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Transfusion of Plasma and its Components

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5. Transfusion of Plasma and its Components

Several blood components and products are available for the treatment of disorders with abnormal coagulation. These range from simple donation of fresh frozen plasma, useful mainly for treatment of acquired broad-spectrum coagulation abnormalities to more highly purified coagulation factors prepared to correct specific deficiency states.

The terms ‘blood products’ and ‘blood components’ are frequently interchanged. It is preferrable in reserve the term blood products for materials that have been extracted and purified from crude plasma, sterilized and presented in a single concentrated from e.g. coagulation factor concentrates, albumin and immunoglobulins. Blood components are best regarded as materials which are relatively easy to seperate from the main donation by differential centrifugation e.g. fresh plasma, cryprecipitate, red cell and platelet concentrates.

A number of plasma products can be obtained by stepwise fractionation of large pools of fresh frozen plasma using differential cryoprecipitation.

Fresh Frozen Plasma (FFP)

Fresh frozen plasma is obtained either by separation of plasma from whole blood or by plasmapheresis. In either case the plasma is frozen within 6 hrs of collection to preserve liable coagulation factors. Cre must be taken during storage and thawing to preserve the activity of these factors.

Freshly collected, separated and frozen plasma contains all the clotting factors required for haemostasis.

Indications

FFP should not be used simply as a volume expander for which safe alternatives e.g. albumin and plasma substitutes are available.

The only absolute indication for use of FFP is Thrombotic Thrombocytopenic Purpura. The other indications are:

Broad-spectrum (multiple) coagulation factor replacement
- Severe liver disease
- Oral anticoagulant overdose
- Massive transfusion coagulation problems
- DIC
- Coagulation disorders of newborn
- Combined plasma volume and coagulation factor replacement as during apheresis procedure.
Replacement of single factor deficiency
- Mild factor IX deficiency
- Factor V, XII, XI & XIII deficiency
- Antithrombin lii therapy
- Cl esterase inhibitor therapy (in patient of angioneurotlc oedema)

Dosage and administration

Accepted dose of plasma for infusion is 12-15 mI/kg or approximately 4-5 donor bags of plasma for an adult weighing 60 kg.

FFP may be thawed in a 37°C waterbath or in a microwave oven for quick thawing. It should be wrapped in plastic over-wrap to avoid bacterial contamination. It is preferrable to use ABO group- specific plasma. Group AB plasma is the single most useful group of holding stock if turnover is small.

Rh negative plasma should be transfused to Rh negative women of child-bearing age to avoid the risk of immunization due to contaminating red cells.

Adverse effects of FFP

Transfusion of FFP is not without risks. Special risks associates with FFP include:

Allergic and anaphylactoid reaction
- Mild - Urticaria
  - Rigors
- Severe - Anaphylactoid reaction (in IgA deficient person with anti-IgA)
- Transmission of viruses e.g.
  - Hepatitis B & C
  - HIV
  - Parvovirus, etc.
    
    Certain viral inactivation procedures have been tried to inactivate viruses such as HBV and I-IIV in fresh frozen plasma.
- Circulatory overload.

Cryoprecipitate

When plasma is snap frozen and thereafter thawed slowly at 4^o - 6^oC, a small amount of protein is precipitated which is rich in factor VIII. The resulting precipitate is then separated from supernatent plasma and refrozen for storage. The protein can be redissolved by warming to give a small volume (20-30 ml) of solution which is a highly effective and convenient source of FV111.

Once thawed, the product should be transfused immediately, with completion of transfusion within 4 hours of issuing product.

Factors contained

Contains FVIII:C, von Willebrand factor (vWF), fibrinogen, FXIII, and fibronectin. Cryoprecipitate has the following factor activities:

91 IU of FVIII: C per bag,
113 IU of vWF per bag, and
150 mg of fibrinogen per bag.

Dosage and administration

Initial doses of 10-15 units (1.5-2.0)/10 kg body weight) are used for treatment of factor VIII deficiency. Cryoprecipitate should be administered through 170 um filter. Thawing should be performed as for fresh frozen plasma. Pooling of units may be done under all aseptic conditions and infusion should not take more than 30 minutes.

Typical adult dose of cryo is 1 unit/5 kg body weight, up to a total dose of 10 units

The pediatric dose is 1 unit/5–10 kg body weight or 5–10 mL/kg.

Will raise fibrinogen by 0.5 g/L, assuming there is no ongoing consumption/loss of fibrinogen.

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