Fresh Frozen Plasma Transfusion Increases Organ Failure in Trauma Patients

Transfusion of fresh frozen plasma (FFP) in critically injured patients is associated with an increased risk for multiple organ failure (MOF), according to a new study.

Researchers at the University of Colorado (Denver, USA) conducted a prospective cohort study involving 1,440 critically injured patients admitted to the surgical intensive care unit (ICU) between 1992 and 2004, and survived at least 48 hours. Of these, 1,415 had complete data on age, Injury Severity Score (ISS), and units of FFP, platelets, and packed red blood cells (PRBCs) transfused. The main outcome measure was MOF; multiple logistic regression analysis was used to adjust transfusion of FFP, platelets, and PRBCs for known MOF risk factors.

The results showed that among all the patients, 346 (24%) developed MOF, and 118 (8.2%) died. The analysis detected a significant interaction between units of FFP and PRBCs transfused; but regardless of the units of PRBCs transfused, FFP transfusion was independently associated with the development of MOF; but the deleterious effect associated with FFP transfusion was found to be more prominent among patients receiving fewer than 6 units of PRBCs. Platelet transfusion was unassociated with MOF after adjustment for age, ISS, and FFP, and PRBC transfusion. The researchers recommended that further work was needed to develop clotting assays that differentiate between types of coagulopathy, and that the study highlights the need for improved transfusion protocols. The study was published in the October 2010 issue of Archives of Surgery.

"The scientific rationale for early fresh frozen plasma administration remains a matter of debate; neither the efficacy nor the safety of this approach is well described,” said lead author Jeffrey Johnson, M.D. and colleagues of the department of surgery. "In fact, the clinical efficacy of FFP transfusion remains largely unproven, and most evidence for FFP administration is from observational data alone.”

FFP refers to the fluid portion of one unit of human blood that has been centrifuged, separated, and frozen solid at -18 °C or colder within eight hours of collection. It contains the labile as well as stable components of the coagulation, fibrinolytic, and complement systems; the proteins that maintain oncotic pressure and modulate immunity; and other proteins that have diverse activities. In addition, fats, carbohydrates, and minerals are present in concentrations similar to those in circulation. There is little scientific evidence to support the increasing use of FFP in clinical medicine purely for volume expansion; while FFP is a reliable solution for intravascular volume replacement in acute blood loss, alternative therapies are equally satisfactory and considerably safer.

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