Fresh frozen plasma (FFP) is the primary source of coagulation factors. Indications of FFP use are very limited such as disseminated intravascular coagulation, massive bleeding, thrombotic thrombocytopenic purpura, biopsy for chronic liver disease, and reversing warfarin anticoagulation with severe bleeding. In clinical practice, FFPs are reported to be used inappropriately either in respect of the particular indication or excessive in adult studies. Therefore, we aimed in this study to evaluate indications of pediatric FFP usage in our tertiary care hospital

Patients aged 0-18 years, who were hospitalized in Ankara City Hospital Children's Hospital between September and December 2020, were analyzed retrospectively. Demographic information, diagnosis, FFP transfusion indication, pre-transfusion coagulation results, surgical procedure and bleeding status, and the amount of FFP administered were recorded. Statistical analysis was done with SPSS 18.0 program.

1110 units of FFP were transfused to 324 patients (57% males) in 987 transfusion episodes. The mean age of the patients was 5.4±5.7 years68% of the transfusion episodes had a pre-transfusion coagulation testing. 249 (25%) of the transfusion episodes were given before or after minor or major surgery, and 226 (23%) were for plasmapheresis. The most FFP usage was in pediatric and cardiovascular surgery intensive care and hematology/oncology clinics. 69% of the FFP transfusions were appropriate.

Misuse of FFP exposes patients to unpredictable adverse effects such as allergic reactions, infectious complications, hemolysis, fluid overload, and transfusion-induced acute lung injury (TRALI). In this study, the use of FFP in children was evaluated for the first time in our country, and it was found that the 31% of the FFP transfusions was inappropriate. Regular audit and education programs for the efficient use of FFP by hospital transfusion committees can improve transfusion practices.