Society for the Advancement of Patient Blood Management

View all recommendations from this society

July 23, 2018

Don’t transfuse plasma in the absence of active bleeding or significant clinical and laboratory evidence of coagulopathy.

Recent studies demonstrate that plasma is often transfused inappropriately. In the absence of active bleeding and clear evidence of coagulopathy, current literature shows no reduction in blood loss or transfusion requirements with the use of plasma. Transfusion of plasma may lead to an increased risk of transfusion-associated adverse events such as transfusion-related acute lung injury, transfusion-associated circulatory overload and allergic reactions. These adverse events lead to poorer outcomes and increased cost of care.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Executive Committee and Board of Directors (BOD) of the Society for the Advancement of Patient Blood Management (SABM) had a strong desire to participate in the Choosing Wisely campaign. Participation allows SABM to align with the national Choosing Wisely® team and other specialty societies to further the mission of collaborative physician-patient health care delivery and responsible use of resources.

A Task Force was appointed from within the BOD to draft the initial set of recommendations. Evidence-based recommendations were based on our society’s foundational pillars and structured around published SABM Standards. A critical feature was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were submitted to the membership for input via an email survey. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The BOD approved the materials prior to submission. Recent review with updates was undertaken by the SABM Educational Oversight Committee.

Working with this initiative, our selected recommendations and integrated materials were further honed based on subsequent campaign review. This list and supporting material resulted in a publication in a peer-reviewed journal in 2019. SABM will also develop monitors to assess the impact of the initiative for our members and hospital affiliates. We foresee this as a vehicle for outreach to other professional societies, health care providers and patients.


Stanworth SJ, Brunskill SJ, Hyde CJ et al. Is fresh-frozen plasma clinically effective? A systematic review of randomized controlled trials. Brit J Haematol 2004; 126(11): 139-152

Holland LL, Foster TM, Marlar RA, Brooks JP et al. Fresh frozen plasma is ineffective for correcting minimally elevated international normalized ratios. Transfusion 2005; 45(7): 1234-1235.

Segal J and Dzik W Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion 2005; 45(9): 1412-1425.

Stanworth S, Grant-Casey J, Lowe D et al. The use of fresh-frozen plasma in England: high levels of inappropriate use in adults and children. Transfusion 2011; 51(1): 62-70.

Yang L, Stanworth S, Hopewell S et al. Is fresh-frozen plasma clinically effective: an update of a systematic review of randomized controlled trials. Transfusion 2012; 52(8): 1673-1686.

Muller M, Arbous MS, Spoelstra-de Man AM et al. Transfusion of fresh-frozen plasma in critically ill patients with coagulopathy before invasive procedures: a randomized controlled trial. Transfusion 2015; 55(1): 26-35.

Green L, Bolton-Maggs P, Beattie C et al. British Society of Haematology guidelines on the spectrum of fresh frozen plasma and cryoprecipitate products: their handling and use in various patient groups in the absence of major bleeding. Brit J Haematol 2018; 181(1): 54-67.

Tibi P, McClure RS, Huang J, Baker RA, Fitzgerald D, Mazer CD, Stone M, Chu D, Stammers AH, Dickinson T, Shore-Lesserson L, Ferraris V, Firestone S, Kissoon K, Moffatt-Bruce S. STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management. J Extra Corpor Technol. 2021 Jun;53(2):97-124. doi: 10.1182/ject-2100053. PMID: 34194077; PMCID: PMC8220901.