IN critically ill adults, fresh frozen plasma (FFP) and platelet transfusions are commonly administered, but new guidance urges caution. A comprehensive evidence review by a panel of experts has challenged the routine use of these blood products in the ICU, emphasizing the need for individualized decision-making grounded in risk-benefit assessment.
The new recommendations are based on a systematic review of 7,172 studies, ultimately narrowing the evidence to 16 qualifying studies, just one of which was a randomized controlled trial. The rest were observational, leading the panel to rate the overall certainty of the evidence as very low. Despite this, seven conditional recommendations were developed through consensus using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework and a modified Delphi process.
Key populations examined included critically ill patients with thrombocytopenia, both with and without active bleeding, and those undergoing common ICU procedures where prophylactic transfusion is often considered. In all cases, the panel found insufficient high-quality evidence to justify standard transfusion practices.
Their main conclusion? Most critically ill patients are likely better off not receiving platelets or FFP, unless they are at high risk of bleeding or face procedures where a bleeding complication could be catastrophic. Given the known risks of transfusions, including transfusion reactions, volume overload, and immunologic complications, the panel advocates for greater clinical discretion.
This updated guidance marks a notable shift from traditional protocols and signals a growing emphasis on evidence-based, patient-specific approaches in critical care medicine.
Reference:
Barton C et al. Transfusion of Fresh Frozen Plasma and Platelets in Critically Ill Adults. Chest. 2025;[Epub ahead of print].
