FFP (Fresh Frozen Plasma)

One unit of blood = 450 (just under a pint)

One unit of plasma = 50% of blood (normal Hct) so = 450 X 50% = 220 mL (200-250 mL)

  • One unit of FFP = 220 mL

FFP is prepared from whole blood, separated by centrifugation steps from RBCs.

  • Can be stored up to 1 year under -18 celcius.
  • Need to be thawed for 37 celcius in waterbath for 30 minutes.

FFP has intrinsic INR of 1.5

1 mL of FFP has 1 U of clotting factors, 1 U (220 mL) therefore has 220 U of clotting factors

  • BUT factor recovery of FVIII (most studied is literature) is only 40%, so 1 U of FFP can only recover ~ 88 U of clotting factors
  • Vd in blood = 0.05 L/kg, in a 70 kg = 3.5 L
    (3.5 X 88)/100 = 2-3%
  • Therefore transfusing 1 U of FFP will only result in 2.5% raise in cotting factors.
  • A change of coagulation status needs at least 10% raise in clotting factors, usual starting dose of FFP is 4 units.

250, 2.5, 15, 1.5 rule

  • 1 unit of FFP = 250 mL
  • 1 U increases clotting factors by 2.5%
  • 15 cc/kg in adults
  • Intrinsic INR = 1.5

Thawed plasma

  • If thawed FFP is not used, it can be refrigerated (~5 celcius).
  • Shelf life after thawing is 5 days (NOT 24 hours).
  • Contains a slighly lesser amount of FV and FVIII but still therapeutic (clotting levels >30% of normal)
  • FVIII tends to increase during stress events as it is acute phase reactants.
  • For the great majority of situations, thawed plasma can be used interchangeably with FFP, except perhaps in DIC (severe consumptive coagulopathy).
  • Thawed plasma reduce wastage of unusused FFP and can improve turnaround timer by eliminating the 30 minutes needed to thaw the FFP to 37 celcius.

Indications of FFP

Note: to have a clinically significant clotting factors deficiencies (levels <30% of normal), INR is >1.5:

  1. Documented clotting factors deficiencies eg liver disease, DIC, dilutional coagulopathy
  2. Reversal of warfarin bleeding (BUT NOT recommended for reversal of NOACs because massive volume will be needed ~10 units)
  3. For Hemophilia, factor concentrate should be used preferably.
  4. FFP but NOT thawed plasma can be used for Factor V Leiden.

Compatibility

  • ABO Identical is better than compatible.

    ABO compatible chart for plasma: AB is universal donor, O is universal acceptor; A can receive from A or AB, B can receive from B or AB
  • No Rh status needed
  • Free of leucocytes so no risk of acute rejection

Possible viral infectivity as it does not undergo viral inactivation

  • Solvent-detergent FFP, SD-FFP (FFP treated with solvent and detergent)
    – Lipid coated viruses eg HIV, HBV and HCV are eliminated, but not viruses which aren’t lipid coated eg HAV, EBV.

Cryoprecipitate

  • When FFP is thawed slowly at 1-6 celcius, a precipitate is formed.
  • Cryoprecipitate is also called cryoprecipitated anti-hemiphilic factor (FVIII).
  • Contains most of the FVIII, vWF, fibrinogen and fibronectin.
    – 100 U of FVIII and vWF
    – 200 mg of fibrinogen
  • Stored frozen. Must be transfused ASAP once thawed (within 4 hours)
    – 4 hours if pooled units (cryo is often transfused as 4-6 units pooled.)- 6 hours if closed single unit
  • Dose depends on the lab assay of coagulation factors.
    – No specific dose, but generally 1 unit/10kg increases 1 g/dL of fibrinogen.Each unit is around 10 mL
  • ABO compatibility, but if unable, ABO incompatible can be used with caution
    – Patient may have positive Coombs’ test and rarely hemolytic anemia

Cryo-poor plasma

  • Is the supernatal recoverred after cryo is made.
  • For exchange transfusion eg in TTP
  • Theoretically, better than FFP for TTP due to lack of vWF. But has not been shown to be superior.

Pimped question:

  • What’s the difference between fresh plasma and fresh frozen plasma?
    – Not much, except that FP has slightly low level of FV and FVIII

Summary

Capture

Reference:

http://lifeinthefastlane.com/ccc/fresh-frozen-plasma-ffp/

http://www.itxm.org/tmu/tmu2004/issue2004-1.htm

http://pathology.ucla.edu/workfiles/Education/Transfusion%20Medicine/2-4-Plasma-Products.pdf

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