Study: Kids Given Plasma Despite No Clear Benefit

Many kids get plasma transfusions when there's little evidence they do much good, according to a new study.
Transfusions of so-called fresh frozen plasma are sometimes given to both kids and adults whose blood has problems clotting, or if they have lost a lot of blood from surgery or an accident.
But only a couple of studies in kids have shown that plasma transfusions are a good option for one specific heart surgery procedure. The rest of the time, researchers have found they don't work, or that their benefit is uncertain.
In the current study, pediatricians reported that almost three percent of kids admitted to children's hospitals in the U.S. had a transfusion. More than half of the transfusion recipients were under a year old, a third had heart disease and 70 percent were critically ill.
"For all we know, it may be used entirely appropriately," said Dr. John Puetz, from Saint Louis University, who worked on the study.
"The problem is, we don't have the evidence base... to demonstrate what's inappropriate use and what's not inappropriate use."
"The concern," he told Reuters Health, "is a fair number of children are being exposed to (fresh frozen plasma) without published data showing what it's effective for."
The problem with that, researchers said, is that the transfusions always come with a risk of side effects and complications, which range from allergic reactions to heart failure, if doctors give kids more plasma than their hearts can handle.
Puetz's team consulted a database of about 3.2 million admissions to 40 different children's hospitals in the last decade. According to hospital records, just under three percent of those kids got a plasma transfusion, most in the intensive care unit.
The researchers couldn't tell why the plasma was used in each case, or how much of it kids got. But only about one-third of the kids' records also showed they had a heart procedure known as a cardiopulmonary bypass -- when a pump does the job of the heart and lungs during surgery, and a plasma transfusion (along with red blood cells) is indicated.
There were 24 recorded cases of acute lung injuries related to the transfusions, but the authors write in the Journal of Pediatrics that it's hard to tell how many kids had other complications.
"The biggest reason not to give any transfusion... is the risk of the complications that you can have," said Dr. Lorne Holland, of the Nashville-based pathology services company PathGroup, Inc., who has researched the use of fresh frozen plasma. That would include lung injuries and congestive heart failure, as well as more minor itchy allergic reactions.
Still, Puetz added, "No one's really looked to see what all the possible side effects may be."
A typical plasma transfusion would cost a few hundred dollars, Holland said.
He thinks that too many kids are still getting the transfusions, despite the general lack of evidence that they work -- or are better than other alternatives such as whole-blood transfusions in certain cases.
"I think the numbers in that study and ones in adults are too high," Holland, who was not involved in the study, told Reuters Health. "A lot of physicians are convinced by evidence of, 'That one patient, that one time, seemed to do better when I gave it to them.'"
Puetz said it's still not clear whether plasma transfusions are being done too often, based on the lack of data. He called for more critical studies to see if fresh frozen plasma transfusions really do work in all of the cases where they're commonly used in kids.

Scientists Use Stem Cells for Blood 'Self-Transfusion'

Researchers report that they used stem cells to create cultured red blood cells and then successfully injected the blood cells back into the human donor who provided the stem cells in the first place.
The findings raise the possibility of creating individualized blood supplies without making people donate their own blood for storage before they need a transfusion, a potentially dicey situation if someone is ill.
The researchers said that the cultured red blood cells created with the help of stem cells from the donor -- and then inserted back into the donor -- lived about as long as regular blood cells normally do.
The study, the first to show that red blood cells created from stem cells can survive in the human body, is "a major breakthrough for the transplant community," Dr. Luc Douay, senior study author and a professor of hematology at Universite Pierre et Marie Curie in Paris, said in a news release from the American Society of Hematology.
"There is a dire need for an alternative source of transfusable blood products, especially with the risk of infection from emergent new viruses that comes with traditional transfusion," Douay explained. "Producing red blood cells in culture is promising since other efforts to create alternative sources have not yet been as successful as once hoped."
However, one expert said the research isn't quite as exciting as it may sound.
Creating red blood cells from your own stem cells is "going to be an extremely complex process, extremely expensive, not very convenient and uncommonly used," explained Dr. Paul Holland, a blood banking specialist and a clinical professor of medicine and pathology at the University of California, Davis Medical Center.
"Most people who need a transfusion need it now, and they use blood from donors that's already there," he said. One exception might be if someone has a condition that makes it difficult to match his or her blood to other donors and it's dangerous to draw and save their own blood, he said.
The findings appear in the Sept. 1 issue of the journal Blood.