title: Plasma is ineffective in correcting mildly elevated PT-INR in critically ill children: a retrospective observational study.
abstract: BACKGROUND
  Fresh frozen plasma transfusion is widely utilized in pediatric clinical practice to correct mild coagulopathy. Several studies on adult population have shown that transfusion of plasma cannot effectively correct mild coagulopathy when international normalized ratio (INR) is ≤1.5. Much controversy exists about the generalization of this finding for pediatric populations, especially since pediatric dosages often exceed those in adults. The aim of this study is to determine the prevalence of plasma transfusion with mild coagulopathy (INR ≤ 1.5) and its effectiveness in a pediatric setting.
  
  
  METHODS
  In our tertiary referral hospital, we retrospectively reviewed the electronic medical records of all patients who received plasma (April to October 2011) for mildly elevated prothrombin time (PT)-INR levels (≤1.5) and had post-transfusion PT-INR measurements; patients who received intraoperative, ECMO, or plasma exchange-related plasma transfusions were excluded from this study. We abstracted demographic data and pre- and post coagulation test results for the patients included in our study.
  
  
  RESULTS
  Among 468 plasma transfusions administered to 285 patients from April to June 2011, 60 plasma transfusions (12.8%) were given to patients with PT-INR ≤ 1.5 (range 1.3-1.5). Forty-one patients [median age 2.5 years (IQR, 0.14 to 13.75 years), median weight of 16.0 kg (IQR, 8.0 to 69.3 kg)] who received 41 single plasma transfusions [median dose 11 mL/Kg (IQR, 6-15)] had post-transfusion PT-INR measurements and were included in our study. There was no significant difference in their PT-INR values (p = 0.34) pre- and post-transfusion. Of our study, only 15.4% patients showed post-transfusion normalization [median change in PT-INR 0.15 (IQR, 0.1-0.2)] and were not different from the remaining 85% in age, plasma dose, and bleeding status.
  
  
  CONCLUSIONS
  The prevalence of plasma transfusion for correction of mildly elevated PT-INR levels in critically ill children is high (12.8%). Plasma transfusion showed no significant effect in correcting minor prolongation of PT-INR in pediatric patients regardless of age, volume of plasma transfused per kilogram (dosage), or bleeding status.
authors.affiliation: Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
authors.forename: Esther Paula
authors.initials: EP
authors.lastname: Soundar
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Childrens' Hospital, 6621 Fannin Street, Suite WB 1100, Houston, TX 77030 USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Besandre
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Childrens' Hospital, 6621 Fannin Street, Suite WB 1100, Houston, TX 77030 USA ; Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
authors.forename: Sarah Kate
authors.initials: SK
authors.lastname: Hartman
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Childrens' Hospital, 6621 Fannin Street, Suite WB 1100, Houston, TX 77030 USA ; Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Teruya
authors.affiliation: Division of Transfusion Medicine and Coagulation, Texas Childrens' Hospital, 6621 Fannin Street, Suite WB 1100, Houston, TX 77030 USA ; Department of Pathology and Immunology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030 USA.
authors.forename: Shiu-Ki Rocky
authors.initials: SK
authors.lastname: Hui
keywords: Children; Coagulopathy; Guidelines; Mildly prolonged PT-INR; Pediatric intensive care unit; Plasma transfusion