Effectiveness of early and aggressive administration of fresh frozen plasma to reduce massive blood transfusion during cytoreductive surgery

Background: Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been consistently associated with high volume blood loss and red blood cell (RBC) transfusion. This study evaluates the effectiveness of the introduction of a novel protocol to reduce blood loss and subsequent intra-operative transfusion in patients with high volume disease. Methods: One hundred and thirty-one consecutive patients with high volume disease (peritoneal cancer index = 16) who underwent CRS and PIC were evaluated. Group I consisted of the sixty patients (46%) treated before June 2006. Group II consistent of the seventy-one (54%) patients treated after June 2006 under the new protocol. The clinical and treatment-related data of patients in the two groups were compared. Results: Group II was associated with reduced intra-operative red blood cell transfusion (P< 0.001), reduced cryoprecipitate transfusion (P= 0.020), reduced platelet transfusion (P< 0.001), reduced fresh frozen plasma transfusion (P= 0.024), reduced operation length (P< 0.001), reduced crystalloid administration (P< 0.001) and reduced colloid administration (P< 0.001). Group II was also associated with increased transfusion of FFP in the first half of the surgical intervention relative to the second half [FFP1st: FFP2nd ratio > 1 (P< 0.001)] and increased transfusion of RBC in the first half of the surgical intervention relative to the second half [RBC1st: RBC2nd ratio = 1 (P= 0.016)]. Conclusion: Early administration of fresh frozen plasma combined with restrictive fluid resuscitation may reduce overall intra-operative transfusion of RBC and other blood components.