Fresh frozen plasma transfusion – a risk factor for pulmonary hemorrhage in extremely low birth weight infants?

Jakob Usemann; Lars Garten; Christoph Bührer; Christof Dame; Malte Cremer

doi:10.1515/jpm-2016-0309

Article

Fresh frozen plasma transfusion – a risk factor for pulmonary hemorrhage in extremely low birth weight infants?

Jakob Usemann , Lars Garten , Christoph Bührer , Christof Dame and Malte Cremer

Published/Copyright: February 14, 2017

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From the journal Journal of Perinatal Medicine Volume 45 Issue 5

Abstract

Aim:

To evaluate risk factors for pulmonary hemorrhage (PH) in extremely low birth weight infants (ELBW) taking into consideration coagulation screens, platelet counts, transfusion of fresh frozen plasma (FFP), and platelet concentrates prior to PH.

Patients and methods:

A retrospective case-control study consisting of 20 ELBW infants with PH and 40 matched controls. Coagulation screens, platelet counts at birth and at onset of PH, and transfusion frequencies prior to PH were compared to case-controls at birth and 24–96 h after birth.

Results:

While the initial platelet counts, fibrinogen concentrations, and international normalized ratios were similar in PH infants and controls, the activated partial prothrombin time was prolonged (P=0.05). Compared to 28% of case controls (P<0.05), 55% of infants with later PH received FFP prior to PH. Platelet counts were significantly lower at onset of PH (median 81/nL; range: 37–236/nL) compared to controls (166/nL; 27–460/nL; P<0.005). Multivariate analysis indicated a lack of antenatal steroids, supplemental oxygen, and transfusion of FFP as independent risk factors for PH.

Conclusion:

Prolonged activated partial thromboplastin time (aPTT) might be associated with PH. PH does not primarily depend upon severe thrombocytopenia. A developmental mismatch in hemostasis by transfusion of adult donor plasma should be considered a risk factor for PH.

Keywords: Bleeding; coagulation disorder; extremely low birth weight; fresh frozen plasma; platelet transfusion; thrombocytopenia

Corresponding author: Christof Dame, MD, Department of Neonatology, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany, Tel.: +49 30 450559006, Fax: +49 30 450559906

Acknowledgement

We thank Boris Metze, BSc, for his help in obtaining the clinical data and performing statistical analysis, Petra Blank, Jessica Blank, and Regina Nagel for administrative support, and Karine Landgren Hugentobler for language editing.

Contributors: CD, LG, CB, and MC conceived the study. Clinical data was analyzed by JU; statistics were done by JU and MC. JU, MC, and CD drafted the article, and all authors agreed to the final manuscript.
Funding: None.
Author’s Statement
Conflict of interest: The authors declare that there are no conflicts of interest regarding the publication of this article.
Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.
Ethical approval: The study was approved by the local Institutional Review Board (Ethikkommission der Charité – Universitätsmedizin Berlin) that waived the need to obtain informed parental consent.

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Received: 2016-9-19

Accepted: 2016-12-9

Published Online: 2017-2-14

Published in Print: 2017-7-26

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Articles in the same Issue

https://doi.org/10.1515/jpm-2016-0309

Keywords for this article

Bleeding; coagulation disorder; extremely low birth weight; fresh frozen plasma; platelet transfusion; thrombocytopenia