Plasma transfusion practice: A five-year audit of plasma transfusion at 23 hospitals.

Background: There is limited high-quality evidence to guide plasma transfusion, and plasma transfusion practices remain variable.

Study design and methods: This is a retrospective cohort study that included adult medical and intensive care unit (ICU) inpatients (age ≥ 18 years) admitted to 23 hospitals in Canada between January 1, 2017, and December 31, 2022, when both whole blood derived (~290 mL) and apheresis plasma (~250 mL) were available for transfusion. Nine additional hospital sites with missing plasma data or coagulation testing were excluded. Data collected included patient demographics, most responsible diagnoses, procedures, laboratory tests, transfusion information, and physician characteristics.

Results: Among 950,740 included hospital admissions at 23 hospitals, there were 11,163 admissions with plasma use, with 46,377 plasma units transfused. Of the plasma recipients, 63.5% were male, with a mean age of 61.2 years (SD 16.4). Most plasma transfusions were administered in the ICU (64.1%). The number of plasma units transfused per 1000 inpatient days across centers varied from a median (IQR) of 0.2 (0.1-0.4) to 11.0 (10.6-12.0) units. There was significant variability in pre-transfusion INR values across hospitals (ranging from a median (IQR) of 1.5 (1.3-1.9) to 2.5 (1.4-4.6)) and physician specialties (ranging from a median (IQR) of 1.4 (1.3-1.8) to 2.2 (1.8-3.0)). There was no significant change in plasma utilization over the study period.

Discussion: This study demonstrated variability in plasma utilization and pre-transfusion INR thresholds across hospitals and physician specialties. This highlights the importance of developing evidence-based guidelines and effective knowledge translation to guide appropriate plasma use.