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