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Fresh frozen plasma and cryoprecipitate: Can we safely reduce their use in the NICU?

Abstract

Objective

To study patterns of use of Fresh Frozen Plasma (FFP) and Cryoprecipitate (CRYO) in a level 4 NICU and assess what proportions were not supported by literature.

Study Design

single centered retrospective observational. Charts of neonates admitted between 1/1/2010 to 12/31/2017 to CT Children’s level 4 NICU were reviewed. Transfusions were assigned as “supported” or “non-supported” based on available evidence. Groups were compared using T-tests and chi-squared analyses.

Results

of 4110 total admissions, 197 (4.8%) received a total of 461 transfusions (374 FFP, 87 CRYO). Only 59% of FFP and 60% CRYO were supported by literature. Within the “non-supported” group the largest category was neonates transfused prophylactically.

Conclusion

A large proportion of transfusions administered to neonates was not evidence-based, suggesting there are opportunities for improvement in use of these products.

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Fig. 1: Patients receiving FFP/CRYO by Gestational Age (N=197).

Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

References

  1. Motta M, Del Vecchio A, Perrone B, Ghirardello S, Radicioni M. FFP in the NICU: A prospective observational, multicentered study. Arch Dis Child Fetal Neonatal Ed. 2014;99:F303–308.

    Article  Google Scholar 

  2. Puetz J, Witmer C, Huang YS, Raffini L. Widespread use of FFP in US children’s hospitals despite limited evidence demonstrating a beneficial effect. J Pediatr. 2012;160:210–15. e1

    Article  Google Scholar 

  3. Potterjoy BS, Josephson CD. Platelets, Frozen Plasma and cryoprecipitate: What is the Clinical Evidence for their use in the neonatal intensive care unit? Semin Perinatol. 2009;33:66–74.

    Article  Google Scholar 

  4. Pal S, Curley A, Stanworth SJ. Interpretation of clotting tests in the neonate. Arch Dis Child Fetal Neonatal Ed. 2015;100:F270–F274.

    Article  Google Scholar 

  5. Andrew M, Paes B, Milner R, Johnston M, Mitchell L, Tollefsen DM, et al. Development of the human coagulation system in the healthy premature infant. Blood. 1988;72:1651–7.

    CAS  Article  Google Scholar 

  6. Christensen RD, Baer VL, Lambert DK, Henry E, Ilstrup SJ, Bennett ST. Reference intervals for common coagulation tests of preterm infants. (CME). Transfusion. 2014;54:627–32.

    Article  Google Scholar 

  7. Duguid J, O’Shaughnessy DF, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, et al. British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant. Br Soc Haematol. 2004;126:11–28.

    Article  Google Scholar 

  8. Gross SJ, Filston HC, Anderson JC. Controlled study of treatment of disseminated intravascular coagulation in the neonate. J Pediatr. 1982;100:445–8.

    CAS  Article  Google Scholar 

  9. Houben NA, Heeger LE, Stanworth SJ, New HV, Van der Bom JG, Fustolo-Gunnink S, et al. Changes in the use of FFP transfusions in preterm neonates: A single center experience. J Clin Med 2020;9:1–9.

    Article  Google Scholar 

  10. GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group 2007 1(modified by the EBM Guidelines Editorial Team).

  11. Altuntas N, Yenicesu I, Beken S, Kulali F, Burcu Belen F, Hirfanoglu IM, et al. Clinical use of fresh frozen plasma in neonatal intensive care units. Transfus Apher Sci. 2012;47:91–4.

    Article  Google Scholar 

  12. Puetz J, Darling G, McCormick KA, Wofford JD. Fresh frozen plasma and recombinant factor VII a use in neonates. J Pediatr Hematol Oncol. 2009;31:901–6.

    CAS  Article  Google Scholar 

  13. Baer VL, Lambert DK, Schmutz N, Henry E, Stoddard RA, Miner C, et al. Adherence to NICU transfusion guidelines: Data from a multihospital healthcare system. J Perinatol. 2008;28:492–7.

    CAS  Article  Google Scholar 

  14. Erber WN, Perry DJ. Plasma and plasma products in the treatment of massive hemorrhage. Best Pr Res Clin Haematol. 2006;19:97–112.

    CAS  Article  Google Scholar 

  15. Osborn DA, Evans N. Early volume expansion for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2004;2:CD002055.

    Google Scholar 

  16. Northern Neonatal Nursing Initiative (NNNI) Trial Group. A randomized trial comparing the effect of prophylactic intravenous FFP, gelatin or glucose on early mortality and morbidity in preterm babies. Eur J Pediatr. 1996;155:580–8.

    Article  Google Scholar 

  17. Tripody A, Ramenghi LA, Chantarangkul V, De Carli A, Clerici M, Groppo M, et al. Normal thrombin generation in neonates in spite of prolonged conventional coagulation tests. Haematologica. 2008;93:1256–9.

    Article  Google Scholar 

  18. Saxonhouse MA, Manco-Johnson MJ. The evaluation and management of neonatal coagulation disorders. Semin Perinatol. 2009;33:52–65.

    Article  Google Scholar 

  19. Raffaeli G, Pesenti N, Cavallaro G, Cortesi V, Manzoni F, Amelio GS, et al. Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: a quality improvement study. Eur J Pediatr. 2022 Feb. https://doi.org/10.1007/s00431-022-04427-6.

  20. Josephson C, Hillyer CD Transfusion of plasma derivatives: fresh frozen plasma, cryoprecipitate, albumin and immunoglobulins, in Benz E, Cohen HJ, Furie B, et al. (eds.) Hematology, Basic Principles and Practice. (Ed 4) New York, NY, Churchill-Livingston, 2009.

  21. Hensch LA, Indrikovs AJ, Shattuck KE Transfusion in ELBW premature neonates: Current practice trends, risks and early intervention to decrease need for transfusion, Neoreviews 2015;16: e287–e295.

  22. Whyte RK, Kirpalani H, Asztalos E, Andersen C, Blajchman M, Heddle N, et al. Neurodevelopmental outcomes of ELBW infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusions, Pediatrics 2009;123:207–13.

  23. Estcourt L, Standworth S, Murphy M. Prophylactic platelet transfusions. Curr Opin Hematol. 2010;17:411–7.

    Article  Google Scholar 

  24. Christensen RD. Platelet transfusion in the neonatal intensive care unit: Benefits, risks, alternatives. Neonatology. 2011;100:311–8.

    Article  Google Scholar 

  25. Stanworth SJ, Grant-Casey J, Lowe D, Laffan M, New H, Murphy MF, et al. The use of fresh frozen plasma in England: high levels of inappropriate use in adults and children. Transfusion. 2011;51:62–70.

    Article  Google Scholar 

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Acknowledgements

Ahana Nagarkatti for technical support.

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Authors and Affiliations

Authors

Contributions

SS was responsible for designing the study, extracting and analyzing data, interpreting the results, and writing the manuscript. MB was responsible for performing the statistical analysis. VH was responsible for designing the study, analyzing the data, and feedback and advising regarding the final manuscript.

Corresponding author

Correspondence to Shikha Sarkar.

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The authors declare no competing interests.

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Sarkar, S., Brimacombe, M. & Herson, V. Fresh frozen plasma and cryoprecipitate: Can we safely reduce their use in the NICU?. J Perinatol (2022). https://doi.org/10.1038/s41372-022-01438-x

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