Choosing Wisely:

Don’t transfuse plasma in the absence of active bleeding or significant laboratory evidence of coagulopathy.

Rationale and Comments: Recent studies demonstrate that plasma is often transfused inappropriately. In the absence of active bleeding or clear evidence of coagulopathy, current literature shows no reduction in blood loss or transfusion requirements with the use of plasma, but shows increased risk of transfusion-associated adverse events such as transfusion-related acute lung injury, transfusion-associated circulatory overload, and allergic reactions. These transfusion-associated adverse events lead to poorer outcomes and increased cost of care.
Sponsoring Organizations:
  • Society for the Advancement of Blood Management
  • Sources:
  • Systematic review of randomized controlled trials
  • Disciplines:
  • Hematologic
  • References: • Stanworth SJ, Brunskill SJ, Hyde CJ, et al. Is fresh-frozen plasma clinically effective? A systematic review of randomized controlled trials. Brit J Haematol. 2004;126(11):139-152.
    • Holland LL, Foster TM, Marlar RA, Brooks JP, et al. Fresh frozen plasma is ineffective for correcting minimally elevated international normalized ratios. Transfusion. 2005;45(7):1234-1235.
    • Segal J, Dzik W. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion. 2005;45(9):1412-1425.
    • Stanworth S, Grant-Casey J, Lowe D, et al. The use of fresh-frozen plasma in England: high levels of inappropriate use in adults and children. Transfusion. 2011;51(1):62-70.
    • Yang L, Stanworth S, Hopewell S, et al. Is fresh-frozen plasma clinically effective: an update of a systematic review of randomized controlled trials. Transfusion. 2012;52(8):1673-1686.
    • Muller M, Arbous MS, Spoelstra-de Man AM, et al. Transfusion of fresh-frozen plasma in critically ill patients with coagulopathy before invasive procedures: a randomized controlled trial. Transfusion. 2015;55(1):26-35.
    • Green L, Bolton-Maggs P, Beattie C, et al. British Society of Haematology guidelines on the spectrum of fresh frozen plasma and cryoprecipitate products: their handling and use in various patient groups in the absence of major bleeding. Brit J Haematol. 2018;181(1):54-67.

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