Fresh Frozen Plasma

Main Uses

• Indicated for patients with a coagulopathy who are bleeding, or at risk of bleeding, where specific therapy (e.g. vitamin K or factor concentrate) is not appropriate or available.
• May be of use in massive transfusion, cardiac bypass, liver disease or acute DIC to replace labile coagulation factors.
• May be indicated to correct warfarin overdose with life-threatening bleeding in addition to Prothrombin Complex Concentrates (vitamin K dependent factor concentrates e.g. Prothrombinex-VF). 
• May be indicated for Thrombotic Thrombocytopenic Purpura (TTP).

Precautions

• Consider the use of FFP. Is a transfusion required?
• Do not use FFP when specific therapy is available and more appropriate e.g. factor VIII or other specific factor concentrate, vitamin K, cryoprecipitate.
• Do not use for blood volume replacement where this can be achieved safely using other volume expanders e.g. 0.9% NaCl, Hartmann's solution, Haemaccel, Gelofusin.
• Caution is needed with volume.

Dosage

• Compatibility testing is not required however ABO compatible plasma should be used wherever possible. Group AB plasma can be used for all ABO groups in an emergency. Restrict group O plasma to group O recipients.
• Volume depends on clinical situation, patient size and laboratory tests. General guide is 10 -15mL/kg per dose.
• For patients with specific factor deficiencies, always consider specific replacement therapy rather than FFP eg Factor VIII for Haemophilia A.
• Once thawed use immediately or store at 2 - 6 °C for 24 hrs. If used to treat coagulopathies other than Factor VIII deficiency, thawed FFP may be allocated by a medical practitioner for a designated patient under his or her care and stored at 2 - 6 °C for up to 5 days.

Consent and Safety

Patient Identification

Always check the identity of the patient when taking sample for blood grouping or crossmatch before commencing the transfusion

Remember:

• Only one patient should be bled / processed at a time
• Never pre-label the specimen tubes
• Check identity by ASKING the patient to state and spell his/her name AND check the wrist band
• Check that the request form and sample match the patient and wrist band
• Remember to sign the sample and request form

Consent

Consent should be obtained and documented. Check your local institutional guidelines.

Always cover the following when gaining consent:

• Explain

- Cause / likelihood of bleeding or the low blood count (including any uncertainty)?
- Nature of the proposed transfusion therapy - what is involved?
- Benefits expected?
- Risks - common & rare but serious?
- Alternatives - including the risk of doing nothing?

• Ask

- Is there anything else you would like to know?
- Is there anything you do not understand?

• Provide

- Interpreter for non-English speaking patients
- Written information

Click for more detailed information.

Administration

Transfusion Set-Up

Note: this is a guide only - individual hospital guidelines should be followed:

• Mix gently but thoroughly by inversion prior to use
• Administer fresh-frozen plasma through a standard giving set with a 170 - 200 micron administration filter (large particle filter which only removes aggregates and other large particles)

Patient Monitoring

Note: this is a guide only - individual hospital guidelines should be followed:

• Start transfusion as soon as possible after thawing of FFP (within 30 minutes of removal from approved storage)
• Check patient vital signs (pulse rate, respiration rate, blood pressure and temperature) at the start of transfusion AND at least after 15 minutes, at the end of transfusion AND if there is ANY reaction. Record observations in patients notes

When to Transfuse

• Plan ALL transfusions during business hours. Emergency transfusions should be the only transfusions given after hours
• Transfuse ONE unit at a time

How Long is a Transfusion?

• Generally 2-4 hours
• Each unit must be transfused within 4 hours of starting
• May be given faster in acute bleeding situations