Glenview, Illinois – The American College of Chest Physicians® (CHEST) recently released a new clinical guideline on the transfusion of fresh frozen plasma (FFP) andplatelets in critically ill adults . Published in the journal CHEST®, the guideline contains seven evidence-based recommendations to provide a framework for clinicians to implement in their own facilities.
"In practice, we see all too often [that] prophylactic transfusion of platelets or fresh frozen plasma is done unnecessarily," says Angel Coz Yataco, MD, FCCP, lead author on the guideline. "Transfusion is rarely needed prior to bedside procedures, with lumbar puncture being a possible exception. Following the new guideline, we can drastically reduce the use of FFP."
The panel of experts developed seven Population, Intervention, Comparator, and Outcome questions addressing platelet and FFP transfusions in critically ill patients and performed a comprehensive evidence review. The panel applied the Grading of Recommendations, Assessment, Development, and Evaluations approach to assess the certainty of evidence and to formulate and grade recommendations.
"In the United States, 20% of platelets and FFP are transfused to critically ill patients, totaling 2.2 million units of each annually," says Dr. Coz Yataco. "They are scarce resources with variable costs and access globally. If implemented on a large scale, this guideline provides the framework to decrease the use [to] approximately half a million less units of platelets and FFP transfused annually in the United States alone."
The panel formulated seven conditional recommendations. In addition to four procedure-specific recommendations, the guideline recommends:
- In stable non-bleeding critically ill patients with thrombocytopenia and without high risk of spontaneous bleeding, we suggest transfusing platelets if platelet counts fall below 10 × 109/L
(Conditional recommendation, very low certainty of evidence).
- In stable non-bleeding critically ill patients with thrombocytopenia who are considered at high risk of spontaneous bleeding, we suggest transfusing platelets if platelet counts fall below 30-50 × 109/L
(Conditional recommendation, very low certainty of evidence).
- In critically ill patients with thrombocytopenia and serious active bleeding, we suggest transfusing platelets if platelet counts fall below 50 × 109/L
(Conditional recommendation, very low certainty of evidence).
The entire list of recommendations included in the new guideline can be accessed through the CHEST journal website .
About the American College of Chest Physicians
The American College of Chest Physicians®
