Makindo Medical Notes

Related Subjects: |Red blood cells |White blood cells |Lymphocytes |Platelets |Cryoprecipitate |Fresh Frozen Plasma |Blood Cell Maturation

FFP primarily contains stable clotting factors, albumin, and immunoglobulins, and is widely used in clinical settings for patients with coagulation disorders.

About

• Fresh Frozen Plasma (FFP) is the liquid component of whole blood that remains after cellular elements (red cells, white cells, and platelets) have been removed. It is rich in clotting factors and proteins essential for coagulation and maintaining fluid balance.
• Plasma is separated from the blood within hours of donation and frozen at -25°C (or lower) within 6 hours to preserve the activity of the labile clotting factors such as factor V and VIII.
• FFP can be stored for up to 1 year at -25°C or lower. Once thawed, it must be used promptly—within 24 hours if kept at 2-6°C or within 30 minutes if left at room temperature.
• Each unit of FFP typically has a volume of 200-300 mL. It contains albumin, immunoglobulins, and various coagulation factors, including fibrinogen, factors V, VII, VIII, IX, X, and XI.
• FFP is indicated for managing bleeding associated with coagulopathy, such as in patients with severe liver disease or disseminated intravascular coagulation (DIC).
• The typical dose for an adult is 10-15 mL/kg body weight (about 1 liter for a 70 kg adult). The goal of FFP transfusion is to normalize clotting times, targeting an INR ≤ 1.7, PT < 1.5, or an APTT < 2 times the normal range.

Additional Components of FFP

• Coagulation factors: These include fibrinogen, prothrombin, and other clotting factors (V, VII, VIII, IX, X, and XI), which play a crucial role in stopping bleeding and ensuring blood clots appropriately.
• Albumin: The most abundant plasma protein, albumin helps maintain oncotic pressure and fluid balance within blood vessels and tissues.
• Immunoglobulins: Antibodies present in FFP provide immune defense against infections, particularly for patients with immunodeficiency or after significant blood loss.

Indications for FFP Transfusion

• Coagulopathy with active bleeding: FFP is indicated in patients with documented coagulation disorders, such as in liver disease, where synthesis of clotting factors is impaired.
• Prolonged PT or INR with bleeding: FFP is recommended when PT > 1.5, INR > 2, or APTT > 2 times the normal limit, particularly in actively bleeding patients or those requiring invasive procedures.
• Warfarin reversal: In cases where urgent reversal of Warfarin is needed (e.g., in life-threatening bleeding or prior to surgery), FFP is used when Prothrombin Complex Concentrate (PCC) is unavailable or contraindicated.
• Massive transfusion protocol: FFP is often part of a balanced resuscitation strategy in massive hemorrhage, alongside red blood cells and platelets, to correct dilutional coagulopathy.
• Disseminated Intravascular Coagulation (DIC): DIC is a condition in which widespread clotting depletes coagulation factors, leading to severe bleeding. FFP helps replenish these factors.
• Thrombotic Thrombocytopenic Purpura (TTP): FFP is used to replace deficient ADAMTS13 enzyme, which is critical in TTP management.
• Inherited factor deficiencies: FFP can be used when specific factor concentrates (e.g., factor V or XI) are not available.
• Liver disease: In patients with severe liver disease and coagulopathy, FFP may be used to prevent or treat bleeding during surgical or invasive procedures.
• ABO compatibility: While FFP must be ABO-compatible, AB plasma is considered the universal plasma donor since it lacks anti-A and anti-B antibodies. O plasma should only be given to O recipients.

Contraindications for FFP

• Volume overload: In patients prone to fluid overload, such as those with heart failure or renal failure, FFP should be used cautiously as it can exacerbate fluid retention.
• Allergic reactions: Rarely, patients may develop allergic reactions, including anaphylaxis, to the plasma proteins present in FFP.
• Coagulopathy without active bleeding: FFP should not be used for correcting mildly abnormal clotting tests in the absence of active bleeding or high-risk invasive procedures.

Risks and Complications

• Allergic reactions: Ranging from mild urticaria to severe anaphylaxis.
• Transfusion-related acute lung injury (TRALI): A rare but serious complication that leads to acute respiratory distress, often within 6 hours of transfusion.
• Transfusion-associated circulatory overload (TACO): This occurs when the patient receives too much fluid, leading to heart failure and pulmonary edema.
• Infections: While rare due to rigorous screening, there remains a minimal risk of transmitting viral or bacterial infections through plasma transfusion.

References

• Transfusion Triggers for Platelets and Other Blood Products
• AABB Guidelines for Blood Transfusion
• Canadian Blood Services - FFP Use