Table II.
Synoptic analysis of the major indications for the clinical use of FFP in the guidelines considered in the study
| IDICATION | GUIDELINES | ||||
|---|---|---|---|---|---|
| British Committee for Standards in Haematology1 | Agence Française de Securité Sanitaire de Produits de Sante20 | Australasian Society of Blood Transfusion19 | Canadian Members of the Expert Working Group17 | American Society of Anesthesiologists18 | |
| 2004
|
2002
|
2001
|
1997
|
1996–2006
|
|
| Dose | 10–15 mL/kg | 10–15 mL/kg | 10–20 mL/kg | Not stated | 10–15 mL/kg |
| Trigger | Fibrinogen <100mg/dL INR and aPTT ratio>1.5 | Fibrinogen <100mg/dL INR and aPTT ratio>1.5–1.8 normal range | Coagulation values>1–1.5 normal range | Not stated | Fibrinogen <100mg/dL INR and aPTT ratio>2* |
| Inherited deficiency of single clotting factors | When specific, virus-safe or recombinant factors are not available. If the patient is bleeding. | When the specific factors are not available. | If the patient is bleeding or in preparation for surgery. | Only when DDAVP and specific factors are ineffective or not available and the patient is bleeding or there is reasonable expectation of bleeding. | When the specific factors are not available. |
| Disseminated Intravascular Coagulation (DIC) | If the patient is bleeding | Indicated for DIC in obstetric patients | If the patient is bleeding and there are coagulation abnormalities | If the patient is bleeding and the INR increase and Apt ≥ trigger unless the underlying cause can be treated effectively. | Not stated |
| Thrombotic Thrombocytopaenic Purpura (TTP) | During plasma exchange | During plasma exchange | During plasma exchange | During plasma exchange | Not stated |
| Haemolytic-uraemic Syndrome | Not stated | Yes | Not stated | Yes (except in children) | Not stated |
| Warfarin anticoagulation | If the patient has severe bleeding | If the patient is bleeding (However, prothrombin complex in association with vitamin K is preferable) | If the patient is bleeding, in association with vitamin K and factor IX concentrate | If the patient is bleeding. (However, prothrombin complex, in association with vitamin K, is preferable) | Yes (5–8 mL/Kg) |
| Vitamin K deficiency | No | Not stated | No | If the patient is bleeding | Not stated |
| Liver diseases | Routine use not appropriate | If the patient is bleeding and PT and apt ≥ trigger | If the patient is bleeding and PT and aPTT ge; trigger | If the patient is bleeding and PT and aPTTge;trigger | Not stated |
| Massive transfusion | Use guided by updated coagulation test carried out at the patient’s bedside | In cases of traumatic haemorrhagic shock that cannot be managed immediately by surgery | If PT and aPTT ge; trigger | If the patient has microvascular bleeding and PT and apt ≥ trigger In preparation for invasive procedures/sugerry | If the patient has microvascular bleeding and PT and aPTT ≥ trigger |
| Heart surgery | Prophylactic use not indicated | Prophylactic use not indicated | Not stated | Prophylactic and therapeutic use not indicated | Not stated |
| Liver biopsy | If PT ≥ 4 times higher than the normal value. Results unpredictable | Not stated | Not stated | If INR >2 | Not stated |
| Not indicated | Hypovolaemia Plasma exchange except for TTP Test of clotting correction in the absence of haemorrhage | Hypovolaemia Plasma exchange except for TTP Test of clotting correction in the absence of haemorrhage | Not stated | Hypovolaemia Plasma exchange except for TTP Test of clotting correction in the absence of haemorrhage Hypoproteinaemia Hypogammaglobulinaemia | Hypovolaemia Albumin concentration |