CH 140 Using Plasma and Plasma Component Therapy Flashcards
soluble protein containing solution of blood that contains the clotting factors
PLASMA
plasma products are all therapeutically equivalent except for (2)
liquid plasma and plasma cryoprecipitate–reduced
Two ways plasma can be collected
from either apheresis or
from whole blood collections
To prepare frozen plasma for transfusion, the frozen product requires thawing at _____ °C, a process that requires _____ minutes
30–37
20 to 30
After thawing, plasma is routinely stored at _____°C and transfused within ____ hours, labile clotting factors (i.e. FVIII and factor V) decline
1–6
24
Plasma that is not used within 24 hours can be relabeled as _____ and stored for an additional ____ days at 1–6 °C.
thawed plasma
4
After thawing:
FVIII activity will decrease about ____ at 5 days,
FV and FVII activity decreases to approximately _____,
the other factors remaining relatively stable
50%
20%
T/F: Plasma is not indicated if specific clotting factor concentrates, human or recombinant, are available.
T
Contents of 4-PCC
Factors II, VII, IX, and X
anticoagulant proteins C and S
3-factor-PCC contains
factors II, IX, X, and little or no factor VII
T/F: Plasma products should be ABO compatible with the patient
T
During an emergency and patient’s blood type may not be known, and plasma is required. What can be transfused traditionally?
group AB plasma products are administered until definitive blood typing can be obtained
***Practices have changed to using group A plasma instead of group AB plasma in emergency situations due to unavailability of AB.
T/F plasma units do not need to be matched for RhD
T
T/F frozen plasma can leukoreduced or irradiated
False
frozen plasma does not need to be leukoreduced or irradiated
plasma that is frozen within 8 hours of collection and stored at –18 °C or colder
Fresh frozen plasma
FFP, once thawed, should be transfused immediately or stored at 1–6 °C for up to 24 hours; after 24 hours, the unit can be relabeled as____
as thawed plasma
defined as plasma frozen within 24 hours after collection but is stored at 1–6 °C within 8 hours of collections (labeled as plasma frozen within 24 hours after phlebotomy).
FP24
product remaining after cryoprecipitate is removed from FFP
Plasma cryoprecipitate–reduced
The primary indication for Plasma cryoprecipitate–reduced is
transfusion or use in plasma exchange in patients with TTP
made from whole blood, and must infused no later than 5 days after the whole-blood expiration date and should be stored at 1–6 °C.
Liquid plasma
Only indication for liquid plasma transfusion
initial tx for massive hemorrhage
With pathogen reduction, coagulation factor levels are decreased 30% to 40%, specifically (3), but may also include anticoagulant factors as well and reduce enveloped viruses.
FVIII, fibrinogen, and FXI
reduces prions and removes cellular debris and lipid contaminants, a process that is thought to reduce the risk of TRALI
Solvent/detergent–treated plasma
T/F: Leukocyte antibodies are not detected in Octaplas because the process is considered to dilute neutrophil antibodies and soluble HLAs
T
Solvent/detergent–treated plasma
The product is a _____ml unit and is stored at –18 °C or colder; the thawed product should be transfused immediately or stored at 2–4 °C for____ hours
200 mL
12
Appropriate uses of plasma include (4)
bleeding patient during surgery and trauma
for factor replacement during therapeutic plasma exchange
used in the presence of depleting coagulation factor abnormalities, where specific concentrates are not available
DIC
T/F 30% of critically ill ICU px receive plasma; of which 50% are inappropriate
T
When treating coagulation abnormalities, ______ of plasma should be administered to achieve a ______% of plasma factor levels
10 to 15 mL/kg
minimum of 30
perioperative bleeding is often caused by (2)
thrombocytopenia and/or platelet dysfunction
T/F: PT and PTT have never been demonstrated to accurately reflect the cause of bleeding in surgical patients
T
T/F Rapid INR reduction occurred in 62.2% of 4F-PCC versus 9.6% of plasma-treated patients with a similar safety profile
T
massive transfusion defined as more than or equal to
10 RBCs within a 24-hour period (or one blood volume)
Trauma patients often develop a _____, elevation of PT and PTT correlated to shock, onsets immediately after injury.
trauma-induced coagulopathy
T/F Between 1:1:1 or 1:1:2 (plasma:platelet:RBCs) there was no difference in survival.
True
T/F Patients who received more plasma (1:1:1 ratio) achieved hemostasis more frequently.
True
- intended to answer the question regarding the optimal ratio of 1:1:1 or 1:1:2 (plasma:platelet:RBCs) and
- that early plasma transfusion of plasma on trauma center arrival improved 6-hour survival
The Prospective Observational Multicenter Major Trauma Transfusion study
compare the effectiveness and safety of a 1:1:1 transfusion ratio with a 1:1:2 transfusion ratio in patients with trauma predicted to need a massive transfusion, but there was no difference in survival. However, patients who received more plasma (1:1:1 ratio) achieved hemostasis more frequently.
Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial
Variations on Massive Transfusion protocols
- fibrinogen repletion with cryoprecipitate or fibrinogen concentrate
- PCCs and fibrinogen concentrates instead of plasma
- use of whole blood
- routine use of tranexamic acid in traumatic injury for fibrinolysis
T/F patients requiring ECMO, cardiac or liver surgery, or massive bleeding after PPH, massive transfusion protocols can also be lifesaving
True
TACO can occur in ____% of patients receiving plasma
6
T/F
TACO has now replaced TRALI as the most frequent transfusion-associated cause of morbidity and mortality
Current mitigation strategies for TACO include
assessing the patient for TACO risk before transfusion
potentially reducing the rate and volume of transfusion
Mitigation strategies for plasma, platelets, and cryoprecipitate to avoid TRALI
male donors or female donors without a previous pregnancy or who are HLA-antibody negative
Contents of cryoprecipitate
FVIII, fibrinogen, fibronectin, factor XIII, and vWF
T/F: it is a multi-donor product and has a higher potential for pathogen transmission
True
Indication for cryoprecipitate transfusion
for fibrinogen repletion in patients who are coagulopathic, where fibrinogen concentrates are not available
Explain how cryoprecipitate is made
- Each unit of cryoprecipitate is made from a unit of FFP by thawing at 1–6 °C and centrifugation to remove the supernatant.
- The precipitate (ie, cryoprecipitate) that forms is then refrozen at −18 °C or colder
The fibrinogen content in cryoprecipitate units varies from ____g/L (____ ± 1.7 g/L mean concentration) with a total fibrinogen content of approximately _____mg/unit cryoprecipitate
3–8
5.6
200 ± 58
10 cryoprecipitate units contains _____ grams of fibrinogen, raising the plasma fibrinogen levels by ____ mg/dL (___g/L)
2–2.5
100
1
T/F Most cryoprecipitate are pre-pooled using a closed process made from five individual units.
True
Before transfusion of cryoprecipitate, the units must be thawed.
If pre-pooled units are used, after they have been thawed at 30–37 °C, they are kept at ____ °C and expire in___ hours.
20–24
6
If the transfusion services pool the cryoprecipitate using an open system, the pooled units expire in _____ hours.
4
T/F cryoprecipitate units need to be ABO or RhD compatible
False
cryoprecipitate units do not need to be ABO or RhD compatible
T/F Cryoprecipitate need to be leukoreduced or irradiated
False
Cryoprecipitate does not need to be leukoreduced or irradiated
a fibrinogen-to-RBC repletion ratio of ____grams fibrinogen per each RBC unit transfused increased survival after trauma
how?
≥ 0.2
administering 10u cryoprecipitate for every 10u PRBCs,
1u whole blood for every 4 units of RBCs, or
1u plasma for every 2u PRBCs
T/F The Prospective Observational Multicenter Major Trauma Transfusion study show improved mortality with cryoprecipitate administration
False
The Prospective Observational Multicenter Major Trauma Transfusion study did not show improved mortality with cryoprecipitate administration
was a feasibility pilot study for a multi-center RCT to evaluate the feasibility of early high-dose cryoprecipitate administration after major traumatic hemorrhage
CRYOSTAT-1
evaluated cryoprecipitate within 90 minutes of admission in trauma patients compared with standard blood transfusion therapy
CRYOSTAT-2
Current guideline recommendations for fibrinogen repletion in major bleeding with fibrinogen ≤ 150 mg/dL
Recommended fibrinogen dose is 3–4 grams
== 15 to 20u cryoprecipitate or 3–4 g fibrinogen concentrate needed
In Obstetric Patients
fibrinogen concentrates instead of cryoprecipitate as a therapeutic modality due to:
acute nature of the bleeding, lack of need for crossmatching, and ability to rapidly administer
an RCT that examined the effect of cryoprecipitate vs. fibrinogen concentrate for bleeding management within 24 hours after cardiopulmonary bypass
FIBRES
Result of FIBRES Study
fibrinogen concentrate is equivalent to cryoprecipitate in bleed patients after cardiac surgery
After liver transplantation with major bleeding, cryoprecipitate was eval- uated to replenish fibrinogen levels and was suggested to be associated with ____.
biliary complications
most common risk during cryoprecipitate transfusion
allergic reaction
Fibrinogen concentrates which are made from pooled human plasma and are purified and pathogen inactivated, are FDA approved for the treatment of bleeding in patients with congenital fibrinogen deficiency.
Purified Fibrinogen Concentrates
Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery
FIBRES cardiac surgical study
Result of FIBRES cardiac surgical study
In patients undergoing cardiac surgery who develop clinically significant bleeding and hypofibrinogenemia after cardiopulmonary bypass, fibrinogen concentrate is noninferior to cryoprecipitate with regard to number of blood components transfused in a 24-hour period post bypass.
Use of fibrinogen concentrate may be considered for management of bleeding in patients with acquired hypofibrinogenemia in cardiac surgery.
an antibody fragment that targets von Willebrand factor and inhibits its interaction with platelets, was approved for acquired TTP, which decreases the number of plasma exchanges needed
caplacuzimab
Risk factors for TRALI
- patient factors (inflammation, chronic alcohol abuse, older age, acute renal failure, trauma, liver surgery, and MV)
- product factors (anti-HLA and anti-HNA antibodies, mediators)
