Written by: Mediware Consulting and Analytics on Thursday, May 31, 2012 Posted in: Blood Management

CA-plasma-bag_bwPlasma transfusion, whether FFP, plasma 24, thawed plasma, or any variation on this theme, continues to increase in the U.S. The 2009 National Blood Collection & Utilization Survey Report documented 5.7 million units of plasma produced and close to 4.5 million units transfused. This was an increase of roughly 400, 000 units from 2006.1

When compared to the evidence base associated with RBC transfusion, research surrounding plasma has been relatively sparse until recent years. Not surprisingly then, plasma use is steeped in myth. This is especially true in the clinical arenas of prophylactic plasma transfusion prior to invasive procedures and ratio-based massive transfusion protocols.

The medical community hears much about restrictive transfusion practice associated with RBCs and appears to have partially embraced the concept. Plasma therapy, on the other hand, tends to be somewhat misunderstood and the risks ignored. Perhaps it is viewed as merely that “yellow stuff” with “good” proteins thus it must be good for you.

It must be ardently reported and urgently recognized among healthcare providers that plasma is, in fact, NOT a banal proteinacious liquid without risk. Although the content, indeed, consists of coagulation factors, immunoglobulins, albumin etc. which certainly could be beneficial in the right clinical circumstance, cavalier transfusion may result in significant and severe adverse events.

TRALI still remains the number one cause of transfusion-associated mortality reported to the FDA, representing >45% of the total deaths.2 Plasma carries this high risk.

Allergic reactions are actually the number one reaction reported to the FDA, overall, and are common with plasma given the plethora of proteins present. 2 An allergic reaction may not seem serious to clinicians, however, it certainly causes our patients much discomfort and concern. This should not be disregarded. These reactions also have a domino effect within the hospital, necessitating clinical time, medication and sometimes extensive laboratory work-ups.

The overuse of plasma transfusion to correct “abnormal” coagulation studies (e.g. INRs < 1.9) typically results in over-exposure to often high volumes and rates of plasma transfusion. This typically is to no avail and places patients at clear risk for other pulmonary complications such as TACO. A multitude of studies point to the LACK of evidence for plasma transfusion in this situation.3-5 High plasma ratios in MTPs have also been called into question for similar reasons.6, 7 Hopefully the TOPIC and PROPPR trials, respectively will provide additional information to guide appropriate plasma use and build our evidence base.8,9

Current literature points to a need for restrictive use of plasma components mirroring the literature base for RBCs. Plasma transfusion must be considered a serious therapy/intervention which comes with its attendant good AND bad accouterments. In the end, the medical community should not sit idly by assuming plasma is “mellow yellow”!

References

  1. National Blood Collection and Utilization Survey Report, 2009; ISBN# 978-1-56395-328-6
  2. Fatalities Reported to FDA Following Blood Collection and Transfusion, Annual Summary for Fiscal Year 2010
  3. Segal J and Dzik W Transfusion, 2005; 45: 1413
  4. Roback J et al. Transfusion, 2010; 50:1227
  5. Yang L et al. Transfusion, 2012; DOI: 10.111/j.
  6. Murad M et al. Transfusion, 2010; 50: 1370
  7. Inaba K et al. Am Coll Surg, 2010; 210: 957
  8. Muller M et al. Trials, 2011; 12: 266
  9. www.uth.tmc.edu/cetir/PROPPR