scholarly journals Therapeutic Plasmapheresis: Seven Year Experience of an Intensive Care Unit in Portugal

2021 ◽  
Vol 34 (13) ◽  
Author(s):  
Rita Faria ◽  
Alexei Bucur ◽  
André Gordinho ◽  
Luis Falcão ◽  
André Carrão ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fresh Frozen Plasma ◽  
Solution Studies ◽  
Replacement Solution ◽  
Fresh Frozen ◽  
Uremic Syndrome ◽  
Frozen Plasma

Introduction: Therapeutic plasmapheresis is a therapeutic procedure in which the patient’s blood is passed through a medical device which separates out plasma from other components of blood. The plasma is removed and replaced with a replacement solution. Studies on the use of plasmapheresis in critically ill patients are scarce. The aim of this study was to review all therapeutic plasmapheresis sessions carried out in the Hospital Beatriz Ângelo intensive care unit.Material and Methods: An observational retrospective study was conducted between April 2012 and March 2019. All patients who underwent therapeutic plasmapheresis in the intensive care unit were included, and plasmapheresis sessions held outside the intensive care unit were excluded.Results: Of 46 patients, 63% were men (n = 29), with a median age of 53 years. The most frequent diagnoses were hypertriglyceridemia-induced pancreatitis, vasculitis, autoimmune haemolytic anaemia, and atypical haemolytic-uremic syndrome. A total of 198 plasmapheresis sessions were carried out in the intensive care unit. Most of the used replacement solutions were fresh frozen plasma (34.4%), albumin/crystalloid (24.2%), and albumin/fresh frozen plasma (19.2%). The most common complications were hydroelectrolytic changes (84; 42.4%) and coagulation disorders/thrombocytopenia (65; 32.8%). There was no need to interrupt any plasmapheresis session due to complications related to the patient.Discussion: Therapeutic plasmapheresis is an urgent procedure that can reduce morbidity and mortality in critically ill patients. This justifies that 37% of patients started the technique before the diagnostic confirmation. The indications for plasmapheresis and the choice of replacement solution were in agreement with the guidelines. Despite the risk of bleeding, no haemorrhagic complications were recorded.Conclusion: Therapeutic plasmapheresis is a complex technique that requires specific training. The indications are diverse, and some are not consensual. Complications were frequent, but they did not increase morbidity.

scholarly journals Transfusion of Fresh Frozen Plasma in Critically Ill Patients: Effective or Useless?

2018 ◽  
Vol 6 (5) ◽  
pp. 820-823 ◽  
Author(s):  
Ermira Biu ◽  
Silvana Beraj ◽  
Gentian Vyshka ◽  
Lordian Nunci ◽  
Tatjana Ҫina
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Service ◽  
Coagulation Factors ◽  
Fresh Frozen Plasma ◽  
Minor Bleeding ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Frozen Plasma

BACKGROUND: Fresh frozen plasma (FFP) is widely used in critically ill patients to correct the deficiency of coagulation factors or increased INR.AIM: In the present study we aimed to evaluate the outcome of the freshly frozen plasma use as prophylaxis in ICU patients before an invasive procedure.METHODS: The study was conducted at Central Anaesthesiology and Intensive Care Service UHCT “Mother Theresa”, Tirana. 136 patients were enrolled with coagulopathy with no bleeding before the invasive procedure, from June 2016 to December 2016. A group of 75 patients underwent a median volume of 12.5 ml/kg FFP given, and 61 had no transfusion. Data were collected on demographics, the severity of illness measured by APACHE III scores, INR, medication use, hemodynamic data.RESULTS: From 136 patients with coagulopathy with no bleeding who underwent planned invasive interventions, 75 [55%] received FFP, vs 61 [45%] p = 0.04 who did not receive. Overall, the median FFP dose was 12.5 ml kg-1. Median INR level in FFP and non-FFP groups was respectively 3.1 (1.9-4.8) and 3.5 (1.8-5.2). INR was corrected in 24 of 75 (32%) of those who received a transfusion. The frequency of minor bleeding episodes was 9.3% in transfused patients vs 4.9% in the non-transfused group. Patients who developed an onset of acute lung injury were more frequent in the FFP group. No allergic transfusion complications were observed. Also, the median length of hospital stay [LOS] was 3.05 days vs 2.91 days and mortality rate 8.2% vs 6.5% with no significant difference between two groups.CONCLUSIONS: Freshly frozen plasma transfusions are often unnecessarily administered during an inadequate correction of the deficiencies of coagulation factors. When comparing a liberal FFP transfusion strategy vs restrictive other clinical trials are required to asses which one is the best to adopt in intensive care settings.

Fresh frozen plasma transfusion in critically ill patients*

2007 ◽  
Vol 35 (7) ◽  
pp. 1655-1659 ◽  
Author(s):  
François Lauzier ◽  
Deborah Cook ◽  
Lauren Griffith ◽  
Julia Upton ◽  
Mark Crowther
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Fresh Frozen Plasma ◽  
Plasma Transfusion ◽  
Fresh Frozen ◽  
Frozen Plasma

Fresh frozen plasma transfusion fails to influence the hemostatic balance in critically ill patients with a coagulopathy

2015 ◽  
Vol 13 (6) ◽  
pp. 989-997 ◽  
Author(s):  
M. C. A. Müller ◽  
M. Straat ◽  
J. C. M. Meijers ◽  
J. H. Klinkspoor ◽  
E. de Jonge ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Fresh Frozen Plasma ◽  
Plasma Transfusion ◽  
Fresh Frozen ◽  
Frozen Plasma

A Multifaceted Strategy to Reduce Inappropriate Use of Fresh Frozen Plasma Transfusions in the Intensive Care Unit.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1412-1412
Author(s):  
Donald M. Arnold ◽  
Heather Whittingham ◽  
Francois Lauzier ◽  
France Clarke ◽  
Ellen McDonald ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Phase I ◽  
Phase Ii ◽  
Fresh Frozen Plasma ◽  
Phase Iii ◽  
Request Form ◽  
Assessment Period ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Abstract 1412 Poster Board I-435 Introduction: The overuse of fresh frozen plasma (FFP) transfusions has been well documented, especially among critically ill patients. In a mixed medical surgical intensive care unit (ICU), we documented that 43% of FFP transfusions were given for indications other than those proposed in published guidelines (Lauzier 2007). Methods: We developed a 3-Phase multifaceted behavior-change strategy to curtail inappropriate FFP transfusions, documenting all patients who had FFP, excluding plasmapheresis. Phase I was a 3-month baseline assessment period with no intervention, in which the FFP transfusion orders prescribed at the discretion of the ICU team were recorded. Phase II was a 3-month intervention targeted to all ICU clinicians, comprised of education on the appropriate use of FFP transfusions, audit and feedback of performance indicators, and a pre-order FFP Request Form to specify the indication and the pre-transfusion INR. Phase III was a 9-month assessment period incorporating only the FFP Request Form. At the end of the study, the indications for all transfusions were adjudicated independently in triplicate by 2 ICU clinicians and 1 hematologist, to determine whether each FFP transfusion was a) consistent with published guidelines, b) inconsistent with guidelines but appropriate for the ICU context, or c) inconsistent and inappropriate. Discrepancies were resolved in all cases. FFP orders were not withheld if FFP Request Forms were not completed. Results: Chance-corrected agreement (which considers clustered transfusions within patients) between ICU reviewers on whether transfusions were consistent or appropriate versus inconsistent and inappropriate was high (phi = 0.80). During Phase I (3 months), 66 FFP transfusions were administered (n= 26 patients), of which 30 were for bleeding. During Phase II (3 months), 24 transfusions were administered (n = 11 patients), of which 11 were for bleeding. During Phase III (7 months of data), 96 transfusions were given (n= 41 patients), of which 57 were for bleeding. Rates of FFP transfusions per month for all indications and for bleeding indications were 22 and 10, respectfully in Phase I; 8 and 4 in Phase II; and 14 and 8 in Phase III. A FFP Request form accompanied 39 (40.6%) of 96 FFP transfusions in Phase III. Conclusions: A multifaceted behavior-change strategy appears to be an effective method of changing inappropriate FFP transfusion practices; however satisfactory uptake of a pre-transfusion FFP Request Form requires consistent reminders. We recommend that transfusion guidelines are improved to explicitly incorporate FFP transfusion criteria appropriate for the ICU setting. Disclosures: No relevant conflicts of interest to declare.

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