CoChat
Sign Up
Cited by 237Blood transfusion and managementTrauma, Hemostasis, Coagulopathy, ResuscitationBlood donation and transfusion practices

The use of fresh‐frozen plasma in England: high levels of inappropriate use in adults and children

Open access
Stanworth, Simon J., Grant‐Casey, John, Lowe, Derek, Laffan, Mike, New, Helen, Murphy, Mike F., Allard, Shubha·2011·Transfusion
DOI 10.1111/j.1537-2995.2010.02798.x
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Fresh-frozen plasma (FFP) is given to patients across a range of clinical settings, frequently in association with abnormalities of standard coagulation tests. STUDY DESIGN AND METHODS: A UK-wide study of FFP transfusion practice was undertaken to characterize the current patterns of administration and to evaluate the contribution of pretransfusion coagulation tests. RESULTS: A total of 4969 FFP transfusions given to patients in 190 hospitals were analyzed, of which 93.3% were in adults and 6.7% in children or infants. FFP transfusions to adults were given most frequently in intensive-treatment or high-dependency units (32%), in operating rooms or recovery (23%), or on medical wards (22%). In adult patients 43% of all FFP transfusions were given in the absence of documented bleeding, as prophylaxis for abnormal coagulation tests or before procedures or surgery. There was wide variation in international normalized ratio (INR) or prothrombin times before FFP administration; in 30.9% of patients where the main reason for transfusion was prophylactic in the absence of bleeding the INR was 1.5 or less. Changes in standard coagulation results after FFP administration were generally very small for adults and children. CONCLUSIONS: This study raises important questions about the clinical benefit of much of current FFP usage. It highlights the pressing need for better studies to inform and evaluate quantitative data for the effect of plasma on standard coagulation tests.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/j.1537-2995.2010.02798.x

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The inappropriateness of blood transfusion did not change dramatically over the past 20 years.

    “This issue of inappropriateness of blood transfusion did not dramatically change during the past 20 yr.[27][28][29]”

    From Point-of-Care Testing: A Prospective, Randomized Clinical Trial of Efficacy in Coagulopathic Cardiac Surgery Patients (2012) · cites this paper as [29]

    The Discussion reports that many patients were continuing to receive fresh-frozen plasma unnecessarily. It does not compare inappropriate use across the past 20 years, and its findings concern fresh-frozen plasma rather than blood transfusion generally. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 36

  1. British Committee for Standards in Haematology. Guide- lines for the use of fresh frozen plasma (updated). Br J Haematol 2004;126:11-28.
  2. British Committee for Standards in Haematology. Transfu- sion guideline for neonates and older children. Br J Hae- matol 2004;124:433-53.
  3. British Committee for Standards in Haematology. Guide- lines on oral anticoagulation (warfarin): third edition- 2005. Br J Haematol 2006;132:277-85.
  4. Roseff SD, Luban NL, Manno CS. Guidelines for assessing appropriateness of pediatric transfusion. Transfusion 2002; 42:1398-413.
  5. Lundberg GD, Cooper ES, Bracey AW, Horvath AE, Shan- berge JN, Simon TL, Yawn DH. College of American Pathologists practice guidelines development taskforce. Fresh-frozen plasma, cryoprecipitate and platelets admin- istration. Practice Parameter for the use of fresh-frozen plasma, cryoprecipitate and platelets. JAMA 1994;271:777- 81.
  6. British Committee for Standards in Haematology. Guide- lines on the management of massive blood loss. Br J Hae- matol 2006;135:634-41.
  7. Shehata N, Kouroukis C, Kelton JG. A review of randomized controlled trials using therapeutic apheresis. Transfus Med Rev 2002;16:200-29.
  8. Holland LL, Brooks JP. Toward rational fresh frozen plasma transfusion: the effect of plasma transfusion on coagula- tion test results. Am J Clin Pathol 2006;126:133-9.
  9. Goodnough LT, Johnston MF, Shah T, Chernosky A. A two- institution study of transfusion practice in 78 consecutive adult elective open-heart procedures. Am J Clin Pathol 1989;91:468-72.
  10. Stanworth SJ, Tinmouth AT. Plasma transfusion and use of albumin. In: Simon TL, Synder EL, Solheim BG, Stowell CP, Strauss RG, Petrides M, editors. Rossi's textbook of transfu- sion medicine. Wiley-Blackwell: Oxford, UK; 2009. pp. 287- 97.
  11. Wells AW, Llewelyn CA, Casbard A, Johnson AJ, Amin M, Ballard S, Buck J, Malfroy M, Murphy MF, Williamson LM. The EASTR Study: indications for transfusion and esti- mates of transfusion recipient numbers in hospitals sup- plied by the National Blood Service. Transfus Med 2009;19: 315-28. Epub 2009 Sep 3.
  12. Palo R, Capraro L, Hovilehto S, Koivuranta M, Krusius T, Loponen E, Mäntykoski R, Pentti J, Pitkänen O, Raitakari M, Rimpiläinen J, Salmenperä M, Salo H, Mäki T. USE OF FRESH-FROZEN PLASMA IN ENGLAND Volume 51, January 2011 TRANSFUSION 69 15372995, 2011, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1537-2995.2010.02798.x by Mount Vernon Nazarene University, Wiley Online Library on [23/06/2026]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License Population-based audit of fresh frozen plasma transfusion practices. Transfusion 2006;4:1921-5. · DOI
  13. Schulman S, Bijsterveld NR. Anticoagulants and their reversal. Transfus Med Rev 2007;21:37-48.
  14. Makris M, Greaves M, Phillips WS, Kitchen S, Rosendaal FR, Preston EF. Emergency oral anticoagulant reversal: the relative efficacy of infusions of fresh frozen plasma and clotting factor concentrate on correction of the coagulopa- thy. Thromb Haemost 1997;77:477-80.
  15. Lauzier F, Cook D, Griffith L, Upton J, Crowther M. Fresh frozen plasma transfusion in critically illl patients. Crit Care Med 2007;35:1655-9.
  16. Youssef WI, Salazar F, Dasarathy S, Beddow T, Mullen KD. Role of fresh frozen plasma infusion in correction of coagulopathy of chronic liver disease: a dual phase study. Am J Gastroenterol 2003;98:1391-4.
  17. Abdel-Wahab OI, Healy B, Dzik WH. Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities. Transfusion 2006;46:1279-85.
  18. Tripodi A, Chantarangkul V, Primignani M, Fabris F, Dell'Era A, Sei C, Mannucci PM. The international normal- ized ratio calibrated for cirrhosis (INR(liver)) normalizes prothrombin time results for model for end-stage liver disease calculation. Hepatology 2007;46:520-7.
  19. Dzik WH. Predicting hemorrhage using preoperative coagulation screening assays. Curr Haematol Rep 2004;3: 324-30.
  20. Burns ER, Goldberg SN, Wenz B. Paradoxic effect of mul- tiple mild coagulation factor deficiencies on the prothrom- bin time and activated partial thromboplastin time. Am J Clin Pathol 1993;100:94-8.
  21. Holland L, Sarode R. Should plasma be transfused prophy- lactically before invasive procedures? Curr Opin Haematol 2006;13:447-51.
  22. Tripodi A, Chantarangkul V, Mannucci PM. Acquired coagulation disorders: revisiting using global coagulatiobn/ anticoagulation testing. Br J Haematol 2009;147:77-82.
  23. Segal JB, Dzik WH. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion 2005;45:1413-25.
  24. McVay PA, Toy PT. Lack of increased bleeding after liver biopsy in patients with mild hemostatic abnormalities. Am J Clin Pathol 1990;94:747-53.
  25. Damiani G, Pinnarelli L, Sommella L, Fareeli V, Mele L, Menechella G, Ricciardi W. Appropriateness of fresh-frozen plasma usage in hospital settings: a meta-analysis of the impact of organizational interventions. Transfusion 2010; 50:139-44.
  26. Chowdhury P, Saayman AG, Paulus U, Findlay GP, Collins PW. Efficacy of standard dose and 30 mL/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. Br J Haematol 2004;125:69-73.
  27. Doust J, Del Mar C. Why do doctors use treatments that do not work? Br J Haematol 2004;328:474-5.
  28. Wilson K, MacDougall L, Fergusson D, Graham L, Tin- mouth A, Hebert PC. The effectiveness of interventions to reduce physician's levels of inappropriate transfusion: what can be learned from a systematic review of the litera- ture. Transfusion 2002;42:1224-9.
  29. Peterson GA. Does systematic anticoagulation increase the risk of internal jugular vein cannulation? [letter]. Anesthe- siology 1991;75:1124.
  30. Ewe K. Bleeding after liver biopsy does not correlate with indices of peripheral coagulation. Dig Dis Sci 1981;26:388- 93.
  31. Stanworth SJ, Brunskill S, Hyde CJ, McClelland DB, Murphy MF. What is the evidence base for the clinical use of FFP: a systematic review of randomised controlled trials. Br J Haematol 2004;126:139-52.
  32. Northern Neonatal Nursing Initiative (NNNI) Trial Group. A randomized trial comparing the effect of prophylactic intravenous fresh frozen plasma, gelatin or glucose in preterm babies: outcome at 2 years. Lancet 1996;348:229- 32.
  33. Casbard AC, Williamson LM, Murphy MF, Rege K, Johnson T. The role of prophylactic fresh frozen plasma in reducing blood loss and correcting coagulopathy in cardiac surgery: a systematic review. Anaesthesia 2004;59:550-8.
  34. MacLennan S, Williamson LM. Risks of fresh frozen plasma and platelets. J Trauma 2006;60:S46-50.
  35. Holness L, Knippen MA, Simmons L, Lachenbruch PA. Fatalities caused by TRALI. Transfus Med Rev 2004;18: 184-8.
  36. Li G, Daniels CE, Kojicic M, Krpata T, Wilson GA, Winters JL, Moore SB, Gajic O. The accuracy of natriuretic peptides (brain natriuretic peptide and N-terminal pro-brain natri- uretic) in the differentiation between transfusion-related acute lung injury and transfusion-related circulatory over- load in the critically ill. Transfusion 2009;49:13-20.

Cited by

Sorted by citations

Authors
Stanworth, S. J., Grant‐Casey, J., Lowe, D., Laffan, M., New, H., Murphy, M. F., & Allard, S.
Affiliations
Imperial College Healthcare NHS Trust (GB)
Corresponding author
Allard, Shubha
ORCID
Venue
Transfusion
Publisher
Wiley
Published
2010-08-27
Volume
51
Issue
1
Pages
62-70
ISSN
  • 0041-1132 (ISSN-L)
  • 1537-2995
DOI
10.1111/j.1537-2995.2010.02798.x
OpenAlex
W2153636570
Cited by
237
References
1
Citations by year
2026: 7 · 2025: 12 · 2024: 8 · 2023: 10 · 2022: 10 · 2021: 14 · 2020: 16 · 2019: 16 · 2018: 13 · 2017: 15 · 2016: 19 · 2015: 17 · 2014: 24 · 2013: 27 · 2012: 22
FWCI
11.51
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Transfusion (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
  • Social Sciences › Business, Management and Accounting › Management of Technology and Innovation › Blood donation and transfusion practices
Keywords
fresh frozen plasma, transfusion practice, inappropriate transfusion, prophylactic transfusion, coagulation tests, international normalized ratio, prothrombin time, intensive care unit, infants and children
MeSH terms
Adult, Blood Coagulation Disorders, Child, England, Humans, Plasma, Blood Component Transfusion

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review