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Indications and Effects of Plasma Transfusions in Critically Ill Children

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  • Oliver Karam
  • Pierre Demaret
  • Alison Shefler
  • Stéphane Leteurtre
  • Philip C Spinella
  • Simon J Stanworth
  • Marisa Tucci
  • Canadian Critical Care Trials Group (CCCTG)
  • Arash Afshari
  • Mathias Johansen
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RATIONALE: Plasma transfusions are frequently prescribed for critically ill children, although their indications lack a strong evidence base. Plasma transfusions are largely driven by physician conceptions of need, and these are poorly documented in pediatric intensive care patients.

OBJECTIVES: To identify patient characteristics and to characterize indications leading to plasma transfusions in critically ill children, and to assess the effect of plasma transfusions on coagulation tests.

METHODS: Point-prevalence study in 101 pediatric intensive care units in 21 countries, on 6 predefined weeks. All critically ill children admitted to a participating unit were included if they received at least one plasma transfusion.

MEASUREMENTS AND MAIN RESULTS: During the 6 study weeks, 13,192 children were eligible. Among these, 443 (3.4%) received at least one plasma transfusion and were included. The primary indications for plasma transfusion were critical bleeding in 22.3%, minor bleeding in 21.2%, planned surgery or procedure in 11.7%, and high risk of postoperative bleeding in 10.6%. No bleeding or planned procedures were reported in 34.1%. Before plasma transfusion, the median international normalized ratio (INR) and activated partial thromboplastin time (aPTT) values were 1.5 and 48, respectively. After plasma transfusion, the median INR and aPTT changes were -0.2 and -5, respectively. Plasma transfusion significantly improved INR only in patients with a baseline INR greater than 2.5.

CONCLUSIONS: One-third of transfused patients were not bleeding and had no planned procedure. In addition, in most patients, coagulation tests are not sensitive to increases in coagulation factors resulting from plasma transfusion. Studies assessing appropriate plasma transfusion strategies are urgently needed.

Original languageEnglish
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume191
Issue number12
Pages (from-to)1395-402
Number of pages8
ISSN1073-449X
DOIs
Publication statusPublished - 15 Jun 2015

    Research areas

  • Adolescent, Analysis of Variance, Blood Component Transfusion, Canada, Child, Child, Preschool, Critical Care, Critical Illness, Cross-Sectional Studies, Europe, Female, Hemorrhage, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, International Normalized Ratio, Male, Partial Thromboplastin Time

ID: 45808980