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fresh frozen plasma

A unit of fresh frozen plasma is obtained from centrifugation of 500 mL of whole blood. 200 mL of plasma is separated from 300 mL of packed red blood cells & stored frozen for up to 1 year. Indications: 1) treatment of coagulation abnormalities secondary to multiple clotting factor deficiencies a) liver failure (INR > 1.5) b) vitamin K deficiency c) massive transfusion d) disseminated intravascular coagulation (DIC) 2) treatment of thrombotic thrombocytopenic purpura (TTP) in association with plasmapheresis 3) for correction of specific clotting factor deficiencies when specific clotting factors are not available - prothrombin deficiency - factor V deficiency - factor VII deficiency - factor IX deficiency (hemophilia B, Christmas disease) - factor XI deficiency 4) correction of coagulation inhibitor deficiencies - antithrombin III, protein C or protein S 5) correction of warfarin therapy* when reveral by vitamin K is not feasible because of time constraints 6) infants with protein-losing enteropathy 7) massive transfusion of packed RBC to avoid dilutional coagulopathy [2] 8) replacement solution for plasma exchange [2] * prothrombin complex concentrate is preferred; the 2 may be given together [2] Contraindications: 1) specific factor deficiencies for which the isolated factor is available as a single component a) factor VIII deficiency b) factor IX deficiency c) fibrinogen deficiency 2) as a simple volume expander 3) ineffective for treating mild coagulopathy (INR < 1.9) [2] 4) no consistent evidence of significant benefit for prophylactic or therapeutic use [4] Pharmacokinetics: - duration of effect is limited by short 1/2life of factor VII [1] Complications: - transfusion-related acute lung injury - transfusion-related infection - transfusion-related circulatory overload - allergic reactions, anaphylaxis [2] - hemolysis Management: 1) compatibility of donor plasma with recipient erythrocytes - recipient blood type A is compatible with donor plasma type A & AB - recipient blood type B is compatible with donor plasma type B & AB - recipient blood type AB is compatible with donor plasma type AB - recipient blood type O is compatible with any donor plasma type [2] 2) transfusion: - 10 mL/kg or 1 unit/20 kg of ideal body weight - consider coadministration of vitamin K

Related

ideal body weight (IBW) plasma

General

transfusion component

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 613-614
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018.
  3. Roback JD, Caldwell S, Carson J et al Evidence-based practice guidelines for plasma transfusion. Transfusion. 2010 Jun;50(6):1227-39 PMID: 20345562
  4. Yang L, Stanworth S, Hopewell S, Doree C, Murphy M. Is fresh-frozen plasma clinically effective? An update of a systematic review of randomized controlled trials. Transfusion. 2012 Aug;52(8):1673-86; PMID: 22257164
  5. Fresh Frozen Plasma: Indications and Risks NIH Consensus Statement http://consensus.nih.gov/cons/045/045_intro.htm