FFP and cryoprecitate

Question 1

What are the different types of FFP?

Answer 1

Standard FFP for adults and solvent detergent treated FFP called Octaplas (mainly used for plasma exchange in TTP and HUS).

Question 2

What are some indications for the use of FFP?

Answer 2

No use in patients who aren’t actively bleeding

• inherited coagulation factor deficiency, where no suitable factor concentrate is available eg. Factor V deficiency
• acute DIC with active bleeding
• TTP (use solvent detergent FFP)
• major haemorrhage
• prophylaxis before surgery/invasive procedure if abnormal coagulation test results and one or more additional risk factors for bleeding:
  
  • personal or family history of abnormal bleeding
  • procedure associated with major blood loss
  • procedure involves critical tissues such as eye, brain or spinal cord
  • concurrent thrombocytopenia

Question 3

What are the risks of a FFP transfusion?

Answer 3

Anaphylaxis, transfusion associated acute lung injury (TRALI), haemolysis from transfused antibodies, especially A and B.

Question 4

What are the benefits of a FFP transfusion?

Answer 4

Prevent life threatening bleeding.

Question 5

What are some contraindications to FFP being used?

Answer 5

• as a plasma expander to correct hypovolaemia
• for the reversal of warfarin anticoagulation, use of vitamin K and PCC
• to non-bleeding patients with liver disease
• to critically ill patients with prolonged PT or APTT in the absence of bleeding
• for patients with liver disease

Question 6

What is the universal donor of FFP?

Answer 6

AB blood because it lacks any anti A or anti B antibodies.

Question 7

What are the indications for Cryoprecipitate (CP)?

Answer 7

• prophylaxis before surgery or other invasive procedure associated with significant bleeding risk in patients with fibrinogen level <1g/l
• DIC with bleeding and fibrinogen less than 1g/l
• major haemorrhage and fibrinogen level less than 1.5g/l
• major obstetric haemorrhage and fibrinogen level less than 2g/l

Question 8

What is CP rich in?

Answer 8

Fibrinogen

Question 9

What are some other plasma derivatives also used for blood transfusions?

Answer 9

• albumin solutions
• fibrinogen concentrate
• prothrombin complex concentrate (PCC)
• IV IgG

Question 10

What is PCC?

Answer 10

• prothrombin complex concentrate
• a freeze-dried concentrate of 3 or 4 inactivated clotting factors (II, IX and X or II, VII, IX, X) and protein S and C anticoagulant factors

Question 11

What is the use of PCC?

Answer 11

Immediate reversal of warfarin in acute bleeding.

Question 12

How soon should FFP and CP be transfused?

Answer 12

As soon as possible and must be completed within 4 hours of removal from TCS (temperature controlled storage)