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Argyrou A, Valsami S, Pouliakis A, Gavalaki M, Aggelidis A, Voulgaridou V, Pliatsika V, Adraktas T, Papachronis A, Alepi C, Giannopoulou V, Siourounis P, Tsagia S, Martinis G, Kontekaki E, Zervou E, Koliofotis S, Kyriakou E, Mougiou A, Dimitra L, Chairopoulou A, Tsakania A, Baka M, Apostolidou I, Moschandreou D, Livada A, Politou M, Roussinou F, Pappa C, Koika V, Vgontza N, Gafou A, Dendrinou I, Sakellaridi F, Labrianou L, Alexandropoulou Z, Sochali V, Malekas K, Skordilaki A, Kakava G, Lebesopoulos K, Stamoulis K, Grouzi E. Current Practice in FFP Preparation and Use in Greece: A National Survey. Turk J Haematol 2021; 38:22-32. [PMID: 33233876 PMCID: PMC7927442 DOI: 10.4274/tjh.galenos.2020.2020.0241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/18/2020] [Indexed: 12/01/2022] Open
Abstract
Objective Fresh frozen plasma (FFP) transfusion is widely used in modern clinical settings. Practices regarding its use vary due to lack of guidelines from randomized trials. The aim of this study was to assess both the current practices regarding FFP production, use, and wastage and the implementation of quality control (QC), female donor plasma production policies, and use of pharmaceutical hemostatic agents in Greece. Materials and Methods The study was conducted during February-April 2018. For the first part of the study, data including FFP transfusion indication, hospital department, diagnosis, FFP units/transfusion episode, ABO compatibility, blood donor’s sex, and reasons for discarding were collected. For the second part, questionnaire data were analyzed. Results According to data from 20 Greek hospitals, 12655 FFP units were transfused to 2700 patients during 5069 transfusion episodes in the studied period of time. Most patients were hospitalized in internal medicine, general surgery, and intensive care unit departments. Each patient received on average 4.69 units (2.5 units/episode). Transfusion requests were in accordance with international guidelines in 63.44% of cases and 99.04% of the units were given to ABO-identical patients. Main reasons for discarding included failure to meet quality requirements (30.06%), female donors (22.17%), and other causes (27.26%). Among 96.9% of all transfusion services across the country, 28.26% perform QC according to the directions of the European Directorate for the Quality of Medicines & Health Care and 68.83% discard plasma from female donors. Pharmaceutic hemostatic agents are used in 37.23% of the hospitals. Conclusion This is the first national survey regarding FFP production and transfusion in Greece. Staff of internal medicine, general surgery, and ICU departments, where most FFP-transfused patients are hospitalized, should be regularly involved in training on contemporary transfusion guidelines. Upcoming centralization of FFP production and inventory management could help in homogenizing practices regarding FFP use and improve product quality. Strengthening the use of pharmaceutic hemostatic agents could improve patients’ management.
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Affiliation(s)
- Aspasia Argyrou
- These authors contributed equally to this work
- Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
| | - Serena Valsami
- These authors contributed equally to this work
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Abraham Pouliakis
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Maria Gavalaki
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Antonis Aggelidis
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Vasiliki Voulgaridou
- AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
| | - Vasiliki Pliatsika
- AHEPA, University Hospital, Department of Blood Transfusion, Thessaloniki, Greece
| | - Theofanis Adraktas
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Andreas Papachronis
- National and Kapodistrian University of Athens, Attikon University Hospital, Second Department of Pathology, Athens, Greece
| | - Chrysoula Alepi
- General Hospital Tzaneio, Department of Blood Transfusion, Piraeus, Greece
| | | | - Panagiotis Siourounis
- Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
| | - Sofia Tsagia
- Agios Panteleimon General Hospital of Nikaia, Department of Blood Transfusion, Athens, Greece
| | - Georges Martinis
- University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
| | - Eftihia Kontekaki
- University Hospital, Department of Blood Transfusion, Alexandroupolis, Greece
| | - Eleftheria Zervou
- University Hospital, Department of Blood Transfusion, Ioannina, Greece
| | - Spiridon Koliofotis
- Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
| | - Elias Kyriakou
- Attikon University Hospital, Laboratory of Hematology and Blood Bank Unit, Athens, Greece
| | - Athina Mougiou
- University Hospital, Blood Transfusion Center, Patras, Greece
| | | | | | - Aggeliki Tsakania
- Sismanogleio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Maria Baka
- Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Ioanna Apostolidou
- Thriasio General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Dimitra Moschandreou
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| | - Anastasia Livada
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
| | - Marianna Politou
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Fragoula Roussinou
- National and Kapodistrian University of Athens, Aretaieion University Hospital, Medical School, Hematology Laboratory-Blood Bank Department, Athens, Greece
| | - Christina Pappa
- General Hospital, Department of Blood Transfusion, Korinthos, Greece
| | - Vasiliki Koika
- General Hospital, Department of Blood Transfusion, Korinthos, Greece
| | - Niki Vgontza
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | - Anthippi Gafou
- Agioi Anargyroi Hospital, Department of Blood Transfusion, Athens, Greece
| | - Ioanna Dendrinou
- Konstantopouleio-Neas Ionias General Hospital, Department of Blood Transfusion, Athens, Greece
| | | | | | | | - Vasiliki Sochali
- General Hospital, Department of Blood Transfusion, Giannitsa, Greece
| | - Kostas Malekas
- General Hospital, Department of Blood Transfusion, Livadia, Greece
| | - Areti Skordilaki
- General Hospital, Department of Blood Transfusion, Chania, Greece
| | - Georgia Kakava
- Pammakaristos General Hospital, Department of Blood Transfusion, Athens, Greece
| | | | | | - Elisavet Grouzi
- Saint Savvas Oncology Hospital, Department of Blood Transfusion and Clinical Hemostasis, Athens, Greece
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Agarwal N, Subramanian A, Pandey RM, Albert V, Karjee S, Arya V. An audit of fresh frozen plasma usage in a tertiary trauma care centre in north India. Indian J Hematol Blood Transfus 2013; 30:328-32. [PMID: 25435737 DOI: 10.1007/s12288-013-0265-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 04/19/2013] [Indexed: 11/29/2022] Open
Abstract
Fresh frozen plasma (FFP) transfusion is a crucial part of management of trauma patients. There is a paucity of literature about the audit of appropriateness of FFP use in trauma patients. To evaluate and analyze the appropriateness of FFP transfusion practices for trauma patients. Prospectively compiled blood bank records of FFP transfusion practices over a period of 4 months from Augusts'08 through Deember'08 were retrospectively analyzed for 207 patients. The number of FFP units used in all these trauma patients were evaluated a propos the cause of injury, departments, type of surgery, presence of coagulopathy, bleeding, massive transfusion, length of hospital stay and patient outcome. Trauma scores such as Glasgow coma score and injury severity score were also calculated to estimate the severity of injury. The appropriateness of FFP transfusion was assessed according to the guidelines drafted by the College of American Pathologists. FFP transfusion for patients experiencing active bleeding, micro vascular bleeding, coagulopathy and/or massive transfusion, was deemed appropriate. Patients receiving FFP were categorized and individually correlated with the outcome. The influences of other variables which affect patient outcome were excluded using stepwise multivariate logistic regression analysis. p value < 0.05 were considered to be statistically significant. A total of 207 trauma patients were included in the study, 183 (88.4 %) males and 24 (11.6 %) females. The FFP use among neurosurgery patients was 46.9 %, general surgery patients 40.6 % and orthopedics 12.6 %. Appropriate use of FFP was 49.5 % according to the CAP guidelines. Trauma patients who required FFP as a part of treatment were categorized as; Patients who had bleeding alone (n = 40), bleeding with coagulopathy (n = 16), and coagulopathy alone (n = 43), and further correlated with the outcome and were found statistically insignificant. The prevalence of appropriate use of FFP at trauma centre was 49.5 %. The FFP use by neurosurgery:orthopedics:general surgery was 5:1:4. The highest appropriate FFP use was by Neurosurgery department (50.5 %). Assessing the pattern of usage and rate of misuse of FFP units, allows us to establish required strategies to improve the state of affairs.
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Affiliation(s)
- Neha Agarwal
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
| | - Arulselvi Subramanian
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India ; Department of Blood Bank, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India
| | - Venencia Albert
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
| | - Sulekha Karjee
- Department of Blood Bank, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
| | - Vedanand Arya
- Department of Blood Bank, Jai Prakash Narayan Apex Trauma centre, AIIMS, New Delhi, India
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Audit of the clinical use of fresh-frozen plasma in Umbria: study design and results of the pilot phase. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2009; 6:211-9. [PMID: 19112736 DOI: 10.2450/2008.0042-07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Fresh-frozen plasma (FFP) is unanimously recognised by international guidelines as the blood component of choice for the management of acute haemorrhage when accompanied by disorders of haemostasis, for disseminated intravascular coagulation in the presence of haemorrhage, for rare bleeding disorders when specific clotting factor concentrates are not available and for thrombotic thrombocytopenic purpura. The literature, however, reports a high percentage of inappropriate requests for FFP. This article presents the results of a pilot study of clinical auditing of the use of FFP in the Region of Umbria (Italy). METHODS This study was based on the examination of the requests for FFP made in April 2006 to four Immunotransfusion Services (ITS) in Umbria and of the clinical records of the patients receiving transfusions. The following indicators were identified and evaluated: completeness of the request, appropriateness of the indication and the dose, completeness of the records in the clinical charts, adverse events, in-hospital morbidity and mortality, efficacy of the treatment (evaluated by analysing the changes between pre- and post-transfusion coagulation test results) and, as an indicator of the process, the correspondence between data in the paper request form and in the computerised database. The data were extracted from the ITS databases, from the paper request forms and from the patients' clinical records. RESULTS Two hundred and twenty-one requests (615 units of FFP) for 109 patients and 92.8% of the related clinical records were examined. The patients were admitted in medical (22.9%), surgical (51.4%) and critical care units (25.7%). In 50.7% of the cases, the completeness of the data in the individual requests was good (65-80% of the fields filled in). The indication was appropriate in 31.5% of the requests evaluated (56.1% of the total), with no difference related to different requesters. The dosage was appropriate in 62.7% of the requests evaluated (62% of the total). A comparison of pre- and posttransfusion laboratory data showed a significant correction of pathological values (p=0.02) only for the International Normalised Ratio (INR). CONCLUSIONS Critical areas that should be targeted by interventions to improve plasma usage are those related to the appropriateness of the indication, the completeness of the data entered in the request forms and the data recorded in the clinical charts.
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