Fresh Frozen Plasma Flashcards
When is plasma given
Massive haemorrhage to replace coagulation factors
Usually only given if patient has been transfused mutliple units of blood i.e. 10 units
How is fresh frozen plasma made
Separation and freezing to -30 degrees within 6 hours of donation
Typically between 200-220 mls but sometimes 600mls
How is fresh frozen plasma used
(4)
Thawed at 37 degrees in a waterbath or in the microwave
Transfused ASAP within 2 hours
Dosage depends on clinical situation but typically 10-15 ml/kg body weight
Clinical response may be the best monitor but also lab tests useful
Comment on a microwave defroster
(4)
Not used anymore
Used to thaw plasma in 10 minutes which is faster than a water bath
Used to have to bend the top of the pack to fit the packs in the microwave -> they used to spill and burst in microwave
Heat spots common
What are four blood group issues
Fresh frozen plasma labelled with ABO and RhD groups
First choice would be same ABO group if not, A to B or vice versa
Avoid Group O with ‘high titre’ anti-A and anti-B except to group O recipients
AB plasma useful but particularly in infants -> used to be called uniplas
When would we use plasma?
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Replacement of single factor deficits, where specific cocnetrates are unavailable
Reversal of warfrin effect only if evidence of bleeding otherwise Prothromplex orOctaplax is used
DIC, if bleeding
Massive transfusion - guided by lab tests, but also by the use of ‘near patient’ devices
In a plasma exchange procedure
Neonates with coagulopathy who are bleeding or are facing an invasive procedure
Inherited deficiencies of inhibitors of coagulation, e.g. AT 111; Protein C and Protein S - if specific concentrations are not available
Liver disease -> PT may be used as a guide, but use of plasma is debatable - may be justified if liver biopsies are performed with high PTs
Covid Convalescent Plasma in the treatment of patients with severe covid
What is convalescent plasma
Plasma taken from donor recovered from COVID-19
This is then donated to someone struggling to recover
Antibodies are donated sensitive for covid
When is it not recommended to give plasma
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Formula replacement - overuse common
Low blood volume - hypovolaemia -> use cheaper crystalloids/colloids instead
Immunodeficiency states - use IVIg instead
Vitamin K deficiency
What are some adverse affects of transfusing plasma
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Allergic reactions, anaphylactic reactions
HIV, Hep B, C and bacterial agents
Haemolysis due to potent ABO antibodies
Overload - TACO
Granulocyte antibodies in plasma causing acute pulmonary injury - TRALI
Anti-T antibodies when treating infants with Necrotising Enterocolitis
How do we virally inactivate plasma?
Solvent/detergent treatment of large pools
Methylene blue with visible light on single units
Write about solvent/detergent treatment to virally inactivate
(4)
Used on large pools of ABO identical plasma can be up to 25,000 donations
Disrupts the ‘lipid’ structures of enveloped viruses usch as HBV, HCV or HIV
Non-enveloped viruses are not affected e.g. HAV, Parvovirus or B19
Some loss of clotting factors, particularly Von Willebrand’s multimers, Protein S functional activity and reduced FVIII activity
Write about how methylene blue with light can be used to virally inactivate packs
MB has an affinity for nucleic acids and viral core proteins
Single units treated
‘Enveloped’ disrupted and most ‘non enveloped’ viruses
Some loss of fibrinogen and of FVIII activity
Method does not effectively inactivate intracellular virsus, bacteria and protozoa
Non enveloped viruses especially HAV - relatively resistant to MBLT
Illumination leads to the formation of ‘singlet oxygen’, hence photo-oxidative inactivation
What is meant by FFP- Donor Retested
This allows for window periods after supoosed infectivity of donor
Unit is frozen for approximately 122 days
Doctor recalled and tested
Seroconversion rates (antibody production)
HIV = 16 days (range 6-38)
HBV = 56 days (range 24 - 128)
HCV = 64 days (range 26-117)
