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Fresh‐frozen plasma transfusion in patients with mild coagulation abnormalities at a large Canadian transfusion center

We read with interest the recent article by Abdel-Wahab and Dzik regarding fresh-frozen plasma (FFP) transfusion in patients with mild coagulation abnormalities. As a large Canadian transfusion center, we questioned whether FFP was being transfused inappropriately to this patient population. Therefore, we collected retrospective audit data from the laboratory information system (LIS) regarding plasma transfusions to understand the nature of plasma transfusions at our institution. During the half-year audit (January 7, 2006-June 30, 2006), there were 722 plasma transfusion episodes at the Capital District Health Authority, Halifax, Nova Scotia. The mean number of units transfused per episode was 1.07 (range, 1-6). Although the mean pretransfusion international normalized ratio (INR) was 2.04, a significant number (452/722 [62.6%]) were being transfused for an INR between 0.9 and 1.8 (Fig. 1). The median age of these patients was 55.7 years, with 136 of 452 (30.1%) women and 316 of 452 (69.9%) men. The overall response to plasma transfusion was a decrease in both INR (Fig. 2) and prothrombin time of 0.047 and 0.73 seconds, respectively. This was based on coagulation data measured at a mean of 4.4 hours before transfusion and 4.2 hours after transfusion. It is reassuring that these findings are consistent with the findings of Abdel-Wahab and Dzik. Our data, however, are only from the available LIS data and, therefore, we were unable to capture other clinical patient characteristics (i.e., diagnosis, bleeding, medication history, other transfusion requirements). In a previous letter to the editor, Wallis and Dzik concluded that plasma is being overtransfused in the United States. In their Table 1, which compares annual red blood cell (RBC) and FFP usage in various countries, we have noticed that there did not appear to be any Canadian data. Data from Nova Scotia from 2003 to 2005 demonstrated mean FFP usage of 12.2 units per 1000 population (range, 10.8-14.7) and mean RBC usage of 34.4 units (range, 33.035.3 units); the mean FFP:RBC ratio was 1:2.8 (Nova Scotia Provincial Blood Coordinating Program, personal communication, September, 2006). Overall, our crude data suggest that a large proportion of all FFP transfusions are given to patients with minimally elevated INRs at our institution and with very little coagulation variable benefit.We recognize that although our data may not necessarily apply to other centers across Canada, at least it provides a glimpse into FFP utilization in Canada. Calvino K. Cheng, MD, FRCPC e-mail: calvino.cheng@cdha.nshealth.ca Irene Sadek, MD, FRCPC Capital District Health Authority and Department of Pathology and Laboratory Medicine Dalhousie University Halifax, Nova Scotia, Canada