Evidence-based practice guidelines for plasma transfusion
Version of Record online: 19 MAR 2010
© 2010 American Association of Blood Banks
Volume 50, Issue 6, pages 1227–1239, June 2010
How to Cite
Roback, J. D., Caldwell, S., Carson, J., Davenport, R., Drew, M. J., Eder, A., Fung, M., Hamilton, M., Hess, J. R., Luban, N., Perkins, J. G., Sachais, B. S., Shander, A., Silverman, T., Snyder, E., Tormey, C., Waters, J. and Djulbegovic, B. (2010), Evidence-based practice guidelines for plasma transfusion. Transfusion, 50: 1227–1239. doi: 10.1111/j.1537-2995.2010.02632.x
- Issue online: 1 JUN 2010
- Version of Record online: 19 MAR 2010
- Received for publication November 12, 2009; revision received January 22, 2010, and accepted January 23, 2010.
BACKGROUND: There is little systematically derived evidence-based guidance to inform plasma transfusion decisions. To address this issue, the AABB commissioned the development of clinical practice guidelines to help direct appropriate transfusion of plasma.
STUDY DESIGN AND METHODS: A systematic review (SR) and meta-analysis of randomized and observational studies was performed to quantify known benefits and harms of plasma transfusion in common clinical scenarios (see accompanying article). A multidisciplinary guidelines panel then used the SR and the GRADE methodology to develop evidence-based plasma transfusion guidelines as well as identify areas for future investigation.
RESULTS: Based on evidence ranging primarily from moderate to very low in quality, the panel developed the following guidelines: 1) The panel suggested that plasma be transfused to patients requiring massive transfusion. However, 2) the panel could not recommend for or against transfusion of plasma at a plasma : red blood cell ratio of 1:3 or more during massive transfusion, 3) nor could the panel recommend for or against transfusion of plasma to patients undergoing surgery in the absence of massive transfusion. 4) The panel suggested that plasma be transfused in patients with warfarin therapy–related intracranial hemorrhage, 5) but could not recommend for or against transfusion of plasma to reverse warfarin anticoagulation in patients without intracranial hemorrhage. 6) The panel suggested against plasma transfusion for other selected groups of patients.
CONCLUSION: We have systematically developed evidence-based guidance to inform plasma transfusion decisions in common clinical scenarios. Data from additional randomized studies will be required to establish more comprehensive and definitive guidelines for plasma transfusion.