Transfusion medicine

Transfusion therapy

Plasma use



Topic Completed: 8 September 2021

Minor changes: 8 September 2021

Copyright: 2021, PathologyOutlines.com, Inc.

PubMed Search: Plasma use [TI]

Abdulaziz Al Mana, M.D. M.Sc.
Yamac Akgun, M.D.
Page views in 2020: 17
Page views in 2021 to date: 154
Cite this page: Al Mana A, Yan C, Akgun Y, Wu Y. Plasma use. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/transfusionmedplasma.html. Accessed December 3rd, 2021.
Definition / general
Essential features
Terminology

Product Postcollection temporary hold Frozen postcollection
FFP Within 8 hours
PF24 Refrigerated within 8 hours Within 24 hours
PF24RT24 Room temperature for up to 24 hours Within 24 hours

Post thaw 0 - 24 hours Post thaw 24 - 120 hours
FFP Thawed plasma
PF24 Thawed plasma
PF24RT24 Thawed plasma
Plasma, cryoprecipitate reduced Thawed plasma, cryoprecipitate reduced
Characteristics
  • All types of plasma should contain coagulation factors, natural anticoagulants and ADAMTS13 at acceptable levels but lower levels of heat labile Factors V and VIII can result if freezing of fresh plasma is delayed
  • All frozen plasma products should be infused immediately after thawing or refrigerated for up to 24 hours
    • After 24 hours, the product must be relabeled as thawed plasma and can be stored in the refrigerator for an additional 4 days
    • Thawed plasma has reduced levels of mainly Factors V, VII and VIII
  • PF24 and PF24RT24 are prepared when whole blood or plasma cannot be transported, processed and frozen in time after phlebotomy due to geographic or logistical constraints
    • Both have reduced levels of Factor VIII compared with FFP
    • PF24 also has reduced levels of protein C while PF24RT24 furthermore has reduced levels of Factor V and protein S
  • Plasma, cryoprecipitate reduced is deficient in fibrinogen, Factor VIII, Factor XIII and von Willebrand factor (vWF) due to removal of the cryoprecipitate
  • Liquid plasma has variable levels of coagulation factors and other proteins
  • Reference: AABB: Circular of Information for the Use of Human Blood and Blood Components [Accessed 2 June 2021]

Product Compared with FFP, reduced levels of
PF24 Factor VIII and protein C
PF24RT24 Factors V and VIII and protein S
Thawed plasma Factors V, VII and VIII
Liquid plasma Variable; depends upon storage condition

Product Shelf life
FFP 12 months frozen
7 years at -65 °C (with FDA approval)
Thawed plasma 4 days after the initial 24 hour post thaw period
Liquid plasma 26 days (from anticoagulant citrate dextrose (ACD) / citrate phosphate
dextrose (CPD) or citrate phosphate double dextrose (CP2D) whole blood units)
40 days (from citrate phosphate dextrose adenine (CPDA-1) whole blood units)
Pathophysiology
  • Transfusion reactions that are strongly associated with plasma transfusion include allergic / anaphylactic reactions, transfusion related acute lung injury (TRALI) and transfusion associated circulatory overload (TACO); although less common, other types of transfusion reaction may occur (Transfusion 2012;52:65S, Blood 2019;133:1840)
  • TRALI is one of the leading causes of transfusion related mortality
    • Characterized by acute hypoxemia and noncardiogenic pulmonary edema occurring within 6 hours of transfusion
    • Most patients recover within 96 hours with respiratory support
    • Higher risk from plasma containing blood products due to the presence of antibodies against human leukocyte antigens (HLA) or human neutrophil antigens (HNA)
    • Current mitigation strategies to minimize the exposure risk to HLA alloantibodies include collection from men, never pregnant women or parous women who test negative for HLA antibodies
  • Transfusion associated circulatory overload (TACO) has a similar presentation and should be included in the differential diagnosis for TRALI
    • TACO is typically involved with large volume plasma transfusions in susceptible individuals with evidence of cardiogenic pulmonary edema and volume overload (increased brain natriuretic peptide [BNP] or N terminal pro B type natriuretic peptide [NT proBNP])
  • References: Cohn: Technical Manual, 20th Edition, 2020, Hematology Am Soc Hematol Educ Program 2018;2018:585
Clinical features
Blood donor screening
Blood donor testing
Treatment
  • Actively bleeding patients with multiple coagulation factor deficiencies / defects
  • Rapid vitamin K antagonist reversal in cases of Coumadin (warfarin) overdose, that results in bleeding or in patient undergoing an invasive procedure requiring prompt coagulation factor replacement when factor concentrates, such as 4 factor prothrombin complex concentrates, are not available or contraindicated
  • During massive transfusions associated with significant coagulation factor deficiencies / defects
  • Specific plasma protein factor deficiencies / defects, either congenital or acquired, when licensed factor concentrate is not available
  • Transfusion or replacement fluid for therapeutic plasma exchange (TPE) in patients with TTP (first line treatment) or in conjunction with albumin as replacement fluid in patients with underlying coagulopathy, requiring therapeutic plasma exchange for other indications
  • Perioperative management of coagulopathy (see note below)
  • Dosing: typical dose of plasma is around 10 - 15 mL/kg
  • Hemostasis is usually achieved when the coagulation factor activity is at least 25 - 30% of normal
  • Infusion: infusion rates depend on the volume load that can be tolerated by the patient
  • Suggested rates:
    • Healthy individual: 2 - 4 mL/kg per hour
    • Individual with volume overload or heart failure: 1 mL/kg per hour or less
  • Note: other approaches should be explored whenever possible before transfusing with plasma to avoid the risks of an adverse event, which includes various types of blood product related transfusion reaction, transfusion transmitted infections, etc.
  • References: AABB: Circular of Information for the Use of Human Blood and Blood Components [Accessed 2 June 2021], Cohn: Technical Manual, 20th Edition, 2020
Sample assessment & plan
  • Assessment: 37 year old female with prior history of chronic relapsing thrombotic thrombocytopenic purpura (TTP) treated with multiple FFP transfusions / plasma exchanges. She presented to the emergency room directly from hematology clinic due to an acute drop in platelet count (28 x 10³/mcL), with undetectable ADAMTS 13 activity and elevated inhibitor level indicating relapsed TTP. The patient had history of bruises with prior episodes but currently denies bleeding, fever or neurological symptoms.
  • Plan: The patient will start daily plasma exchange sessions using plasma as replacement fluid (1 - 1.5 plasma volume) until platelet counts recover (> 150 x 10³/mcL) and lactate dehydrogenase (LDH) is near normal for 2 - 3 consecutive days. An order for stat central venous catheter placement is placed. The patient will be premedicated with diphenhydramine before starting the procedure. Please report any transfusion reaction to blood bank.
  • Reference: J Clin Apher 2019;34:171
Board review style question #1
Which of the following is a correct statement?

  1. Fresh frozen plasma (FFP) has a shelf life of 5 days
  2. Liquid plasma has a shelf life of 26 days if derived from citrate phosphate double dextrose (CP2D) whole blood
  3. Plasma frozen within 24 hours after phlebotomy (PF24) has a shelf life of 24 hours
  4. Thawed plasma has a shelf life of 3 days
Board review style answer #1
B. Liquid plasma has a shelf life of 26 days if derived from citrate phosphate double dextrose (CP2D) whole blood

Comment Here

Reference: Plasma use
Board review style question #2
Which of the following is a correct statement?

  1. Group A plasma may be given to any patients during a bleeding emergency
  2. Group A plasma should never be given to a group AB patient
  3. Group O plasma is the universal plasma
  4. Liquid plasma should not be used for bleeding emergency, as it has decreased levels of Factor V and VIII
Board review style answer #2
A. Group A plasma may be given to any patients during a bleeding emergency

Comment Here

Reference: Plasma use
Back to top
Image 01 Image 02