A Concise Synopsis of Current Literature and Guidelines on the Practice of Plasma Transfusion

Evidence-based indications for plasma transfusion are limited, and much of the clinical practice relies on expert opinion. This article highlights key studies, meta-analyses, and guidelines for plasma transfusion in adults. The goal is to limit non-evidence-based plasma transfusion that is outside of clinical guideline, because as with all transfusions, the administration of plasma is not without risk. Any intended potential benefit must be appraised against the real risks associated with transfusion. Moving forward, the practice of plasma transfusion would benefit greatly from randomized controlled trials to update and expand the existing guidelines. Key points • There is insufficient data from randomized controlled trials on plasma transfusion practices. • Plasma should not be used to treat laboratory derangements in coagulations. • Prophylactic plasma transfusion preprocedure does not reduce the risk of intraprocedural bleeding. • Plasma is indicated for therapeutic plasma exchange for the treatment of thrombotic thrombocytopenia. • Patients with trauma with massive bleeding requiring massive transfusion may also benefit from plasma transfusion.     Introduction Constituting up to 55% of our total blood volume, plasma consists of proteins including albumin and immunoglobulins, clotting factors (procoagulants) and inhibitors (anticoagulants), hormones, carbon dioxide, electrolytes, and glucose. 1 , 2 Plasma is transfused with the goal of achieving hemostasis in bleeding patients by replacing deficient, consumed, depleted, or diluted coagulation factors. Randomized controlled trials (RCTs) that assess the efficacy of plasma compared with other interventions or placebo are scarce. 2 Despite limited and low-quality evidence, plasma is transfused in a wide variety of settings and even in nonbleeding patients. This article begins with an introduction on the different preparations of plasma, followed by a summary of select key clinical trials and meta-analyses that assess the efficacy of plasma transfusion, and then a synopsis of clinical guidelines. The article concludes with a discussion of the complications of plasma transfusion.