CHEST Guidelines-Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults

Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults

Pdf Summary

The American College of Chest Physicians’ clinical practice guideline focuses on the transfusion of fresh frozen plasma (FFP) and platelets in critically ill adult patients. The guideline provides evidence-based recommendations for transfusion practices in various clinical scenarios, considering the variability in indications and thresholds for these procedures.<br /><br />The study incorporated decisions made by an expert panel, which resulted in seven conditional recommendations based on a low certainty of existing evidence. These recommendations offer guidance on platelet and FFP transfusions in critically ill patients with thrombocytopenia or coagulopathy, emphasizing a risk/benefit evaluation before proceeding with transfusions.<br /><br />For non-bleeding patients without a high risk of spontaneous bleeding, a platelet transfusion is suggested if counts drop below 10 x 10^9/L, transitioning to 30-50 x 10^9/L in those at higher risk. Active bleeding warrants transfusion at thresholds below 50 x 10^9/L. Routine prophylactic transfusions are generally discouraged, especially during procedures like central venous catheter insertions or thoracentesis, due to the low certainty of benefits versus risks.<br /><br />Despite the low prevalence of severe bleeding and high procedural success rates without prophylactic transfusions, patient-specific factors should guide clinical judgments, especially in complex or high-risk cases.<br /><br />Research priorities include better understanding bleeding risks, evaluating platelet and FFP transfusion protocols, and exploring innovative diagnostic and monitoring technologies. The guidelines emphasize shared decision-making and encourage thoughtful transfusion practices to optimize patient care, reduce costs, and improve resource utilization and equity in access. Without robust evidence, these recommendations mostly derive from expert interpretations to support management decisions in critically ill patients.

Keywords

clinical practice guideline

fresh frozen plasma

platelet transfusion

critically ill patients

thrombocytopenia

coagulopathy

risk/benefit evaluation

expert panel recommendations

bleeding risks

shared decision-making