Plasma Transfusion

Question 1

What is plasma

Answer 1

• Blood minus cells
  *Contains most clotting factors-
  -Decreased conc of 5,7,8 (due to degradation )and Fibrinogen (factor 1) due to dilution.

*Spontaneous haemorrhage rare if factors>25%of normal conc.

*Dose- 10-15ml/kg IBW

*5units of random donor platelets and 1unit of SDP contain 1unit of plasma(platelets suspended in plasma)

Question 2

Indications for Plasma transfusion

Give 6 indications

Answer 2

prophylactic FFP for correction of INR in non bleeding patients not recommended

1.Reversal of Warfarin induced coagulopathy
2.Part of MTP
3.Liver disease with active bleeding and evidence of coagulopathy
4.DIC with evidence of active bleeding
5. Plasmapheresis in TTP
6. Individual factor deficiencies

Question 3

Prothrombin complex concentrate (PCC)

Answer 3

*Concentrate of 3 or 4 vit K -dependent factors-2,7,9,10 hence more suitable for warfarin induced coagulopathy
*Less volume- no risk of fluid overload/TACO
*No need to thaw - quicker than FFP
Type or screen not required

Question 4

Adverse effects:

Answer 4

TRALI- more common after plasma transfusion
Rarely seen now as plasma is collected from nulliparous women of those with very few babies-reduces the variability in plasma proteins.

Haemolytic transfusion reactions - possible after transfusing plasma containing Anti A or Anti B antibodies.

TRIM- one study found 3 fold higher risk of infection in critically ill surgical patients who received plasma.