FFP Transfusion in Dysentery with Deranged Coagulation Profile
Do not give FFP to a child with dysentery and abnormal coagulation tests unless there is active bleeding or a planned invasive procedure. The presence of laboratory coagulation abnormalities alone is not an indication for FFP transfusion.
Core Principle: Laboratory Values ≠ Bleeding Risk
The fundamental error in clinical practice is transfusing FFP solely to "normalize" laboratory values. Fresh frozen plasma should not be used to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures 1, 2. This recommendation applies across all patient populations, including pediatric patients.
Standard coagulation tests are poor predictors of actual bleeding risk and do not reflect the true hemostatic status of patients 2. In fact, transfusing FFP for mildly prolonged INR values (≤1.5-1.7) fails to reliably correct the INR and unnecessarily exposes patients to transfusion risks 3, 4.
When FFP IS Indicated in Children
FFP should only be administered when BOTH conditions are met:
1. Active Bleeding Present
2. Documented Severe Coagulopathy
- INR > 2.0, OR
- PT > 1.5 times normal, OR
- aPTT > 2 times normal 6
The therapeutic dose when indicated is 15 ml/kg to achieve minimum 30% concentration of plasma factors 6, 7.
Special Pediatric Considerations
In the pediatric population, particularly neonates and young infants, physiologic differences exist in the hemostatic system 8. Despite lower plasma levels of many procoagulant factors compared to adults, healthy neonates demonstrate:
- No easy bruising
- No increased bleeding during surgery
- Excellent wound healing 8
There is absolutely no indication to "correct" physiologic pediatric coagulation values to adult norms prior to invasive procedures by administering FFP 8. The hemostatic system in children works optimally with their age-appropriate physiologic concentrations.
Risks of Inappropriate FFP Use
Transfusing FFP without proper indication exposes children to significant risks:
- Transfusion-related acute lung injury (TRALI) - now a major cause of transfusion-related death 2, 9
- Transfusion-associated circulatory overload (TACO) 7
- Allergic reactions and anaphylaxis 9
- Infectious disease transmission 9
- Volume overload (particularly problematic in children) 7
FFP and platelets are the blood components most frequently implicated in transfusion reactions 7.
Clinical Algorithm for Dysentery with Abnormal Coagulation
Step 1: Is the child actively bleeding?
- No → Do NOT give FFP. Treat underlying dysentery and monitor.
- Yes → Proceed to Step 2
Step 2: Check coagulation parameters
- INR ≤ 2.0 and PT ≤ 1.5× normal → Do NOT give FFP
- INR > 2.0 OR PT > 1.5× normal → Consider FFP at 15 ml/kg 6
Step 3: Is an invasive procedure planned?
- For low-risk procedures → Proceed without FFP 2
- For high-risk procedures with severe coagulopathy → Consider FFP only if additional bleeding risk factors present 2
Management of Dysentery-Related Coagulopathy
The deranged coagulation profile in dysentery typically results from:
- Sepsis/septic shock
- Disseminated intravascular coagulation (DIC)
- Hepatic dysfunction
The primary treatment is addressing the underlying infection and sepsis, not transfusing FFP 4. Studies demonstrate that minimally prolonged INRs decrease with treatment of the underlying disease alone, and adding FFP fails to accelerate this improvement 4.
If septic shock is present, follow sepsis guidelines for hemodynamic support, antibiotics, and source control 1. The coagulopathy will improve as the sepsis resolves.
Common Pitfall to Avoid
The most common error is prophylactic FFP transfusion based on laboratory values alone. This practice persists despite lack of evidence and exposes patients to unnecessary risks 2. Emerging evidence shows that for stable patients, transfusing plasma for INR ≤1.5 does not confer hemostatic benefit 3.