Fresh frozen plasma

General
Fresh frozen plasma that has experienced an extra safety step relating to the transfer of infectious diseases is employed for clinical use: the quarantine method. Quick frozen plasma is thawed shortly before use.

Indication

haemorrhages or expected large blood loss with demonstrated combined coagulation factor deficiency (massive blood loss, L-asparagine therapy, serious liver disease or diffuse intravesicular coagulation)
isolated factor V deficiency
plasmaphaeresis with thrombotic thrombocytopoenia purpura

Method of administration
Precaution
It is advisable that every blood product be administered as rapidly as possible after arrival at the Department.
Where possible, blood products should be administered during the day (for the monitoring of transfusion reactions).

Blood product checks and identity
The unit must always be carefully inspected prior to the transfusion to ensure it is intended for the patient concerned. At the bedside, check the identity and the ABO-blood group/Rhesus (D) factor of the patient, the data on the label of the blood product concerning ABO-blood group/Rhesus (D) factor, the expiry date, product code, and, if available, the result of the compatibility study. Before the administration the transfusion bag should also be visually checked for leakage and the presence of coagulants, contaminants or discolouration.

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Administration system
An infusion for the administration of blood products may only be filled with physiological saline (NaCl 0.9%). A filter of 170 – 200 µm must be included in the administration system. For the administration, mix with blood products made decoagulant with citrate. NEVER use Ringers lactate or other calcium-containing fluids.
Medicines must never be added to blood products or be connected to the infusion. A double lumen catheter (whereby the blood product is administered by the other line) must be employed when central lines are used for parenteral feeding.
If no separate infusion line is available, then an already inserted line can be used (after pre-rinsing and after-rinsing with physiological saline) to transfuse erythrocytes or plasma. Thrombocytes must never be transfused with a used administration system.
The administration system must be thoroughly rinsed with physiological saline both before and after every unit.
Micro-aggregate filter (40 µm) may not be included in the administration system with thrombocyte transfusions.
A peripheral administration system must preferably be replaced within 6 hours after the last transfusion

Administration rate
The infusion rate for all blood products must be slow during the first 10 minutes. The patient must be continuously observed for the occurrence of transfusion reactions with this. If these do not occur, then the administration rate can be adjusted as follows:

Erythrocytes are administered dependent upon the clinical condition; for stable patients approximately 300 mL in 1 to 2 hours (3 – 5 mL/kg/hour for children), faster with substantial blood loss, slower for patients with compromised cardiac function.
Thrombocytes are administered as rapidly as possible (approximately 300 mL in 15 to 30 minutes).
Plasma may be administered equally rapidly (approximately 300 mL in 15 to 30 minutes).
A blood product may be administered until a maximum of 6 hours after needling.

Warming of erythrocyte products
The warming of erythrocyte products is exclusively indicated for extremely rapid transfusions (for adults, 50 – 100 ml/min).
An especially validated blood warming apparatus is used for this, by which the supply hose is warmed. It is not allowed to warm the bag with erythrocytes by immersing it in warm water.

Thawing of plasma
Fresh frozen plasma must be thawed at a maximum of 37 oC in equipment that is intended (validated) for such use. It should be occasionally turned during the thawing. If a water bath is used for the thawing, then the plasma must first be wrapped in a plastic liner. Plasma must NEVER be thawed in a domestic microwave oven.
The plasma should be administered as rapidly as possible (maximum of 2 hours) after thawing.

Handling transfusion reactions
If cold chills, fever, blood pressure reductions, anaphylactic shock or shortness of breath occurs, then the blood product must be disconnected and the infusion transferred over to physiological saline in order to keep open the access to the bloodstream. A physician must be alerted.
See transfusion reactions. Transfusion reactions must always be reported to the blood transfusion laboratory (transfusion reaction form).

Administration
The patient’s dossier must indicate which product code the administered blood products have, as well as the unit identification numbers. The dossier must also indicate which transfusion reactions may possibly have arisen. There is a statutory requirement that these data must be stored for a minimum of 10 years.

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Storage conditions
In order to maintain the activity of the coagulation factors, this must be stored at a temperature of -25 ºC or lower and the performance of compatibility research is then tenable for 2 years. The thawing can, for example, occur packaged in a plastic bag in a water bath (refresh/clean daily) of 37 ºC (with temperature monitoring) or can be done through other validated methods.
The product must be administered as rapidly as possible after thawing in order to allege that the coagulation factors are safe.

Compatibility
Fresh frozen plasma must be transfused ABO identical or compatible. Matching tests are not necessary No consideration needs to be given to Rhesus (D) compatibility when administering plasma that has been fresh frozen.
NB. For plasmaphaeresis, donors with blood group AB, B and A are invited because erythrocytes from these blood groups are less frequently required. Consequently, there is almost no O plasma in stock.

Undesirable effects
Undesirable effects that may occur during or after a transfusion are mostly of an allergic nature with sporadic anaphylactic shock, fever with or without cold chills, rarely TRALI, and infectious diseases.

Fresh frozen plasma products

Fresh frozen plasma, made virus-free with the quarantine method.

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