Plasma transfusions are often used to prevent and/or treat bleeding and to control blood volume in patients with trauma or undergoing surgery. Plasma has many other uses including for burn resuscitation and as a source of antibody treatment. However, there are limited clinical practice guidelines available that clearly define the patient populations who would benefit most. The Biomedical Excellence for Safer Transfusion (BEST) Collaborative performed a systematic review of the randomized clinical trials (RCTs) evaluating plasma transfusions. They found the data are increasing with now 28 RCTs published on plasma transfusions (5 prophylactic and 23 therapeutic transfusion RCTs). However, the trials used a wide variety of outcomes. Currently, no consensus-based standards for RCTs for plasma transfusions have been defined. Among the RCTs that explicitly tested the effects of plasma transfusions in adults and children published between 2020 and 2023, 87 different outcomes for plasma transfusions were measured with a mean of 11 outcomes per study. The outcomes were broadly grouped into clinical, laboratory, resource use, life impact/mortality, adverse events, and transfusion reactions. The most common outcomes measured in therapeutic studies included laboratory measures of coagulation (83%), adverse events (70%), blood usage (65%) and bleeding (61%); the outcomes were also measured differently. The BEST Collaborative recommends that standardized, clinically relevant outcomes be developed for plasma transfusions to better facilitate comparison between trials and studies.
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