Clinical setting affects efficacy of plasma transfusions

SAN DIEGO – Evidence supporting the use of plasma transfusions in a variety of clinical situations, including prolonged pump time during open heart surgery and trauma-related massive hemorrhage, appears to be mixed, according to an analysis presented at the 38th Annual Cardiothoracic Surgery Symposium.

Lawrence Tim Goodnough, MD, professor of pathology and medicine (hematology) in the department of pathology and the department of medicine at Stanford University and director of the Stanford Transfusion Medicine Fellowship Program, examined the use of plasma transfusions during open-heart surgery. He focused on a cohort of 82,446 patients undergoing primary isolated CABG surgery at 408 clinical sites. A wide range was observed in the products that were transfused, which included red blood cells, plasma and platelets.

“There was high variability between the types of transfusions done at the different institutions,” Goodnough said. “However, this was not linked, in any way, to clinical patient outcomes.”

The factors that did correlate with clinical patient outcomes, with regard to morbidity and mortality, included geographic location, whether or not the transfusion was done at an academic medical center and hospital volume.

Goodnough also discussed mortality rates in the setting of plasma transfusions after massive trauma. The evidence for this association was mixed.

The Pragmatic Randomized Optimal Platelet and Plasma Ratios trial randomly assigned patients in a 1:1:1 ratio to early administration of plasma, platelets, and red blood cells. This did not result in significant differences in mortality at 24 hours or at 30 days when compared with a 1:1:2 ratio.

Another report, from the AABB (previously known as the American Association of Blood Banks), provided “very low-quality evidence” that plasma is beneficial.

“This is interesting,” Goodnough said. “It appears that there may be a role for plasma in trauma patients experiencing massive hemorrhage. Beyond that, however, a survival benefit has not been demonstrated in most other transfusion populations.”
Goodnough concluded by highlighting several directions for future research in the management of hemorrhage.

“I think the point-of-care technology is still in evolution, but it shows value,” he said. “There is increasing interest in the role of blood derivatives as targeted therapy, which may point to an evolving role for cryoprecipitate therapy. It’s much cheaper, but the limitation would be the time it would take to thaw and cool prior to use in patients. I think we also need better analytics for quantitative evaluation of clinical blood loss as a metric to determine whether these treatments – and the monitoring – are of value.” - by Julia Ernst, MS

Reference:

Goodnough LT. Indications for plasma transfusion. Presented at: CREF Annual Cardiothoracic Surgery Symposium; September 6-9, 2018; San Diego.

Disclosures: Goodnough reports no relevant financial disclosures.