病院独自の基準による新鮮凍結血漿(FFP)使用抑制の試み

This report describes the recent upsurge in use of fresh frozen plasma (FFP) and its successful suppression with our institutional directives in Shinshu University Hospital.In 1993 (fiscal year), the use of FFP reached 46.5 units per bed per year in our hospital. In contrast, average in the hospitals of national universities in Japan was only 14.9 units. The use of blood and its components in that year was approximately 2.6 times that in the year 1988, immediately before the start of the rise. Repeated promotion of “the standards for use of blood and its components by the Ministry of Welfare” (the “standards”) had been ineffective. Finally, in 1994, our transfusion committee formulated a set of rules of FFP use. Qantities used thereafter fell from 5080 units in the first two months of 1994 to 2924 units in the same months of 1995.Our rules divide FFP transfusion into (1) conservative and (2) surgical varieties. The former use (1) is under the control of the “standards”. For the cases of surgical operation (2), the rules allow the surgeons to consume FFPs freely according to clinical requirements in the perioperative period (4 or 5 days including the date of operation), after which the “standards” restrict its use.Effectiveness was the first consideration of our rules. Accordingly they were considerably generous to the surgeon's clinical judgment. This was reflected in a lack of sufficient academic base, although this was mostly related to the paucity of research in this field. An unexpected result was that the directives substantially reduced the physicians' workload in transfusion inspection.