Переливание плазмы и криопреципитата

USE OF: FRESH FROZEN PLASMA (FFP) should only be used to treat bleeding episodes or prepare patients for surgery in certain defined situations. Transfusion of FFP is linked with an increased risk of transfusion associated complications e.g.TRALI (Transfusion associated lung injury). Each request for FFP is therefore subject to screening by the Transfusion Department in accordance with the nationally agreed indication codes. Requests which do not clearly fall into an indication code category will be referred to a haematologist.

PROPERTIES OF: Anticoagulated human plasma. This will contain high levels of all coagulation proteins including the labile factors V and VIII.

PRESENTATION OF: A pack containing approximately 200ml of anticoagulated plasma. FFP are labelled with donor ABO group. ABO compatible should be used but compatibility testing is not required.

Group O FFP must only be used for group O recipients.

FFP of any Rh type may be given. No Anti D prophylaxis is required if Rh negative women receive Rh positive FFP.

GIVING SET: FFP must be given through a sterile blood administration set.

ORDERING PROCEDURE: Please ensure that the product is certain to be used before requesting. FFP is stored frozen at -30°C and is thawed in a water bath at 37°C. This process takes approximately 20 minutes. Once defrosted this product has to be transfused within four hours — note thawing time on pack label (FFP cannot be refrozen if not used). If the thawed FFP has been stored in the laboratory fridge it can be used up to 24 hours after thawing for some patient groups.

DEFINITE INDICATIONS FOR USE: OF FRESH FROZEN PLASMA

The indications for transfusion below are taken from UK national guidelines for the use of blood components. Although it is accepted that clinical judgement plays an essential part in the decision to transfuse or not, the purpose of drawing available transfusion guidelines together is to help clinicians decide when blood transfusion is appropriate, and to minimise unnecessary exposure to transfusion. Each indication has been assigned a number, which should be written on the transfusion request form when requesting FFP.

F1. Replacement of single coagulation factor deficiencies, where a specific or combined factor concentrate is unavailable e.g. factor V.

F2. Immediate reversal of warfarin effect, in the presence of life-threatening bleeding.

FFP only has a partial effect and is not the optimal treatment; prothrombin complex concentrates are preferred.

F3. Acute disseminated intravascular coagulation (DIC) in the presence of bleeding and abnormal coagulation results.

F4. Thrombotic thrombocytopenic purpura (TTP), usually in conjunction with plasma exchange (Octaplas usage is indicated for plasma exchange).

F5. Massive transfusion and surgical bleeding; the use of FFP should be guided by timely tests of coagulation.

F6. Liver disease; patients with a PT within 4 seconds of the control value are unlikely to benefit from the use of FFP.

CONDITIONAL USES: (In the presence of bleeding and disturbed coagulation).

You may be referred to a haematologist if you request FFP for any reason which does not fall into one of the above categories, for example:

  • Pre-surgical patients with a high INR (see transfusion policy TP016).
  • Paediatric sepsis.
  • Paediatric disseminated intravascular coagulation.
  • Cardiopulmonary bypass surgery (in patients with bleeding and a known abnormality of coagulation other than the residual heparin effect).
  • Plasma Exchange procedures.

Patients likely to receive large or repeated doses of FFP may benefit from products with a reduced risk of transmitting infection, such as pathogen-reduced plasma (PRP). Such patients include those with congenital factor deficiencies for whom no pathogen-reduced concentrate is available and patients undergoing intensive plasma exchange. The two types of PRP available are methylene blue and light-treated FFP (MBFFP) and solvent detergent-treated FFP (SDFFP), commercially known as Octaplas.

Neonates and children up to the age of 16 are issued with Methylene Blue treated non- UK sourced FFP.

NO JUSTIFICATION FOR USE:

  • Hypovolaemia.
  • ‘Formula replacement’- giving 1 FFP per 4-6 units of blood.
  • Nutritional support.
  • Treatment of immunodeficiency states.

DOSAGE: 12-15ml/kg is a generally accepted starting dose. It is important to monitor the response with INR, APTT or specific factor assays. Infusion must be completed within four hours of thawing. Anaphylactoid reaction may be more of a risk with rapid infusion.