Fresh frozen plasma (FFP)

Plasma frozen within 8 hours, and plasma frozen at longer interval after collection is ref2242ed to as frozen plasma.

Fresh frozen plasma (FFP) is the plasma removed from a unit of whole blood and frozen at or below 55° Fahrenheit within eight hours of collection.

Contains all coagulation factors in normal amounts and is free of red cells, leukocytes and platelets.

FFP is indicated for patients with documented coagulation factor deficiencies who are actively bleeding and for those about to undergo an invasive procedure.

Levels of factor V and VIII may be slightly lower in comparison with FFP.

Contains near normal levels of most plasma proteins, including procoagulant and inhibitory components of the coagulation system, acute phase proteins, immunoglobulins, and albumin.

FFP contains plasma constituents other than clotting factors, which introduces replenishment of factors VIII, XIII, von Willebrand factor, or fibrinogen.

Pooled plasma components prepared from pools of 300-5000 plasma donations and is a pathogen inactivated preparation of plasma is available for clinical use.

Coagulation factor content is well maintained in thawed FFP stored at 1 degree C to 6 degrees C for up to 5 days.

Typical unit of plasma derived from a collection of whole blood is under 300 mL.

Typical usage is 10-20 mL/kg.

1 mL contains 1 unit of coagulation factors.

1 unit contains 220 u of coagulation factors.

Factor recovery with transfusion about 40%, so that 1 unit pf FFP provides about 80 coagulation factors.

1 unit of FFP increases most factors by about 2.5 % and 4 units increases factors by about 10%.

One ml of FFP per kg of patient weight will raise most clotting factors by approximately 1%.

FFP should be used as soon as possible after it is thawed and always within 24 hours after thawing.

A 10% increase in coagulation factors is needed to provide necessary factors to produce a change in coagulation status, so that the usual dose is 4 units of FFP.

Must be ABO compatible, but Rh is not necessary to be considered for transfusion.

Free of RBC’s, leukocytes and platelets.

Does not contain viable leukocytes, so does not carry risk for CMV transmission or GVHD.

Can transmit infectious agents, cause volume overload, anaphylactoid reactions and can alter serum ionized calcium levels.

Methods to inactivate pathogens include: solvent detergents, methylene blue treatment, and treatment with psoralens and UV light.

Methods to inactivate pathogens are associated with altered or loss of coagulation factors.

FFP is indicated for patients with documented coagulation factor deficiencies who are actively bleeding and for those about to undergo an invasive procedure.

FFP beneficial for congenital factor deficiencies, liver disease, anticoagulation with warfarin or massive transfusion with red cells and crystalloid/colloid solutions.

FFP is also indicated in treatment of thrombotic thrombocytopenic purpura, usually in conjunction with plasma exchange.

FFP should not be used for volume expansion or nutritional support.

Immune globulin preparations are available for the provision of immune proteins instead of FFP.

Reversal of warfarin anticoagulation should be accomplished with Vitamin K rather than FFP if two to three days can be allowed for clotting factors to return to hemostatic levels.

Massively bleeding may be treated with FFP along with red blood cells to prevent dilution of clotting proteins.

Can be used to concentrate coagulation factors, fibrin sealants, immunoglobulin anti-thrombin, protein C, complement and albumin.

Prophylactic use in the Northern Neonatal Nursing Initiative (NNNI) Trial Group did not demonstrate improvement in the prevention of intraventricular hemorrhage.

Not useful in the management of patients with acute pancreatitis (Stanworth).

Use in cardiac surgery has shown, after cardiopulmonary bypass, not to have a consistent effect on blood loss or transfusion requirements (Stanworth).

There is lack of evidence for clinical benefit when transfused in patients with liver disease.

Indicated in patients with documented coagulation factor deficiencies and active bleeding, or about to undergo an invasive procedures.

May be utilized in patients undergoing aphaeresis procedures, and is the first line treatment for TTP, and is a source of ADAMTS 13.

Limited information is available for its use in DIC or massive transfusions.

In a review of 324 units transfused in 121 patients with a pretransfusion PT between 13.1 seconds and 17 seconds, equivalent to INR 1.1-1.85, fewer than 1% of patients had normalization of the PT/INR after transfusion and only 15% had a correction of half way to normal, in addition there was little evidence for correlation with clinical bleeding or for a dose-response effect (Abdel-Wahap).

May be among the highest risk of all blood components.

Transfusion related acute lung injury is the most immediate serious complication.

Risk factors of use include infections and risk of prion disease and fluid overload.

Allergic reactions to FFP occurs with a frequency of 1-3% and can be life threatening in patients multiply transfused.

An association with female donors and the development of serous hazards including the development of transfusion related acute lung injury (TRALI) has been noted, the use of all male fresh frozen plasma is therefore encouraged.

Use for prophylaxis is justified only if the chance of bleeding is greater than the risk of harmful reactions to FFP.

In patients undergoing interventional radiology procedures, pre-procedural plasma transfusion given in the setting of an elevated INR is associated with increased periprocedural rbc transfusions (MA Warner).

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