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Routine coagulation screening on admission to neonatal intensive care may increase use of fresh frozen plasma

Presented at the Neonatal Society 2010 Summer Meeting.

Muthukumar P1, Clarke P2, Catford K2, Reddy S1, A Mohan1, Curley A1

1 Neonatal Intensive Care Unit, Addenbrookes Hospital, UK
2 Neonatal Intensive Care Unit, Norfolk & Norwich University Hospital, UK

Background: High rates of inappropriate transfusion of fresh frozen plasma (FFP) exist in the UK, with up to 50% non-compliance with national guidelines (1,2). Within our neonatal network we noted a large discrepancy in FFP transfusion rates between two tertiary-level neonatal intensive care units (NICUs) despite comparable numbers of admissions. 

Methods: Retrospective study of all neonatal FFP transfusions administered in two tertiary-level NICUs (‘NICU 1’ and ‘NICU 2’) during the period January 2003 – March 2008. We examined indications and practices for FFP transfusion in each NICU, and the short-term effects of transfusion on everyday measures of coagulation status (prothrombin time, PT and activated partial thromboplastin time, APTT). Ethics approval was not required for this study.

Results: 164 neonates received 268 FFP transfusions (83% (223/268) in NICU 1 vs. 17% (45/268) in NICU 2). The median number of transfusions was 1 (range 1-9). Median age at transfusion was 3 days (range 1-90 days). In both centres principal reason cited for FFP transfusion was abnormal laboratory measures of coagulation status (72%); other indications included active bleeding (15%), surgical management (7%), volume expansion (4%) and other (2%). Routine coagulation screening of all babies requiring intensive care on admission was the routine practice in NICU 1 but not NICU 2, and was associated with significantly higher rates of FFP transfusion for ‘abnormal’ coagulation values (172/223 (77%) of transfusions in NICU 1 vs 21/45 in NICU 2. Pre and post transfusion coagulation studies were available for 72% of neonates. FFP transfusion corrected PT and APTT to within the ‘normal’ range for gestational age in only 14% and 16% of FFP transfusions respectively. Median (IQR) pre- and post-transfusion values were: PT 22.7s (19.5-27.4s) vs 19.8s (17.5-23.9s) APTT 60.8s (49.3-76.7s) vs. 47.3s (40.0-57.8s).

Conclusion: Routine admission screening of neonates for coagulopathy may increase rates of FFP transfusion FFP transfusion corrects prolonged indices of coagulation to within the normal range in only a minority of cases.

1. British Committee for Standards in Haematology: Guidelines for the use of Fresh Frozen Plasma, Cryoprecipitate and Cryosupernatant. Br J Haematol 2004; 126:11-28.
2. National Comparative Audit of the Use of Fresh Frozen Plasma Full Report February 2009 http://hospital.blood.co.uk/safe_use/clinical_audit/national_comparative/NationalComparative

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