Clinical use of plasma components
- Arthur J Silvergleid, MD
Arthur J Silvergleid, MD
- Section Editor — Transfusion Medicine
- Affiliate Associate Professor, Department of Pathology and Cell Biology
- University of South Florida, College of Medicine
- Medical Director, OneBlood, Inc.
Products prepared from human plasma can be lifesaving in some conditions (eg, trauma, massive transfusion, disseminated intravascular coagulation [DIC], bleeding associated with vitamin K antagonist anticoagulation). At the same time, plasma products carry infectious and other risks. Thus, it is important to use the appropriate plasma product in the appropriate clinical setting.
This topic review will discuss available plasma products, indications and dosing for these products, and potential complications of plasma transfusion.
The use of Cryoprecipitate and plasma derivatives such as prothrombin complex concentrates (PCCs) and individual coagulation factor concentrates are discussed in separate topic reviews.
●Cryoprecipitate – (See "Clinical use of Cryoprecipitate".)
●PCCs – (See "Plasma derivatives and recombinant DNA-produced coagulation factors", section on 'Coagulation factors' and "Management of warfarin-associated bleeding or supratherapeutic INR" and "Reversal of anticoagulation in warfarin-associated intracerebral hemorrhage".)
- Dumont LJ, Cancelas JA, Maes LA, et al. The bioequivalence of frozen plasma prepared from whole blood held overnight at room temperature compared to fresh-frozen plasma prepared within eight hours of collection. Transfusion 2015; 55:476.
- Consensus conference. Fresh-frozen plasma. Indications and risks. JAMA 1985; 253:551.
- Dzik W, Rao A. Why do physicians request fresh frozen plasma? Transfusion 2004; 44:1393.
- Van Aken WG. The Collection and Use of Human Blood and Plasma in Europe, Council of Europe Press, Strasbourg 1992.
- Palo R, Capraro L, Hovilehto S, et al. Population-based audit of fresh-frozen plasma transfusion practices. Transfusion 2006; 46:1921.
- Stanworth SJ, Walsh TS, Prescott RJ, et al. A national study of plasma use in critical care: clinical indications, dose and effect on prothrombin time. Crit Care 2011; 15:R108.
- Lauzier F, Cook D, Griffith L, et al. Fresh frozen plasma transfusion in critically ill patients. Crit Care Med 2007; 35:1655.
- Roback JD, Caldwell S, Carson J, et al. Evidence-based practice guidelines for plasma transfusion. Transfusion 2010; 50:1227.
- Tavares M, DiQuattro P, Nolette N, et al. Reduction in plasma transfusion after enforcement of transfusion guidelines. Transfusion 2011; 51:754.
- Sarode R, Refaai MA, Matevosyan K, et al. Prospective monitoring of plasma and platelet transfusions in a large teaching hospital results in significant cost reduction. Transfusion 2010; 50:487.
- Scott E, Puca K, Heraly J, et al. Evaluation and comparison of coagulation factor activity in fresh-frozen plasma and 24-hour plasma at thaw and after 120 hours of 1 to 6°C storage. Transfusion 2009; 49:1584.
- Alhumaidan H, Cheves T, Holme S, Sweeney J. Stability of coagulation factors in plasma prepared after a 24-hour room temperature hold. Transfusion 2010; 50:1934.
- Cardigan R, Van der Meer PF, Pergande C, et al. Coagulation factor content of plasma produced from whole blood stored for 24 hours at ambient temperature: results from an international multicenter BEST Collaborative study. Transfusion 2011; 51 Suppl 1:50S.
- Yazer MH, Cortese-Hassett A, Triulzi DJ. Coagulation factor levels in plasma frozen within 24 hours of phlebotomy over 5 days of storage at 1 to 6 degrees C. Transfusion 2008; 48:2525.
- Cardigan R, Lawrie AS, Mackie IJ, Williamson LM. The quality of fresh-frozen plasma produced from whole blood stored at 4 degrees C overnight. Transfusion 2005; 45:1342.
- Katz LM, Kiss JE. Plasma for transfusion in the era of transfusion-related acute lung injury mitigation. Transfusion 2008; 48:393.
- Klein HG. Standards for Blood Banks and Transfusion Services, 17th ed, AABB, Bethesda 1996.
- Downes KA, Wilson E, Yomtovian R, Sarode R. Serial measurement of clotting factors in thawed plasma stored for 5 days. Transfusion 2001; 41:570.
- O'Neill EM, Rowley J, Hansson-Wicher M, et al. Effect of 24-hour whole-blood storage on plasma clotting factors. Transfusion 1999; 39:488.
- Smak Gregoor PJ, Harvey MS, Briët E, Brand A. Coagulation parameters of CPD fresh-frozen plasma and CPD cryoprecipitate-poor plasma after storage at 4 degrees C for 28 days. Transfusion 1993; 33:735.
- von Heymann C, Keller MK, Spies C, et al. Activity of clotting factors in fresh-frozen plasma during storage at 4 degrees C over 6 days. Transfusion 2009; 49:913.
- Sheffield WP, Bhakta V, Mastronardi C, et al. Changes in coagulation factor activity and content of di(2-ethylhexyl)phthalate in frozen plasma units during refrigerated storage for up to five days after thawing. Transfusion 2012; 52:493.
- Wehrli G, Taylor NE, Haines AL, et al. Instituting a thawed plasma procedure: it just makes sense and saves cents. Transfusion 2009; 49:2625.
- Biesert L, Suhartono H. Solvent/detergent treatment of human plasma--a very robust method for virus inactivation. Validated virus safety of OCTAPLAS. Vox Sang 1998; 74 Suppl 1:207.
- Inbal A, Epstein O, Blickstein D, et al. Evaluation of solvent/detergent treated plasma in the management of patients with hereditary and acquired coagulation disorders. Blood Coagul Fibrinolysis 1993; 4:599.
- Pusateri AE, Given MB, Schreiber MA, et al. Dried plasma: state of the science and recent developments. Transfusion 2016; 56 Suppl 2:S128.
- Pusateri AE, Given MB, Macdonald VW, Homer MJ. Comprehensive US government program for dried plasma development. Transfusion 2016; 56 Suppl 1:S16.
- O'Shaughnessy DF, Atterbury C, Bolton Maggs P, et al. Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol 2004; 126:11.
- Triulzi DJ. The art of plasma transfusion therapy. Transfusion 2006; 46:1268.
- Holland LL, Foster TM, Marlar RA, Brooks JP. Fresh frozen plasma is ineffective for correcting minimally elevated international normalized ratios. Transfusion 2005; 45:1234.
- Segal JB, Dzik WH, Transfusion Medicine/Hemostasis Clinical Trials Network. Paucity of studies to support that abnormal coagulation test results predict bleeding in the setting of invasive procedures: an evidence-based review. Transfusion 2005; 45:1413.
- Stanworth SJ, Brunskill SJ, Hyde CJ, et al. Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol 2004; 126:139.
- Abdel-Wahab OI, Healy B, Dzik WH. Effect of fresh-frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities. Transfusion 2006; 46:1279.
- Holland LL, Brooks JP. Toward rational fresh frozen plasma transfusion: The effect of plasma transfusion on coagulation test results. Am J Clin Pathol 2006; 126:133.
- Cheng CK, Sadek I. Fresh-frozen plasma transfusion in patients with mild coagulation abnormalities at a large Canadian transfusion center. Transfusion 2007; 47:748; author reply 749.
- Friedman KD, Menitove JE. Preparation and clinical use of plasma and plasma fractions. In: Williams' Hematology, 6th ed, Beutler E, Lichtman MA, Coller BS, et al (Eds), McGraw-Hill, New York 2001. p.1917.
- Hellstern P, Haubelt H. Indications for plasma in massive transfusion. Thromb Res 2002; 107 Suppl 1:S19.
- Chowdary P, Saayman AG, Paulus U, et al. Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. Br J Haematol 2004; 125:69.
- Inaba K, Branco BC, Rhee P, et al. Impact of ABO-identical vs ABO-compatible nonidentical plasma transfusion in trauma patients. Arch Surg 2010; 145:899.
- Shanwell A, Andersson TM, Rostgaard K, et al. Post-transfusion mortality among recipients of ABO-compatible but non-identical plasma. Vox Sang 2009; 96:316.
- Vamvakas EC, Carven JH. Exposure to allogeneic plasma and risk of postoperative pneumonia and/or wound infection in coronary artery bypass graft surgery. Transfusion 2002; 42:107.
- Sarani B, Dunkman WJ, Dean L, et al. Transfusion of fresh frozen plasma in critically ill surgical patients is associated with an increased risk of infection. Crit Care Med 2008; 36:1114.
- Pineda AA, Taswell HF. Transfusion reactions associated with anti-IgA antibodies: report of four cases and review of the literature. Transfusion 1975; 15:10.
- Meena-Leist CE, Fleming DR, Heye M, Herzig RH. The transfusion needs of an autologous bone marrow transplant patient with IgA deficiency. Transfusion 1999; 39:457.
- Rogers RL, Javed TA, Ross RE, et al. Transfusion management of an IgA deficient patient with anti-IgA and incidental correction of IgA deficiency after allogeneic bone marrow transplantation. Am J Hematol 1998; 57:326.
- Arnold DM, Blajchman MA, Ditomasso J, et al. Passive transfer of peanut hypersensitivity by fresh frozen plasma. Arch Intern Med 2007; 167:853.
- PLASMA PRODUCTS
- Plasma Frozen Within 24 Hours After Phlebotomy (PF24)
- Thawed Plasma
- Liquid Plasma
- Solvent/Detergent-Treated Plasma (S/D Plasma)
- Plasma Cryoprecipitate Reduced
- Dried plasma
- Overview of indications
- Vitamin K dependent coagulation factor replacement
- Replacement of specific coagulation factors
- Minimally elevated INR
- Plasma exchange
- DOSE AND INFUSION RATE
- ABO MATCHING
- Volume overload
- Febrile and allergic reactions
- Anaphylactic reactions
- Transfusion-related acute lung injury (TRALI)
- SUMMARY AND RECOMMENDATIONS