CH 140 Using Plasma and Plasma Component Therapy

Question 1

soluble protein containing solution of blood that contains the clotting factors

Answer 1

PLASMA

Question 2

plasma products are all therapeutically equivalent except for (2)

Answer 2

liquid plasma and plasma cryoprecipitate–reduced

Question 3

Two ways plasma can be collected

Answer 3

from either apheresis or
from whole blood collections

Question 4

To prepare frozen plasma for transfusion, the frozen product requires thawing at _____ °C, a process that requires _____ minutes

Answer 4

30–37
20 to 30

Question 5

After thawing, plasma is routinely stored at _____°C and transfused within ____ hours, labile clotting factors (i.e. FVIII and factor V) decline

Answer 5

1–6
24

Question 6

Plasma that is not used within 24 hours can be relabeled as _____ and stored for an additional ____ days at 1–6 °C.

Answer 6

thawed plasma
4

Question 7

After thawing:
FVIII activity will decrease about ____ at 5 days,
FV and FVII activity decreases to approximately _____,
the other factors remaining relatively stable

Answer 7

50%
20%

Question 8

T/F: Plasma is not indicated if specific clotting factor concentrates, human or recombinant, are available.

Answer 8

T

Question 9

Contents of 4-PCC

Answer 9

Factors II, VII, IX, and X
anticoagulant proteins C and S

Question 10

3-factor-PCC contains

Answer 10

factors II, IX, X, and little or no factor VII

Question 11

T/F: Plasma products should be ABO compatible with the patient

Answer 11

T

Question 12

During an emergency and patient’s blood type may not be known, and plasma is required. What can be transfused traditionally?

Answer 12

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.

Question 13

T/F plasma units do not need to be matched for RhD

Answer 13

T

Question 14

T/F frozen plasma can leukoreduced or irradiated

Answer 14

False

frozen plasma does not need to be leukoreduced or irradiated

Question 15

plasma that is frozen within 8 hours of collection and stored at –18 °C or colder

Answer 15

Fresh frozen plasma

Question 16

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____

Answer 16

as thawed plasma

Question 17

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).

Answer 17

FP24

Question 18

product remaining after cryoprecipitate is removed from FFP

Answer 18

Plasma cryoprecipitate–reduced

Question 19

The primary indication for Plasma cryoprecipitate–reduced is

Answer 19

transfusion or use in plasma exchange in patients with TTP

Question 20

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.

Answer 20

Liquid plasma

Question 21

Only indication for liquid plasma transfusion

Answer 21

initial tx for massive hemorrhage

Question 22

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.

Answer 22

FVIII, fibrinogen, and FXI

Question 23

reduces prions and removes cellular debris and lipid contaminants, a process that is thought to reduce the risk of TRALI

Answer 23

Solvent/detergent–treated plasma

Question 24

T/F: Leukocyte antibodies are not detected in Octaplas because the process is considered to dilute neutrophil antibodies and soluble HLAs

Answer 24

T

Question 25

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

Answer 25

200 mL
12

Question 26

Appropriate uses of plasma include (4)

Answer 26

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

Question 27

T/F 30% of critically ill ICU px receive plasma; of which 50% are inappropriate

Answer 27

T

Question 28

When treating coagulation abnormalities, ______ of plasma should be administered to achieve a ______% of plasma factor levels

Answer 28

10 to 15 mL/kg
minimum of 30

Question 29

perioperative bleeding is often caused by (2)

Answer 29

thrombocytopenia and/or platelet dysfunction

Question 30

T/F: PT and PTT have never been demonstrated to accurately reflect the cause of bleeding in surgical patients

Answer 30

T

Question 31

T/F Rapid INR reduction occurred in 62.2% of 4F-PCC versus 9.6% of plasma-treated patients with a similar safety profile

Answer 31

T

Question 32

massive transfusion defined as more than or equal to

Answer 32

10 RBCs within a 24-hour period (or one blood volume)

Question 33

Trauma patients often develop a _____, elevation of PT and PTT correlated to shock, onsets immediately after injury.

Answer 33

trauma-induced coagulopathy

Question 34

T/F Between 1:1:1 or 1:1:2 (plasma:platelet:RBCs) there was no difference in survival.

Answer 34

True

Question 35

T/F Patients who received more plasma (1:1:1 ratio) achieved hemostasis more frequently.

Answer 35

True

Question 36

• 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

Answer 36

The Prospective Observational Multicenter Major Trauma Transfusion study

Question 37

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.

Answer 37

Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial

Question 38

Variations on Massive Transfusion protocols

Answer 38

• 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

Question 39

T/F patients requiring ECMO, cardiac or liver surgery, or massive bleeding after PPH, massive transfusion protocols can also be lifesaving

Answer 39

True

Question 40

TACO can occur in ____% of patients receiving plasma

Answer 40

6

Question 41

T/F

Answer 41

TACO has now replaced TRALI as the most frequent transfusion-associated cause of morbidity and mortality

Question 42

Current mitigation strategies for TACO include

Answer 42

assessing the patient for TACO risk before transfusion
potentially reducing the rate and volume of transfusion

Question 43

Mitigation strategies for plasma, platelets, and cryoprecipitate to avoid TRALI

Answer 43

male donors or female donors without a previous pregnancy or who are HLA-antibody negative

Question 44

Contents of cryoprecipitate

Answer 44

FVIII, fibrinogen, fibronectin, factor XIII, and vWF

Question 45

T/F: it is a multi-donor product and has a higher potential for pathogen transmission

Answer 45

True

Question 46

Indication for cryoprecipitate transfusion

Answer 46

for fibrinogen repletion in patients who are coagulopathic, where fibrinogen concentrates are not available

Question 47

Explain how cryoprecipitate is made

Answer 47

• 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

Question 48

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

Answer 48

3–8
5.6
200 ± 58

Question 49

10 cryoprecipitate units contains _____ grams of fibrinogen, raising the plasma fibrinogen levels by ____ mg/dL (___g/L)

Answer 49

2–2.5
100
1

Question 50

T/F Most cryoprecipitate are pre-pooled using a closed process made from five individual units.

Answer 50

True

Question 51

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.

Answer 51

20–24
6

Question 52

If the transfusion services pool the cryoprecipitate using an open system, the pooled units expire in _____ hours.

Answer 52

4

Question 53

T/F cryoprecipitate units need to be ABO or RhD compatible

Answer 53

False
cryoprecipitate units do not need to be ABO or RhD compatible

Question 54

T/F Cryoprecipitate need to be leukoreduced or irradiated

Answer 54

False
Cryoprecipitate does not need to be leukoreduced or irradiated

Question 55

a fibrinogen-to-RBC repletion ratio of ____grams fibrinogen per each RBC unit transfused increased survival after trauma

how?

Answer 55

≥ 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

Question 56

T/F The Prospective Observational Multicenter Major Trauma Transfusion study show improved mortality with cryoprecipitate administration

Answer 56

False
The Prospective Observational Multicenter Major Trauma Transfusion study did not show improved mortality with cryoprecipitate administration

Question 57

was a feasibility pilot study for a multi-center RCT to evaluate the feasibility of early high-dose cryoprecipitate administration after major traumatic hemorrhage

Answer 57

CRYOSTAT-1

Question 58

evaluated cryoprecipitate within 90 minutes of admission in trauma patients compared with standard blood transfusion therapy

Answer 58

CRYOSTAT-2

Question 59

Current guideline recommendations for fibrinogen repletion in major bleeding with fibrinogen ≤ 150 mg/dL

Answer 59

Recommended fibrinogen dose is 3–4 grams

== 15 to 20u cryoprecipitate or 3–4 g fibrinogen concentrate needed

Question 60

In Obstetric Patients
fibrinogen concentrates instead of cryoprecipitate as a therapeutic modality due to:

Answer 60

acute nature of the bleeding, lack of need for crossmatching, and ability to rapidly administer

Question 61

an RCT that examined the effect of cryoprecipitate vs. fibrinogen concentrate for bleeding management within 24 hours after cardiopulmonary bypass

Answer 61

FIBRES

Question 62

Result of FIBRES Study

Answer 62

fibrinogen concentrate is equivalent to cryoprecipitate in bleed patients after cardiac surgery

Question 63

After liver transplantation with major bleeding, cryoprecipitate was eval- uated to replenish fibrinogen levels and was suggested to be associated with ____.

Answer 63

biliary complications

Question 64

most common risk during cryoprecipitate transfusion

Answer 64

allergic reaction

Question 65

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.

Answer 65

Purified Fibrinogen Concentrates

Question 66

Effect of Fibrinogen Concentrate vs Cryoprecipitate on Blood Component Transfusion After Cardiac Surgery

Answer 66

FIBRES cardiac surgical study

Question 67

Result of FIBRES cardiac surgical study

Answer 67

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.

Question 68

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

Answer 68

caplacuzimab

Question 69

Risk factors for TRALI

Answer 69

1. patient factors (inflammation, chronic alcohol abuse, older age, acute renal failure, trauma, liver surgery, and MV)
2. product factors (anti-HLA and anti-HNA antibodies, mediators)