title: Indications and Effects of Plasma Transfusions in Critically Ill Children.
abstract: BACKGROUND
  Plasma transfusions are frequently prescribed for critically ill children, although their indications lack a strong evidence base. Plasma transfusions are largely driven by physician conceptions of need, and these are poorly documented in pediatric intensive care patients.
  
  
  OBJECTIVE
  To identify patient characteristics and to characterize indications leading to plasma transfusions in critically ill children, and to assess the effect of plasma transfusions on coagulation tests.
  
  
  METHODS
  Point-prevalence study in 101 pediatric intensive care units in 21 countries, on 6 predefined weeks. All critically ill children admitted to a participating unit were included if they received at least one plasma transfusion.
  
  
  RESULTS
  During the 6 study weeks, 13,192 children were eligible. Among these, 443 (3.4%) received at least one plasma transfusion and were included. The primary indications for plasma transfusion were critical bleeding in 22.3%, minor bleeding in 21.2%, planned surgery or procedure in 11.7%, and high risk of postoperative bleeding in 10.6%. No bleeding or planned procedures were reported in 34.1%. Before plasma transfusion, the median international normalized ratio (INR) and activated partial thromboplastin time (aPTT) values were 1.5 and 48, respectively. After plasma transfusion, the median INR and aPTT changes were -0.2 and -5, respectively. Plasma transfusion significantly improved INR only in patients with a baseline INR greater than 2.5.
  
  
  CONCLUSIONS
  One-third of transfused patients were not bleeding and had no planned procedure. In addition, in most patients, coagulation tests are not sensitive to increases in coagulation factors resulting from plasma transfusion. Studies assessing appropriate plasma transfusion strategies are urgently needed.
authors: 1 Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland.|2 EA 2694, Public Health: Epidemiology and Quality of Care, University of Lille-Nord-de-France, Lille, France.
authors: Oliver
authors: http://orcid.org/0000-0001-6606-1736
authors: O
authors: Karam
authors: 3 Pediatric Intensive Care Unit, Centre Hospitalier Chrétien Liège, Liège, Belgium.
authors: Pierre
authors: P
authors: Demaret
authors: 4 Pediatric Intensive Care Unit, Oxford University Hospitals, Oxford, United Kingdom.
authors: Alison
authors: A
authors: Shefler
authors: 2 EA 2694, Public Health: Epidemiology and Quality of Care, University of Lille-Nord-de-France, Lille, France.|5 Pediatric Intensive Care Unit, Centre Hospitalier Universitaire (CHU) Lille, Lille, France.
authors: Stéphane
authors: S
authors: Leteurtre
authors: 6 Pediatric Intensive Care Unit, St. Louis Children's Hospital, St. Louis, Missouri.
authors: Philip C
authors: PC
authors: Spinella
authors: 7 National Health Service Blood and Transplant, John Radcliffe Hospital, Oxford, United Kingdom; and.
authors: Simon J
authors: SJ
authors: Stanworth
authors: 8 Pediatric Intensive Care Unit, CHU Sainte-Justine, Montreal, Canada.
authors: Marisa
authors: M
authors: Tucci
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D016913:Blood Component Transfusion / Q000706:statistics & numerical data*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D019934:International Normalized Ratio / Q000706:statistics & numerical data; D008297:Male; D010314:Partial Thromboplastin Time / Q000706:statistics & numerical data
keywords: blood coagulation tests; blood transfusion; child; critical illness; plasma