GUIDELINE FOR THE USE OF FRESH-FROZEN PLASMA

Objective. To make recommendations regarding the rational use of fresh -frozen plasma (FFP), since there is evidence of excessive and uncriti cal use of this blood component. Options. Alternatives to the use of F FP are presented: (i) specific factor concentrates for the treatment o f the haemophilias and related inherited bleeding disorders; (ii) cryo precipitate for the management of fibrinogen deficiency; (iii) vitamin K, where bleeding is associated with a deficiency of this vitamin; an d (ir) crystalloids, plasma and synthetic colloids, the indicated comp onents in the management of hypovolaemia and appropriate replacement f luids in most plasma exchange procedures. Evidence, There is a marked paucity of objective data regarding indications for the use of FFP? Ev idence was therefore obtained from previously published guidelines fro m the USA and the UK. Three clinical studies of massive blood transfus ion,cardiopulmonary bypass and patients with coagulation abnormalities undergoing minor invasive procedures were reviewed. Benefits, harms a nd costs. By Following this guideline unnecessary costs to hospitals a nd patients will be avoided and the well-known risks of blood transfus ion will be decreased. Appropriate use will also result in the greater availability of plasma for fractionation into concentrates for the tr eatment of the haemophilias, of which there is usually a shortage, Rec ommendations. Definite indications for the use of FFP: (i) replacement of single Factor deficiencies; (ii) immediate reversal of warfarin ef fect; (iii) vitamin K deficiency associated with active bleeding; (iv) acute disseminated intravascular coagulation; to thrombotic thrombocy topenic purpura; and (vi,i) inherited deficiencies of inhibitors of co agulation. Conditional uses (if there is bleeding and evidence of dist urbed coagulation): (i) massive transfusion; (ii) liver disease; and ( iii) cardiopulmonary bypass surgery. No justification for the use of F FP: (i) hypovolaemia; (ii) plasma exchange procedures; (iii) nutrition al support and protein-losing states; and (iv) treatment of immunodefi ciency states. Validation. This guideline was circulated in draft form for review by clinical users or groups representing blood users in th e regions served by the various blood transfusion services. Authors an d endorsement. The guideline was developed and endorsed by the Nationa l Blood Transfusion Council through its subcommittee, the Medical Dire ctors Advisory Committee. The initial draft for circulation was prepar ed by Dr Arthur Bird, of the Western Province Blood Transfusion Servic e.