Plasma
Fresh frozen plasma is indicated for treatment of thrombotic thrombocytopenia and for replacement of coagulation factors in a few specific situations. In the UK the only plasma components used are classed as ‘fresh frozen plasma’ or FFP, although blood banks may now hold a thawed unit of FFP for up to 24 hours.
Plasma infusion was used to treat haemophilia before more concentrated forms of coagulation factor were available. Factor VIII is the only plasma protein of which the biological activity is quality controlled in FFP, although other plasma proteins such as fibrinogen should be present at normal plasma levels. Although FFP is widely used, there are few well-founded indications on which to base a specification to ensure its efficacy.(PMID15198745)
Pathogen-reduced plasma components
Methylene blue treated FFP (MBFFP) Single donation units are treated with methylene blue and light to reduce microbial infectivity. The level of functional fibrinogen is lower than in standard FFP (60−80%). There are no published studies showing efficacy of MBFFP relative to untreated FFP in treatment of coagulopathy.
Solvent-detergent treated plasma (SDFFP) Prepared from pools of 300−5,000 plasma donations treated with a solvent and detergent. Reduced levels of coagulation factors, protein S and anti-plasmin. Appears to be associated with a lower risk of transfusion-related acute lung injury (TRALI) and allergic reactions. Some clinicians prefer to use SDFFP for plasma exchange treatment of thrombotic thrombocytopaenic purpura (see TTP). One SDFFP product, now withdrawn, had levels of protein S below 20% and in the USA was associated with hepatic artery thrombosis in patients undergoing liver surgery. There is a report of late deep-vein thrombosis (DVT) following plasma exchange with SDFFP to treat thrombotic thrombocytopenic purpura. Department of Health policy is now to use SDFFP for TTP. Precautions against thromboembolism are recommended (graduated elastic compression stockings at diagnosis and prophylactic low-molecular-weight heparin once the platelet count rises above 50 x 109/l).(PMID12780794)
Cryoprecipitate
Cryoprecipitate was the first practical method of preparing a more concentrated form of antihaemophiliac factor. It is prepared by controlled thawing of frozen plasma to precipitate high molecular weight proteins, including factor VIIIc, von Willebrand factor and fibrinogen. The cryoprecipitate prepared from a single donor unit contains 80−300 units of factor VIII and von Willebrand factor, and 300−600 mg of fibrinogen in a volume of 20−50 ml. It is a requirement of the BSQR that cryoprecipitate is not pooled in a blood bank unless it is registered as a blood establishment. For this reason, a pre-pooled component (five donor units) is available in some areas.
Dose: A typical adult dose is two five-donor pools (equivalent to 10 single donor units) containing 3−6 g fibrinogen in a volume of 200 to 500 ml. One such treatment administered to an adult would typically raise the plasma fibrinogen level by about 1 g/l.
Table 4 Fresh frozen plasma, SDFFP, MBFFP and cryoprecipitate
Fresh frozen plasma | mean | sd | 95%CI | range |
Number of donors per pack | 1 | | | |
Volume ml | 273 | ± 17 | 277−279 | 240−300 |
Plasma ml | 220 | | | |
Anticoagulant ml | 50 | | | |
Fibrinogen g/l | 2 − 5 | | | |
Fibrinogen mg per pack estimated | | | 554−1395 | |
Factor VIII c IU/ml (in > 75% packs) | > 0.7 | | 1.03−1.06 | |
Other coagulation factors | variable | | | |
Other plasma proteins | < normal plasma | | | |
Storage | 2 years at -30°C | | | |
Methylene blue plasma1 |
Number of donors per pack | 1 | | | |
Volume ml | 232 | ± 18 | | |
Plasma ml | 220 | | | |
Anticoagulant ml | 50 | | | |
Factor VIII c IU/ml (in > 75% packs) | > 0.7 | | | |
Storage | 2 years at -30°C | | | |
Solvent-detergent plasma1 |
Number of donors per pack | 380−2500 | | | |
Volume ml | 200 | | | |
Fibrinogen g/l | 2.7 | | | |
Factor VIII c IU/ml (in > 75% packs) | > 0.5 | | | |
Storage | 1 year at -30°C | | | |
Compatibility | FFP should be ABO compatible to avoid risk of haemolysis caused by donor anti A or anti B
FFP does not need to be RhD matched |
Dosing guide | 12−15 ml/kg would typically increase fibrinogen levels by about 1 g/l |
Administration | Use standard blood administration set
Rapid infusion may increase risk of acute reactions |
Cautions | Risk of volume overload
Rapid infusion may increase risk of adverse reaction |
Infection risk | Pathogen reduction should reduce any risk due to micro-organisms
Non-UK plasma should reduce risk of vCJD |
Source: NBS and SNBTS routine QA data
Note:
1More detail of SDFFP and MBFFP is available in the 'Guidelines for the Blood Transfusion Services in the UK' |
[Table 4 resources: View large format or download as Word™ document]
Granulocyte transfusion
Some clinicians believe that some patients with very low neutrophil counts and intractable sepsis can benefit from infusion of granulocyte concentrates. These may be prepared either by apheresis collections or derived from whole blood. Volunteers for apheresis require premedication with steroids and G-CSF to obtain a high cell count in the collection. Granulocyte concentrates prepared from whole blood donations are also used: doses are lower. Clinical trials have not so far established effectiveness of the treatment.(CD005339)(CD005341)