozen plasma, cryoprecipitate, and recombinant factor VIIa for children with hemostatic impairments: An audit of transfusion appropriateness.

Plasma Transfusion in Patients With Cirrhosis in China: A Retrospective Multicenter Cohort Study

.......................................................................................... 9 INTRODUCTION ...................................................................................11 REVIEW OF THE LITERATURE.................................................................13 1. Epidemiology of blood component use..........................................13 1.1. Clinical use of red blood cells ..............................................13 1.2. Clinical use of fresh frozen plasma ......................................18 1.3. Clinical use of platelets ......................................................20 1.4. Use of blood components by diagnosis-related groups............21 1.5. Variation in blood-use practices ..........................................22 2. Optimal use of blood components................................................22 2.1. Guidelines for use of red blood cells.....................................23 2.2. Guidelines for use of fresh frozen plasma .............................24 2.3. Guidelines for use of platelets.............................................25 3. Use of electronic information in hospital databanks ........................27 3.1. Finnish Hospital Discharge Register (FHDR) ..........................27 3.2. Electronic information and transfusion research ....................27 4. Trends in blood component use...................................................28 4.1. Red blood cell usage..........................................................28 4.4. Fresh frozen plasma usage.................................................29 4.4. Platelet usage...................................................................31 4.4. Future trends in blood component use and costs ...................33 AIMS OF THE STUDY ............................................................................34 MATERIALS AND METHODS ...................................................................35 1. Finnish healthcare system and blood transfusion service ........35 2. Participants......................................................................35 3. Data collection..................................................................36 4. Blood components.............................................................38 5. Quality assurance .............................................................39 6. Study characteristics .........................................................40 7. Statistical analyses............................................................40 RESULTS.............................................................................................42 1. Validation of data (I) .................................................................42 2. Finnish transfusion practices.......................................................42 2.1. Finnish blood component recipients (I, II, III, IV, V) ..............42 2.2. Blood usage (I, II) ............................................................45 2.3. Transfusion trigger practices (II, IV)....................................46 2.4. Dosage of blood components (I, II) .....................................48 2.5. Costs of blood components (I) ............................................48 3. Comparison of transfusion practices among Finnish hospitals (I, IV).48 4. Impact of red blood cell transfusion in a selected group of parturients (III) ...................................................................................51 5. Correlation between American Society of Anesthesiologist’s (ASA) Physical Status Classification and transfusions (IV, V) ...............................51 DISCUSSION .......................................................................................53 1. Key results and strengths of the study .........................................53 2. Generalizability and limitations of the study ..................................54 3. Blood component recipients ........................................................55 4. Blood component usage .............................................................58 5. Transfusion trigger practices.......................................................58 5.1. Transfusion of fresh frozen plasma ......................................58 5.2. Transfusion of platelets......................................................59 6. Dosage of blood components ......................................................60 6.1. Dosage of red blood cells ...................................................60 6.2. Dosage with fresh frozen plasma.........................................61 6.3. Dosage of platelets ...........................................................62 7. Transfusion practices .................................................................62 8. Parturients ...............................................................................63 9. Prediction of blood need.............................................................64 10. Influencing blood component use ................................................64 11. Clinical implications ...................................................................65 12. Future perspectives ...................................................................66 CONCLUSIONS ....................................................................................68 YHTEENVETO JA JOHTOPÄÄTÖKSET........................................................69 ACKNOWLEDGEMENTS..........................................................................71 REFERENCES .......................................................................................73 APPENDIX ...........................................................................................88 1. Appendix 1...............................................................................88 2. Appendix 2...............................................................................89 3. Appendix 3...............................................................................91 4. Appendix 4...............................................................................93 5. Appendix 5...............................................................................95 6. Appendix 6...............................................................................96 LIST OF ORIGINAL PUBLICATIONS This thesis is based on the following original publications, referred to the text by their Roman numerals: I Palo R, Ali-Melkkilä T, Hanhela R, Jäntti V, Krusius T, Leppänen E, Mahlamäki EK, Perhoniemi V, Rajamäki A, Rautonen J, Salmenperä M, Salo H, Salonen I, Savolainen E-R, Sjövall S, Suistomaa M, Syrjälä M, Tienhaara A, Vähämurto M, Mäki T. Development of permanent national register of blood component use utilizing electronic hospital information systems. Vox Sanguinis. 91;140-147:2006. II Palo R, Capraro L, Hovilehto S, Koivuranta M, Krusius T, Loponen E, Mäntykoski R, Pentti J, Pitkänen O, Raitakari M, Rimpiläinen J, Salmenperä M, Salo H, and Mäki T. Populationbased audit of fresh-frozen plasma transfusion practices. Transfusion. 46;1921-1925:2006. III Palo R, Ahonen J, Salo H, Salmenperä M, Krusius T, Mäki T. Transfusion of red blood cells: no impact on length of hospital stay in moderately anaemic parturients. Acta Anaesthesiologica Scandinavica. 51;565-569:2007. IV Palo R, Capraro L, Hanhela R, Koivuranta M, Nikkinen L, Salmenperä M, Salonen I, Sjövall S, Tienhaara A, Vähämurto M, Mäki T. Platelet transfusions in adult patients with particular reference to patients undergoing surgery. Transfusion Medicine. 20; 30-37:2009. V Palo R, Rinta-Kokko H, Nikkinen L, Salmenperä M, Mäki T. Correlation of ASA (American Society of Anesthesiologist) classification and blood transfusion requirement in surgical patients. (submitted) Reprinted here with permission of the publisher (John Wiley and Sons).

Epidemiology of blood component use in Finland

Long-term audit of the use of fresh frozen plasma in a university hospital.

Efficacy of a strict surveillance policy towards inappropriateness of plasma transfusion

Evaluation of appropriate usage of fresh frozen plasma: Results of a regional audit in Iran.

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Evaluation of appropriate usage of fresh frozen plasma: Results of a regional audit in Iran.