Skip to main content
SpringerLink
Log in

Effect of FFP Transfusion on International Normalized Ratio in Liver Disease Patients

  • Short Communication
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Fresh frozen plasma (FFP) is widely used in liver diseases to rectify coagulation derangements. In this study we have analysed the pattern of FFP usage in liver diseases and its effect on International normalized ratio (INR). A retrospective study of liver disease patients who received FFP transfusions from January 2016 to June 2016 was done. FFP used for liver transplant surgeries and plasma exchange procedures were excluded from the study. A total of 1935 units of FFP were transfused to 576 patients. We found a high linear correlation between pre transfusion INR and change in INR per unit of FFP. Patients receiving 6 units or more FFP have shown significant INR improvement. Improvement was more in acute liver failure and acute on chronic liver failure cases compared to chronic liver disease. FFP is not effective in correcting mild to moderate coagulation defects in liver diseases. Large volumes are required to cause significant INR improvement. Considering the risks associated with FFP transfusion, decision of transfusion should be carefully weighed. Future prospective randomized control trails are required for understanding the risk benefit ratio better and formulating plasma transfusion guidelines in liver diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Stanworth SJ (2007) The evidence based use of FFP and cryoprecipitate for abnormalities of coagulation tests and clinical coagulopathy. In: Hematology. American Society of Hematology Educational Program, pp 179–186

  2. Abdel-Wahab Omar I, Healy Brian, Dzik Walter H (2006) Effect of FFP transfusion on PT and bleeding in patients with mild coagulation abnormalities. Transfusion 46(8):1279–1285

    Article  Google Scholar 

  3. Youssef WI, Salazar F, Dasarathy S, Beddow T, Mullen KD (2003) Role of FFP infusion in correction of coagulopathy of chronic liver disease: a dual phase study. Am J Gastroenterol 98(6):1391–1394

    Article  Google Scholar 

  4. Stanworth SJ, Brunskill SJ, Hyde CJ, Murphy MF, McClelland DB (2004) Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol 126(1):139–152

    Article  CAS  Google Scholar 

  5. Lisman T, Caldwell SH, Burroughs et al (2010) Hemostasis and thrombosis in patients with liver disease: the ups and downs. J Hepatol 53:362–371

    Article  Google Scholar 

  6. Holland LL, Brooke JP (2006) Toward rational fresh frozen plasma transfusion: the effect of plasma transfusion on coagulation test results. Am J Clin Pathol 126(1):133–139

    Article  Google Scholar 

  7. Caldwell SH (2014) Management of coagulopathy in liver disease. Gastroenterol Hepatol 10(5):330–332

    Google Scholar 

  8. American Association of Blood banks (2002) Technical manual, 14th edn. AABB, Bethesda, pp 461–465

    Google Scholar 

  9. Wong MP, Droubatchevskaia N, Chipperfield KM, Wadsworth LD, Ferguson DJ (2007) Guidelines for frozen plasma transfusion. BCMJ 49(6):311–319

    Google Scholar 

  10. Hshieh TT, Kaung A, Hussain S, Curry MP, Sundaram V (2015) The international normalized ratio does not reflect bleeding risk in esophageal variceal hemorrhage. Saudi J Gastroenterol 21:254–258

    Article  Google Scholar 

  11. Pandit TN, Sarode R (2012) Blood component support in acquired coagulopathic conditions: Is there a method to the madness? Am J Hematol 87:S56–S62

    Article  Google Scholar 

  12. Shinagare SA, Angarkar NN, Desai SR, Naniwadekar MR (2010) An audit of fresh frozen plasma usage and effect of fresh frozen plasma on the pre-transfusion international normalized ratio. Asian J Transfus Sci 4:128–132

    Article  CAS  Google Scholar 

  13. Amarapurkar PD, Amarapurkar DN (2011) Management of coagulopathy in patients with decompensated liver cirrhosis. Int J Hepatol 2011:695470

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, D1-Vasant Kunj, New Delhi, Delhi, 110070, India

    Sukanya Baruah & Meenu Bajpai

Authors
  1. Sukanya Baruah
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meenu Bajpai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meenu Bajpai.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baruah, S., Bajpai, M. Effect of FFP Transfusion on International Normalized Ratio in Liver Disease Patients. Indian J Hematol Blood Transfus 34, 719–722 (2018). https://doi.org/10.1007/s12288-018-0934-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-018-0934-0

Keywords

Search

Navigation