Abstract 38

Our Hospital has 528 beds (99 for day hospital). In 1997 there were 15572 admissions, for total of 7200 days of hospitalization. 16081 patients were treated on a Day-Hospital basis. In 1997, 1641 Units of Fresh Plasma was distributed for a total of 410 liters. An index for clinical use of plasma expresses the ratio between liters of plasma used for every 10 units of red blood cells in one year; the optimal ratio should be lower than the theoretical index that is 0.65 and our index was 0.46. We analyzed data from the first 6 months of 1998: 1263 Units had been distributed, 232 100mL Units and 1031 220mL Units for a total of 250 plasma liters. The index of clinical use is 0.55: although increased, it is still within acceptable limits. As expected, the intensive Care Unit has the highest consumption of plasma, both transfused and discarded. The Bone Marrow Transplant Unit follows with 13.8% of the total Fresh Frozen Plasma requested. The data referred to Surgery Services show that Pediatric Cardiac Surgery is first for plasma use, with the lowest percentage of discarded Units (compared to the others). We divided the Fresh Frozen Plasma requests into two groups: the ones for preventive treatment and the ones for therapeutical use. The first one is the infusion of plasma with donor's group specific substance to recipients of major ABO incompatible bone marrow transplant 1 week before the graft. Recipient's haemolysins are neutralized and their titre lowered: alloimmune haemolysis is consequently minimized. The second is preventive treatment for Venous Occlusive Disease complicating allogeneic bone marrow transplantation: large amounts of Fresh Frozen Plasma are transfused in the first two weeks after the graft. Efficacy of this type of treatment is still controversial. In pediatric surgery FFP is mostly used in small babies or newborns presenting cerebral or intestinal congenital malformations, often associated with coagulation abnormalities and higher risk of bleeding. For disease like TTP, Neonatal Purpura Fulminans and therapeutic procedures like Exchange Transfusion, administration of Fresh Frozen Plasma is mandatory. In conclusion, several factors make correct use of Fresh Frozen Plasma difficult to achieve in premature babies and very small infants. Pathological conditions like coagulopathy, hipoxia, hypoproteinemia, in fact, may often overlap, and choosing between possible benefits and total safety becomes a hard task.