Blood Component Therapy
Fresh Frozen Plasma (FFP) and Thawed Plasma
Deficiencies may be congenital or acquired secondary to liver disease, warfarin anticoagulation, disseminated intravascular coagulation, or massive replacement with red blood cells and crystalloid/colloid solutions. FFP should not be used for Hemophilia B (Factor IX) deficiency unless Factor IX concentrate is not available. FFP, but not thawed plasma, can be used for Factor V deficiency. Recombinant or Factor VIII concentrates should be used to replace Factor VIII.
Usually, there is an increase of at least 1.5 times the normal PT or PTT, or an INR ≥ 1.6 before clinically important factor deficiency exists. This corresponds to factor levels <30% of normal.
Reversal of warfarin anticoagulation with plasma is indicated only if significant bleeding or risk is present. Often it will require recurrent transfusion to maintain normal factor levels. Otherwise, reversal can be achieved by giving Vitamin K or holding warfarin two to three days prior to a planned procedure. Rapid reversal for life threatening bleeding may be achieved with recombinant Factor VIIa (Novo7®).
Plasma is indicated in the treatment of thrombotic thrombocytopenic purpura (TTP), usually in conjunction with plasma exchange.
Plasma should not be used for volume expansion unless the patient also has a significant coagulopathy and is bleeding. Pediatric patients dosing is 10-15mL/kg, to provide ~15-20% rise in factor levels.
Plasma - Dosage
Volume of 1 Unit Plasma: 200-250 mL
In a 70 kg Patient:
Initial Dose of FFP
* These numbers assume normal platelet function. Conditions that may affect platelet function include renal failure, medications, leukemias and myelodysplasias, and congenital disorders. Bleeding Time is a poor predictor of surgical bleeding. The Usefulness of Platelet Function Analysis (PFA) in predicting surgical bleeding is unknown.
|Blood Component Therapy
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