Plasma Transfusions in the Pediatric Intensive Care Unit

Whereas red blood cell transfusions have been used since the nineteenth century, plasma has only been available since 1941. It was originally mainly used as volume replacement, mostly during World War II and the Korean War. Over the years, its indication has shifted to correcting coagulation factors deficiencies or to preventing bleeding. Currently, it remains a frequent treatment in the intensive care unit, both for critically ill adults and children. However, observational studies have shown that plasma transfusion fail to correct mildly abnormal coagulation tests. Furthermore, recent epidemiological studies have shown that plasma transfusions are associated with an increased morbidity and mortality in critically ill patients. Therefore, plasma as any other treatment has to be used when the benefits outweigh the risks. Based on observational data, most experts suggest limiting its use either to massively bleeding patients, or bleeding patients who have documented abnormal coagulation tests, and refraining for transfusing plasma to non- bleeding patients whatever their coagulation tests. In this paper, we will review current evidence on plasma transfusions and discuss its indications.