Korean J Hematol.  2012 Dec;47(4):298-301. 10.5045/kjh.2012.47.4.298.

Complications following an unnecessary peri-operative plasma transfusion and literature review

• Raval JS
• Waters JH
• Triulzi DJ
• Yazer MH

• KMID: 1832110
• DOI: http://doi.org/10.5045/kjh.2012.47.4.298

Abstract

Plasma is used to correct coagulopathies, but not all coagulation abnormalities are clinically significant enough to require correction before an invasive procedure. We report an 82 year old female who, in response to a mildly prolonged INR of unknown etiology, was unnecessarily transfused with plasma in advance of elective surgery. The patient suffered a moderately severe transfusion reaction, including hives and voice hoarseness, which caused a 4-week delay in her surgery. This delay and adverse reaction could have been avoided had the principles of evidence based plasma therapy, which we herein review, been followed and if the etiology of the mildly elevated INR been investigated before the day of her surgery.

Keyword

Plasma; FFP; Transfusion; Allergic; Reaction; Complication

MeSH Terms

Blood Group Incompatibility
Female
Hoarseness
Humans
International Normalized Ratio
Plasma
Urticaria

Reference

1. Advisory Committee on Blood Safety and Availability. The 2007 national blood collection and utilization survey report. 2007. Accessed July 1, 2011. Washington, DC: Department of Health & Human Services;at http://www.hhs.gov/ash/bloodsafety/2007nbcus_survey.pdf.

2. Cobain TJ, Vamvakas EC, Wells A, Titlestad K. A survey of the demographics of blood use. Transfus Med. 2007. 17:1–15.

3. Wallis JP, Dzik S. Is fresh frozen plasma overtransfused in the United States? Transfusion. 2004. 44:1674–1675.

4. Wachtel S, Kiss JE, Triulzi DJ, Winkelstein AW, Bontempo FA. The relationship of prothrombin time (PT) to clotting factor levels and the transfusion "trigger" for fresh frozen plasma (FFP). Blood. 1994. 84:Suppl. abst 682.

5. Dzik WH. The James Blundell Award Lecture 2006: transfusion and the treatment of haemorrhage: past, present and future. Transfus Med. 2007. 17:367–374.

6. Kitchens CS, Alving BM, Kessler CM, editors. Consultative hemostasis and thrombosis. 2007. 2nd ed. Philadelphia, PA: Saunders Elsevier Inc.

7. Hambleton J, Wages D, Radu-Radulescu L, et al. Pharmacokinetic study of FFP photochemically treated with amotosalen (S-59) and UV light compared to FFP in healthy volunteers anticoagulated with warfarin. Transfusion. 2002. 42:1302–1307.

8. 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. 45:1413–1425.

9. 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. 46:1279–1285.

10. Stanworth SJ, Brunskill SJ, Hyde CJ, McClelland DB, Murphy MF. Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol. 2004. 126:139–152.

11. Yazer MH. The how's and why's of evidence based plasma therapy. Korean J Hematol. 2010. 45:152–157.

12. Triulzi DJ. The art of plasma transfusion therapy. Transfusion. 2006. 46:1268–1270.

13. Holland LL, Brooks JP. Toward rational fresh frozen plasma transfusion: The effect of plasma transfusion on coagulation test results. Am J Clin Pathol. 2006. 126:133–139.

14. Holland LL, Foster TM, Marlar RA, Brooks JP. Fresh frozen plasma is ineffective for correcting minimally elevated international normalized ratios. Transfusion. 2005. 45:1234–1235.

15. Grobler C, Callum J, McCluskey SA. Reversal of vitamin K antagonists prior to urgent surgery. Can J Anaesth. 2010. 57:458–467.

16. Ferraris VA, Ferraris SP, Saha SP, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg. 2007. 83:5 Suppl. S27–S86.

17. Tuman KJ, Spiess BD, McCarthy RJ, Ivankovich AD. Effects of progressive blood loss on coagulation as measured by thrombelastography. Anesth Analg. 1987. 66:856–863.

18. Sharma SK, Vera RL, Stegall WC, Whitten CW. Management of a postpartum coagulopathy using thrombelastography. J Clin Anesth. 1997. 9:243–247.