140 Using Plasma and Plasma Component Therapy Flashcards
Types of plasma products:
- Frozen plasma (FFP)
- 24-hour plasma (FP240
- Thawed plasma
- Liquid plasma
- Solvent/ detergent–treated plasma
- Pathogen-reduced plasma
As per the FDA, except for liquid plasma and plasma cryoprecipitate–reduced, these products are all therapeutically equivalent
Ways of plasma collection:
- Apheresis
- Manufactured from whole blood collections
To prepare frozen plasma for transfusion, the frozen product requires thawing at:
30–37 °C
Requires 20 to 30 minutes
After thawing, plasma is routinely stored at______ and transfused within ____ hours
1–6 °C
24 hours
Plasma that is not used within 24 hours can be relabeled as thawed plasma and stored for an additional 4 days at 1–6 °C.
Factor VIII activity will decrease about 50% at 5 days, the activity of factor V and factor VII decreases to approximately 20%, with the other factors remaining relatively stable.
TRUE OR FALSE
Plasma is not indicated if specific clotting factor concentrates, human or recombinant, are available.
TRUE
Plasma is not indicated if specific clotting factor concentrates, human or recombinant, are available.
They provide smaller volumes and are pathogen inactivated, improving their safety profile
TRUE OR FALSE
Plasma products can be ABO incompatible with the patient.
FALSE
Plasma products should be ABO compatible with the patient.
- Because of the negligible number of RBCs, plasma units do not need to be matched for RhD
- Frozen plasma does not need to be leukoreduced or irradiated.
During emergency situations type _____ can be transfused
AB
*A
Absence of anti-A and anti-B antibodies
Only 4% of the population is group AB, whereas 40% are group A
Defined as plasma that is frozen within eight hours of collection and stored at –18 °C or colder
Fresh frozen plasma
Defined as plasma frozen within 24 hours after collection but is stored at 1–6 °C within 8 hours of collection
FP24
Labeled as plasma frozen within 24 hours after phlebotomy
Product remaining after cryoprecipitate is removed from FFP
Plasma cryoprecipitate–reduced
Because factor VII, factor XIII, von Willebrand factor, and fibronectin are removed as cryoprecipitate, the product has adequate albumin; ADAMTS13; and factors II, V, VII, IX, X, and XI
The primary indication for plasma cryoprecipitate–reduced
Plasma exchange in patients with thrombotic thrombocytopenic purpura (TTP)
Made from whole blood and must be separated and infused no later than 5 days after the whole-blood expiration date and should be stored at 1–6 °C.
Liquid plasma
- Contains viable leukocytes so would need product modifications (leukoreduction or irradiation) before transfusion in at-risk individuals (eg, immunocompromised)
The only indication for liquid plasma
Initial treatment of patients undergoing massive transfusion as a result of massive hemorrhage
Methods of pathogen reduction
Occurs post manufacturing to reduce the risk of transfusion-transmitted infections and transfusion-associated graft-versus-host disease
Photochemical reductions include:
* Amotosalen (INTERCEPT Blood System, Cerus)
* Methylene blue (Theraflex, Macropharma)
* Riboflavin (Mirasol Pathogen Reduction Technology System, TerumoBCT)
Function by adding a photosensitizer followed by ultraviolet (UV) or visible light, and subsequent removal (except for Mirasol)
Only amotosalen with UV light is FDA approved.
With pathogen reduction, coagulation factor levels are decreased 30% to 40%, specifically:
FVIII, fibrinogen, and FXI
But may also include anticoagulant factors as well and reduce enveloped viruses
However, the ability to reduce nonenveloped viruses (eg, parvovirus B19, hepatitis E virus, hepatitis A virus) are variable.
Human pooled plasma that has been solvent-detergent treated
Solvent/detergent–treated plasma
Has not been associated with TRALI and is associated with fewer allergic reactions, febrile nonhemolytic transfusion reactions, transfusion-associated circulatory overload (TACO), and hypotensive reaction
Plasma use to reverse vitamin K antagonists in patients has largely been replaced by
Prothrombin complex concentrate
In addition to vitamin K
Although evidence is lacking, plasma is commonly administered in bleeding patients based on laboratory coagulation tests when the prothrombin time (PT) or INR is greater than
Prothrombin time (PT) or INR is greater than 1.5 times normal
Dose of plasma replacement
10 to 15 mL/kg of plasma
Achieve a minimum of 30% of plasma factor levels
Definition of massive transfusion
More than or equal to 10 RBCs within a 24-hour period (or one blood volume)
Trials on massive transfusion
Prospective Observational Multicenter Major Trauma Transfusion study Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial
No difference in the effectiveness and safety of a 1:1:1 transfusion ratio with a 1:1:2 transfusion ratio
Patients who received more plasma (1:1:1 ratio) achieved hemostasis more frequently.
Replaced TRALI as the most frequent transfusion-associated cause of morbidity and mortality
TACO
Used for fibrinogen repletion
Cryoprecipitate
Content of cryoprecipitate
Factor VIII, fibrinogen, fibronectin, factor XIII, and von Willebrand factor
Fibrinogen content in cryoprecipitate
3–8 g/L (5.6 ± 1.7 g/L mean concentration)
200 ± 58 mg/unit
10 cryoprecipitate units contains _______ grams of fibrinogen, raising the plasma fibrinogen levels by approximately ____________
2–2.5 grams of fibrinogen
100 mg/dL (1 g/L)
Expiration of cryopreciptate using closed system
6 hours
Expiration of cryopreciptate using open system
4 hours
TRUE OR FALSE
Cryoprecipitate units do not need to be ABO or RhD compatible; a possible exception is in neonates for which some ABO-compatible products can be provided.
TRUE
Cryoprecipitate units do not need to be ABO or RhD compatible; a possible exception is in neonates for which some ABO-compatible products can be provided.
Cryoprecipitate does not need to be leukoreduced or irradiated.
Recommendations for fibrinogen repletion/cryoprecipitate
- Major bleeding is accompanied by hypofibrinogenemia, determined by either viscoelastic testing (eg, FIBTEM)
- Fibrinogen less than or equal to 150 mg/dL (1.5 g/L)
Recommended fibrinogen dose in trauma
3–4 grams
15 to 20 units of cryoprecipitate or 3–4 grams of fibrinogen concentrate
The most common risk for cryoprecipitate transfusion
Allergic reaction
