Plasma transfusion is not as easy as it sounds! Over half of transfusions have been shown to be unnecessary, and Jeannie Callum can help change how you think about transfusing plasma.
Dr. Jeannie Callum from Sunnybrook Health Sciences Center in Toronto, Ontario joins Dr. Chaffin to discuss appropriate plasma transfusion practices. Numerous studies and audits have shown that plasma transfusion is not really done very well! As many as 50% of plasma transfusions are either unnecessary or inappropriate. Why is it so hard, and what can we do to help make it better?
Jeannie Callum to the rescue!
Dr. Callum has written and lectured extensively on the appropriate use of plasma, not only in the setting of prophylaxis for bedside procedures, but also in a variety of other clinical settings. She shares lots of information with us about new thoughts and methods in plasma transfusion, including the very important understanding that coagulation assay results MUST be interpreted in the clinical context. Dr. Callum also goes over five case examples that illustrate challenging aspects of plasma transfusion, including cases describing bedside procedures, warfarin correction, plasma use in liver failure and sepsis/DIC, and what role (if any) plasma plays in bleeding patients taking novel oral anticoagulants (NOAC). This is a superb episode! Don’t miss it!
DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Dr. Callum wants you to know that her research is funded by Canadian Blood Services and ORBCON. She is the site PI on trials funded by CSL Behring, and materials in kind from TEM international (ROTEM). She is also site PI on a cardiac surgery trial to be funded by Octapharma. Neither Dr. Callum nor I have any additional relevant financial disclosures.
The images below are generously provided by Dr. Callum.
- Jia Qing et al. Prophylactic plasma transfusion for surgical patients with abnormal preoperative coagulation tests: a single institution propensity-adjusted cohort study. The Lancet Haematology 2016;3:e139-e148.
- Haas B et al. Large-bore tunneled central venous catheter insertion in patients with coagulopathy. J Vasc Interv Radiol. 2010 Feb;21(2):212-7.
- Lisman T et al. Intact thrombin generation and decreased fibrinolytic capacity in patients with acute liver injury or acute liver failure. J Thromb Haemost 2012; 10: 1312–9.
- Müller MCA et al. Transfusion of fresh-frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial. Transfusion 2015;55:26-35.
- De Pietri L et al. Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial. Hepatology 2016;63:566–573.
- Choosing Wisely Canada. Transfusion Medicine: Ten Things Physicians and Patients Should Question; updated June 2015.
- Denas G et al. Effectiveness and safety of a management protocol to correct over-anticoagulation with oral vitamin K: a retrospective study of 1,043 cases. J Thromb Thrombolysis. 2009 Apr;27(3):340-7.