Fresh Frozen Plasma

Fresh-frozen plasma (FFP) is plasma that is obtained after the separation of whole blood donations into its plasma and cellular (RBCs and platelets) components. Frozen within 6 h of the collection, FFP is stored at -18°C for up to 1 year. Each bag of FFP contains 200 to 250 mL and, by definition, contains 1 unit of each coagulation factor per milliliter of FFP and 1 to 2 mg of fibrinogen per milliliter of FFP. Transfused FFP should be ABO-compatible. The desired dose to be transfused can be estimated from the plasma volume and the desired incremental increase in factor activity. A typical starting dose is 8 to 10 mL/kg, or approximately two to four bags of FFP. After infusion, the patient should be reevaluated for clinical bleeding and posttransfusion coagulation studies obtained.

The indications for transfusion of FFP are as follows:

1. The presence of a coagulopathy due to acquired factor(s) deficiency with active bleeding or prior to invasive procedures; the patient should have significant (1.5*) prolongation of the prothrombin time (PI) and/or activated partial thromboplastin time (aPTT), or a specific coagulation factor assay less than 25 percent of normal; patients in this category include those with liver disease, DIC, and those taking warfarin.

2. Patients with congenital isolated factor deficiencies when specific virally safe replacement products are not available (see below); those with isolated deficiencies of fibrinogen, factor VIII, or factor XIII are probably better treated with cryoprecipitate.

3. Patients with thrombotic thrombocytopenic purpura (IIP) in the process of plasma exchange (see Chap...214).

4. Some patients who receive massive transfusion and have evidence of a coagulopathy and active bleeding (see below).

5. Patients with antithrombin III deficiency when antithrombin III concentrates are not available.

FFP is not indicated for patients who require volume expansion. Cryoprecipitate

Cryoprecipitate is the cold precipitable protein fraction derived from FFP thawed at 1° to 6°C; it can be stored frozen for up to 1 year. The contents of a bag of cryoprecipitate are outlined in Tabje.215-1. The typical dose of cryoprecipitate given is two to four bags per 10 kg—usually 10 to 20 bags at a time. When given in large volumes, it is preferable to use ABO-compatible cryoprecipitate.

The indications for transfusion of cryoprecipitate are as follows. Keep in mind that it should not be used to treat hemophilia unless virally safe (recombinant or monoclonal-antibody purified) factors are not available and the patient has an immediately life-threatening bleed (see Chap 212).

1. For patients with hypofibrinogenemia. In patients with congenital deficiency of fibrinogen or those with consumptive coagulopathy such as DIC, transfusion is indicated when the fibrinogen level is less than 100 mg/dL.

2. For patients with von Willebrand disease and active bleeding, cryoprecipitate should only be used when desmopressin (DDAVP) is not available or does not work and factor VIII concentrates containing von Willebrand factor are not available.

3. For patients with hemophilia A, only when virally inactivated factor VIII concentrates are not available.

4. For use as fibrin glue surgical adhesives.

5. For fibronectin replacement, which may be beneficial to promote healing in patients with trauma, severe burns, or sepsis.

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