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• Fresh frozen plasma use in the NICU: a prospective, observational, multicentred study
  Elaine Neary
  Published on: 22 March 2016

• Published on: 22 March 2016

  Fresh frozen plasma use in the NICU: a prospective, observational, multicentred study

  • Elaine Neary, Doctor

  We read with interest the recent publication by Motta and colleagues (1). Their data pertaining to use of fresh frozen plasma (FFP) in the neonatal intensive care unit are helpful.

  The British Committee for Standards in Haematology transfusion guidelines (2) suggest that any neonates with significant coagulopathy [e.g. prothrombin time (PT)/activated partial thromboplastin time (APTT) ratio >1.5] and signif...

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  We read with interest the recent publication by Motta and colleagues (1). Their data pertaining to use of fresh frozen plasma (FFP) in the neonatal intensive care unit are helpful.

  The British Committee for Standards in Haematology transfusion guidelines (2) suggest that any neonates with significant coagulopathy [e.g. prothrombin time (PT)/activated partial thromboplastin time (APTT) ratio >1.5] and significant risk of bleeding (e.g. preterm and/or intubated, previous periventricular haemorrhage), FFP is indicated. We believe that this practice may lead to over-transfusion of FFP.

  We have recently published data pertaining to the extremely premature neonatal population (n = 183) born < 27 weeks' gestation on day 1 of life (3). In this large patient cohort, we observed similar clotting times to those reported by Motto and co-workers(Table 3) (1) in their similar but smaller patient population. In our cohort, median (range 25th-75th percentile) prothrombin time (PT) and activated partial thromboplastin time (APTT) values were 20.2 (17.8-24.1) and 67.4 (56.3-88.4) seconds, respectively.

  Unfortunately, timing of both cranial sonography and specific laboratory assessments of haemostasis were not described by Motto et al (1). Coagulation tests were performed pre FFP transfusion, only 42% of which occurred in first 3 days of life, with remainder occurring at later postnatal age. Most intraventricular haemorrhage occurs within first 72 hours of life. The timing of blood sampling may influence results of coagulation parameters, as coagulation values change with gestational age (4). The association/lack thereof between IVH and coagulation values is difficult to establish given lack of clarity regarding timing of both events.

  We agree with the authors that FFP should be used cautiously given paucity of evidence for effectiveness of these transfusions. Given that extremely premature infants have median coagulation values > 1.5 ratio, review of FFP transfusion guidelines is warranted, as many additional infants may have had FFP without good indication.

  Yours Sincerely

  Elaine Neary, MB, BCh, BAO, BA, MSc, MRCPI, PGDIP (1)

  Fionnuala Ni Ainle, MB, BCh, BAO, MRCPI, FRCPath, PhD (2)

  Melanie Cotter, MB, BCh, BAO, DCH, MSc, FRCPI, FRCPath, MD (2)

  Naomi McCallion, MB, BCh, BAO, MRCPI, MD (1)

  (1)Department of Paediatrics, Rotunda Hospital, Dublin, Ireland

  (2)Department of Haematology, Rotunda Hospital, Dublin, Ireland

  References

  1. Motta M, Del Vecchio A, Perrone B, Ghirardello S, Radicioni M. Fresh frozen plasma use in the NICU: a prospective, observational, multicentred study. Arch Dis Child Fetal Neonatal Ed. 2014 Mar 19. doi: 10.1136/archdischild-2013-304747. [Epub ahead of print]

  2. Gibson BE, Todd A, Roberts I, Pamphilon D, Rodeck C, Bolton-Maggs P, Burbin G, Duguid J, Boulton F, Cohen H, Smith N, McClelland DB, Rowley M, Turner G; British Commitee for Standards in Haematology Transfusion Task Force: Writing group. Transfusion guidelines for neonates and older children. Br J Haematol. 2004 Feb;124(4):433-53.

  3. Neary E, Okafor I, Al-Awaysheh F, et al. Laboratory coagulation parameters in extremely premature infants born earlier than 27 gestational weeks upon admission to a neonatal intensive care unit. Neonatology 2013;104:222-7.

  4. Andrew M, Paes B, Milner R, et al. Development of the human coagulation system in the healthy premature infant. Blood 1988;72:1651-7.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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