Effect of Fresh Frozen Plasma Transfusion Inpatients with Coagulation Abnormalities

Aim: To study the efficacy of Fresh Frozen Plasma (FFP) transfusion practice in patients with coagulation abnormalities varies in clinical practice. Study Design: A retrospective study. Place and Duration of Study: This study was conducted in Department of Transfusion Medicine, SMCH, Chennai, between the period of 2019-2020. Methodology: The medical records of each patient receiving FFP transfusions that occurred in patients with coagulation abnormalities were reviewed and the data were collected based on preand post transfusion PT (>12 sec), APTT (>70sec) and INR (>1.5) and then analysed statistically. Patients with normal coagulation parameters were excluded from study. Results: A total of 1259 units of fresh frozen plasma were transfused to 315 patients between the Original Research Article Nagulan et al.; JPRI, 33(48A): 22-26, 2021; Article no.JPRI.75832 23 year 2019-2020. Of the 1259 units transfused 1133 units where transfused to 283 patients with coagulation abnormalities. Apparently 32 patients were excluded from the study as they had normal coagulation profile. Among 251 patients, 37 patients PT were greater than 12 seconds before FFP transfusion out of which the PT was corrected for 14 patients (37.8%) after FFP transfusion. In 228 patients APTT was greater than 70 seconds before FFP transfusion, out of which APTT was corrected in 18 patients (8%) after transfusion. INR values for all 251 patients were greater than1.5 before FFP transfusion, out of which INR was corrected in 84 patients (29%) after transfusion. Conclusion: We conclude that FFP transfusions in patients with coagulation abnormalities maycorrects the defect only in less percentage of patient population, as in our study it corrects only an average of 31% of patient population.

year 2019-2020. Of the 1259 units transfused 1133 units where transfused to 283 patients with coagulation abnormalities. Apparently 32 patients were excluded from the study as they had normal coagulation profile. Among 251 patients, 37 patients PT were greater than 12 seconds before FFP transfusion out of which the PT was corrected for 14 patients (37.8%) after FFP transfusion. In 228 patients APTT was greater than 70 seconds before FFP transfusion, out of which APTT was corrected in 18 patients (8%) after transfusion. INR values for all 251 patients were greater than1.5 before FFP transfusion, out of which INR was corrected in 84 patients (29%) after transfusion. Conclusion: We conclude that FFP transfusions in patients with coagulation abnormalities maycorrects the defect only in less percentage of patient population, as in our study it corrects only an average of 31% of patient population.

INTRODUCTION
Fresh frozen plasma transfusion is mainly used in correcting multiple clotting factor deficiency and many international guidelines are present that recommend its use in correcting the deficiencies and in bleeding [1,2]. The use of fresh frozen plasma has been increasing steadily and mainly used in patients in intensive care units who are critically ill and in patients with excessive active bleeding [1][2][3]. In recent years along with its use in active bleeding and in ICU's it is being used prophylactically even in patients with mild coagulopathy before surgeries or other invasive procedures [3,[4][5][6][7].
However numerous studies on bleeding after central venous line placement, liverbiopsy, thoracentesis, paracentesis, lumbar puncture [8][9][10][11], reveal there is no correlation between bleeding and mild abnormalities in coagulation profile. Inspite of such results the use of prophylactic FFP transfusion for mild abnormalities has increased [4]. FFP transfusion is associated with wide range of adverse effects like transfusion related acute lung injury, transfusion related circulatory over load and allergic reactions [2,5]. FFP is also capable of transmitting viruses like human immunodeficiency virus hepatitis B and C virus [12]. Many retrospective studies suggest that bleeding is low following an invasive procedure and the requirement of transfusion is very low [2].
At present proper guidelines for using FFP prophylactically does not exist. But commonly used in 1) Excessive bleeding in patients with prolonged bleeding or clotting time that cannot be corrected by other methods 2) Prior to a surgery or an invasive procedure in a patient with prolonged bleeding or clotting time [6].

MATERIALS AND METHODS
We studied the effects of fresh frozen plasma transfusion on the coagulation profile of patients with coagulopathy retrospectively in a tertiary health care centre between 2019-2020. The medical records of each patient were reviewed and the data were collected based on pre-and post transfusion values, pre-transfusion values of PT (>12 sec), APTT (>70sec) and INR (>1.5) were selected as inclusion criteria as it was the lowest abnormal value for which blood component was ordered and then analyzed statistically. Any person with normal coagulation profile was excluded from the study [ Table 1]. PT, APTT and INR were determined using the methodology automated opto mechanical functional clotting assay -ACL ELITE PRO by Instrumentation Laboratory. Apparently 32 patients were excluded from the study as they had normal coagulation profile. Among 251 patients [ Fig. 1], 37 patients PT were greater than 12 seconds before FFP transfusion out of which the PT was corrected for 14 patients (37.8%) after FFP transfusion. In 228 patients APTT was greater than 70 seconds before FFP

CONCLUSION
The study sample included were adults with coagulation abnormalities who had undergone Fresh frozen plasma transfusion. The types and severity of the clotting factors was not fully evaluated and characterized. From the data collected it has been shown that there is very little or negligible correction of coagulation profile after Frozen Plasma Transfusion and inappropriateness of FFP utilization is also noticed based on the indications. FFP transfusions, as a prophylactic measure, especially in patients with mildly deranged conventional coagulation screening test results (INR <1.5) without any empirical evidence of clinical bleeding, needs further scrutiny with control group. With this study, we would like to rationalize the use of FFP by implementing new transfusion policy with the approval of hospital transfusion committee.

CONSENT
It is not applicable.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).