Fresh Frozen Plasma (FFP) Collection, Preparation and Uses

Fresh snappy plasm (FFP) Collection, Preparation and UsesSamuel GoodFresh Frozen Plasma understructureFresh Frozen Plasma (FFP) is the name for the liquid portion of gentle line of reasoning, which has been set and preserved. It is returnn by breed donation and is sto sanguine until needed for blood blood transfusion.FFP has been uncommitted since 1941 (Hoffman, et al, 1990), it was utilize initially as a script expander (Erber, et al, 2006), secure is now aimd for the management and prevention of expel in coagulopathic patients (Ho, et al, 2005).The name FFP is confusing as the blood blood blood germ plasm provide non be frozen as healthy as clear at the same eon. What the term implies is that the plasma was frozen rapidly after it was taken and on that pointfore bed be considered fresh.The plasma, from a transfusion aspect, contains essential destinys such as fibrinogen, albumin, globulin and clotting divisors. These allow for precise undivided compone nts to be transferred to a recipient who is in need.The most cost- trenchant and effective way to make optimum use of blood which has been donated, is to let on it into its individual components. This process allows for a wider availability of blood products (Spence, et al, 2006) and in addition reduces the hazard patients ar exposed to transfusion-related ventures (Erber, et al, 2006).The use of FFP and its individual products has increased tenfold since its starting time introduction (Hoffman, et al, 1990). One reason for this may be the declining availability of unanimous blood be bowel movement of the trend to use component therapy (Spence, et al, 2006).Collection and StorageWhen a donor gives a unit of intact blood, the blood is then unconnected into several components positions. These include packed red blood cells (p red blood cell), platelets and FFP. If required the FFP foundation be further divided into cryoprecipitate and whatsoeverthing called cryo-poor pla sma. Cryo-poor plasma is r arly utilize as a healthful response (Lauzier, et al, 2007).As mentioned previously, plasma is the non-cellular, liquid part of the blood. It is made up of water system, electrolytes and proteins. The proteins include the clotting computes and intrinsic coagulants (Murray, et al, 1995).The plasma is isolated from the blood after donation and then frozen. For the plasma to be considered fresh it mustiness be frozen at heart eight hours of collection (Murray, et al, 1995) and stored at a temperature of negative 18 degrees centigrade or lower. If this fails to happen, the product is known just as frozen plasma, which like cryo-poor plasma, is rarely used for therapeutic means. However, to maintain curdling factors to optimum levels the plasma should be stored at electronegative 30 degrees centigrade (Lauzier, et al, 2007).FFP tummy be vigilant by separation from whole blood or via plasmapheresis. Plasmapheresis is the name given to a broad range of procedures where extracorporeal separation of blood components (Erber, et al, 2006) results in a plasma which is filtered.PreparationTo summarise, FFP is cool in citrate-containing anticoagulant solution, frozen within 8 hours and stored at minus 30 degrees centigrade for up to a year.Although e precise protection is taken to reassure sterility, it is quite possible for the donor to incur an asymptomatic bacteraemia at the time of donation (Stanworth, et al, 2004). The bacteria give break its proliferation down-regulated by the plasma existence frozen. However, FFP tail st charge some generation transmit infectious diseases. Therefore, screening and pathogen defusing may be performed to reduce the risk.FFP contains no RBCs and also no white corpuscles. As there are no WBCs the plasma is referred to be as being leucodepleted. This is an indication as to why FFP lot transmit said diseases. As mentioned pathogen in activating lowlife be performed and this is done by using e ither Methylene puritanic or a response/detergent process.The Methylene Blue techniqueMethylene blue is a dye that has been shown to be very effective in the inactivation of pathogens. It binds to nucleic acids and, on illumination with white light, singlet atomic number 8 is formed. This then destroys viral DNA and RNA, therefore viral replication cannot take place.Solvent/Detergent TechniqueThis technique is used for the preparation of factors eighter from Decatur and ix as well as immunoglobulins. First, a solvent is added to the plasma which removes the lipid viral envelope. After this is complete, a detergent is added which inactivates the viral contents. The solvent and detergent are then removed by a physical separation technique, in which they are dissolved in oil. Column chromatography can then be used to isolate factors viii and ix.Once every treatment that is required is complete, the FFP is ready for use. It is an accepted practice that FFP is thawed forrader use (Ho, et al, 2005). The required units of FFP are placed in a water bath set at 30 37 degrees centigrade for approximately 20 30 minutes.Von Heyman, et al investigated the effects of 2 different thawing machines and rivulet warm water of 43 degrees centigrade, on the activity of clotting factors, inhibitors and activation markers in FFP. They discovered no significant differences in the activity of curdling markers over a 6 hour period post thawing. However, a major conclusion found was that, if FFP is immediately transfused after thawing, the product remained affluent in clotting factors. Also, if the plasma is left, the activity of said clotting factors mitigate gradually and therefore FFP should still be maintained at way of life temperature for up to 4 hours.If thawed FFP is not used within 24 hours it becomes a separate product known as thawed plasma (Murray, et al, 1995). Most clotting factors are stable in thawed plasma, merely some labile factors, such as v and viii are not. Their degradation actually accelerates whilst the plasma is in a liquid evoke (Lauzier, et al, 2007).The only main advantage of having thawed plasma readily available, is that it can be transfused rapidly if a severely injured patient requires it.FFP livestock Type SpecificIt is widely accepted that O negative is the cosmopolitan donor for pRBCs, withal for FFP this isnt the crusade. A and B antigens of the blood are located on the red cells themselves. Type O individuals are gratis(p) of these proteins on their red blood cells.Plasma does not contain RBCs, barely it contains antibodies to the corresponding absent protein. An example of this isType A individual has Anti-B antibodies in their blood.Type O plasma has both Anti-A and Anti-B antibodies and is incompatible with close 55 percent of the population.An individual with part AB blood has neither Anti-A nor Anti-B antibodies.This makes the AB plasma ideal for universal use when the blood type of the patient is unknown.The Rh status is irrelevant because any plasma with Anti-D is undo at the manufacturing stage.Recipient bloodAcceptable blood groups of donor plasmaOO,A,B,ABAA,ABBB,ABABABThe major enigma with blood type AB is that the percentage of the population which has it is only 4 percent. Therefore it is better to use FFP which is blood type compatible, which will be determined at the blood bank.UsageThere are very few actual specific needs for the use of FFP (Spence, et al, 2006). Usually FFP is used to treat deficiencies of coagulation proteins where specific factor concentrates are unavailable (Hoffman, et al, 1990). clotting deficiencies can occur in a variety of different clinical situations. These include massive blood expiry, surgery, and infection or acquired multiple coagulation factor deficiencies.Examples of FFP usageReplacement of isolated factor deficiencies regress of warfarin effects broad blood transfusionAntithrombin III deficiency sermon of immunodeficiencyTreatm ent of thrombotic thrombocytopenic purpuraTreatment of Disseminated intravascular coagulationReplacement of isolated factor deficiencyFFP can be used to heat deficiencies of factors II, V, VII, IX, X and XI. It is only chosen as a treatment when no specific component therapy is available. Certain factors require a different haemostatic level, for example severe factor X deficiency only requires a factor level of ab surface 10 percent. Therefore FFP has a range of success when treating factor deficiencies.Reversal of Warfarin effectIf a patient is being treated with Warfarin, they attain been shown to be deficient in functional vitamin K dependent coagulation factors II, VII, IX and X (Spence, et al, 2006). Usually vitamin K will be administered, however anticoagulated patients will be actively exhaust, and therefore FFP can be used.Massive blood transfusionThe use of FFP as a treatment on massive blood transfusion has increased over the decades. Massive bleeding is defined as the loss of one blood volume within 24 hours or as 50 percent blood loss within 3 hours or a bleeding rate of cl ml/minute (Lauzier, et al, 2007). It is indicated for use in patients who have documented blood clotting abnormalities after large blood loss and who are in need of urgent treatment. This is due to the fact that in most indispensableness situations it is unacceptable to wait hours for lab results to be returned.Antithrombin III deficiencyFFP is sometimes used as a source of Antithrombin III in peck who are deficient of this inhibitor. Especially if the patients are undergoing surgery or who use Heparin to treat thrombosis.Treatment of ImmunodeficiencyFFP has been used in children and adults with a humoral immunodeficiency as a source of immunoglobulin. It is also sometimes used for infants when maternal nutrition is lacking, and they are suffering with severe protein losing enteropathy (Erber, et al, 2006).Treatment of thrombotic thrombocytopenic purpuraThe treatment reco mmended for this condition is a daily plasma exchange (Murray, et al, 1995). Prompt interpolation is indicated if development of neurological abnormalities start to appear. This plasma exchange usually continues for at least 2 days after remission (Ho, et al, 2005).Treatment of Disseminated intravascular coagulationDisseminated intravascular coagulation (DIC) is a syndrome where the control of the coagulation system becomes disturbed and out of control. This is usually due to pro-coagulants being dispersed into circulation (Stanworth, et al, 2004). Most of the time this happens substitute(prenominal) to a disease or disorder, such as cancer. In the figurehead of DIC, fibrinogen, platelets and coagulation factors V and VIII become rapidly depleted. FFP is given as treatment to prevent further problems or progression. Treatment usually involves a patient being infused with a single line of FFP and then coagulation tests performed to assess the clinical benefit (Stanworth, et al, 20 04).There are also some conditional uses where FFP can be used but is not the first off choice treatment, such as liver disease and Paediatric use. If patients have an abnormal coagulation profile and are suffering from liver disease, they can be treated with FFP. There is varying success and treatment must be monitored by regular transfusion coagulation tests.Clotting times of infants have been shown to be longer than that of adults (Murray, et al, 1995), and even longer in unseasonable babies (OShaughnessy, et al, 2004). Vitamin K deficiency is the most common cause of neonatal bleeding (Murray, et al, 1995). FFP can be used to counter the effects if required. In the case of babies suffering from haemorrhagic disease of the newborn, FFP can be used as treatment. But only if the chance of bleeding is greater than the risk of injurious reactions to the treatment with FFP (Lauzier, et al, 2007).RisksAs with any transfusion there is a risk of infection, the main risks identified in cludeDisease transmissionExcessive intravascular volumeAnaphylactoid reactionsAlloimmunisationTransfusion related acute lung injuryThe risks associated with viral infectivity of FFP are kindred to that of whole blood and RBCs. As mentioned earlier this risk can be countered by photochemically treating the plasma.Allergic reactions that occur in response to FFP transfusion vary in severity from hives to fatal non-cardiac pulmonary hydrops (Stanworth, et al, 2004). Transfusion relate acute lung injury (TRALI) is defined as a new episode of acute lung injury within 6 hours of compound therapy (OShaughnessy, et al, 2004). It manifests as severe respiratory problems, including hypoxia and other symptoms linked to pulmonary oedema. Symptoms will usually subside 2 days after ceasing FFP treatment (Stanworth, et al, 2004).Alloimmunisation can occur if Anti-Rh antibodies are formed after treatment with FFP. To counter this, plasma containing Anti-D antibodies should not be given to an RhD -positive recipient. There has also been reported incidences of post-transfusion Hepatitis, and depends on a number factors, including donor selection. Also with any intravenously transfused fluid, there is a chance of hypervolemia which could lead to cardiac failure, therefore institution of FFP should not be given in excessive doses.Below is a suggested dosage breakdownVolume of 1 whole Plasma 200-250 mL 1 mL plasma contains 1 u coagulation factors 1 Unit contains 220 u coagulation factors Factor recovery with transfusion = 40% 1 Unit provides 80 u coagulation factors 70 kg X .05 = plasma volume of 35 dL (3.5 L) 80 u = 2.3 u/dL = 2.3% (of normal 100 u/dL) 35 dLIn a 70 kg Patient 1 Unit Plasma increases most factors 2.5% 4 Units Plasma increase most factors 10%Figures taken from (http//reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499)ConclusionIn conclusion, FFP can be used as an effective treatment for a number of different clinical issues. It also does not com e without risk and therefore FFP should be collected, stored, prepared and used in an efficient and safe manner. Below I have summarised the administration of FFP.FFP (Fresh Frozen Plasma) Volume 240-300ml (mean 273ml)Storage designated temperature controlled freezer. Core temperature -30 o CShelf life 24 months (frozen)Must be ABO compatible, but Rh is not necessary to be considered for transfusion and no anti D prophylaxis is required if Rh-D negative patients receive Rh-D positive FFP.Prior to the transfusion FFP must be thawed under controlled conditions using specifically intentional equipment. Thawing usually takes approximately 15-30 minutesOnce thawed, FFP must not be re-frozen and should be transfused as quickly as possible. Post-thaw storage results in a decline in the quality of coagulation factors.If stored at 4 degrees centigrade post thawing (in a designated temperature controlled refrigerator), the transfusion must be finished within 24 hours of thawing.Pooled solve nt-detergent treated plasma is also commercially availableDose typically 10-15ml/kg. This dose may need to be exceeded in massive haemorrhage depending on the clinical situation and its monitoring (BCSH 2004) representative infusion rate 10-20ml/kg/hr (approximately 30 minutes per unit) rapid infusion may be appropriate when given to replace coagulation factors during major haemorrhage. There is anecdotal evidence that acute reactions may be more common with faster administration rates.(http//reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499)REFERENCESErber WN, Perry DJ Plasma and plasma products in the treatment of massive hemorrhage. Best Pract Res Clin Haematol 2006, 1997-112Hewson JR, Neame PB, Kumar N, Ayrton A, Gregor P, Davis C, Shragge BW. Coagulopathy related to dilution and hypotension during massive transfusion. Crit Care Med. 198513(5)387-391.Ho AM, Karmakar MK, Dion PW. Are we giving seemly coagulation factors during major trauma resuscitation? Am J S urg. 2005190(3)479-484.Hoffman M, Jenner P. Variability in fibrinogen and Von Willebrand factor content of cryoprecipitate.Brief Sci Rep. 199093(5)694-697.Lauzier F, Cook D, Griffith L, Upton J, Crowther M Fresh frozen plasma transfusion in critically ill patients. Crit Care Med 2007, 351655-1659.Leslie SD, Toy PT. Laboratory hemostatic abnormalities in massively transfused patients given red blood cells and crystalloid. Am J Clin Pathol. 199196(6)770-773.Murray DJ, Olson J, Strauss R, Tinker JH. clotting changes during packed red cell replacement of major blood loss. Anesthesiology. 198869(6)839-845Murray DJ, Pennell BJ, Weinstein SL, Olson JD.Packed red cells in acute blood loss dilutional coagulopathy as a cause of surgical bleeding. Anesth Analg. 199580(2)336-342.OShaughnessy DF, Atterbury C, Bolton Maggs P, stump spud M, Thomas D, Yates S, Williamson LM, British Committee for Standards in Haematology, phone line Transfusion Task Force Guidelines for the use of fresh-frozen p lasma, cryoprecipitate and cryosupernatant. Br J Haematol 2004, 12611-28.Spence RK clinical use of plasma and plasma fractions. Best Pract Res Clin Haematol 2006, 1983-96.Stanworth SJ, Brunskill SJ, Hyde CJ, McClelland DB, Murphy MF Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol 2004, 126139-152Tieu BH, Holcomb JB, Schreiber MA. Coagulopathyits pathophysiology and treatment in the injured patient. World J Surg. 200731(5)1055-1065http//en.wikipedia.org/wiki/Fresh_frozen_plasmahttp//www.psbc.org/therapy/ffp.htmhttp//reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499http//ccforum.com/content/14/1/202