Prepare a guideline for your hospital on the indications for the use of FFP and Cryoprecipitate
INTRODUCTION
Appropriate use of blood and blood products is becoming an increasingly important clinical governance and public health issue. These guidelines are intended to help the clinician to decide when it is appropriate to transfuse one of those blood components and to minimise the risk of donor exposure. If in doubt always discuss with the Haematology SpR or Consultant on call.
Allow 20-40 minutes for thawing (at 37ºC).
Thawed FFP is best used immediately but can be stored in the blood bank fridge at 4ºC and infused within 24 hours. (If FFP is removed from storage it should returned to the blood bank fridge within 30 minutes.)
Thawed cryoprecipitate stored at room temperature must be infused within 4 hours of thawing.
INDICATIONS FOR THE USE OF FRESH FROZEN PLASMA (FFP)
The risks of transmitting infection are broadly similar to those of other blood components (although it is thought that the risks of CJD are higher with plasma containing products and the risk of bacterial contamination is lower from FFP than blood or platelets).
In addition there risks of allergic reactions and anaphylaxis (particularly if the patient has IgA deficiency) and transfusion related acute lung injury.
Consider Hepatitis A and B vaccination in patients likely to receive large volumes of FFP.
Dose 12-15ml/kg body weight (BW), equivalent to 3-4units for an adult. Typical infusion rate 10-20ml/kg/hr (approximately 30 minutes per unit) 1 unit FFP = (250-300ml).
Solvent detergent virally inactivated FFP = 200ml/pack
Methylene blue virally inactivated FFP = 50-75ml/pack should be given to children (<16?)
The RhD status of the FFP is unimportant and RhD positive FFP can be safely given to Rh negative recipients – even young women. The Blood Safety and Quality
Regulations still requires FFP to be labelled according to the RhD group of the donor, even though this is not a requirement of the Council of Europe.
Indications for FFP
Massive transfusion – FFP should be used to treat coagulation factor deficiency. Coagulation factor deficiency can be expected after rapid replacement of one blood volume within 6 hours but can occur after earlier particularly in the context of trauma, where coagulopathy of trauma can occur (e.g. lung contusions can result in marked depletion of factor VII). FFP can be used at initial dose of 15ml/kg BW aiming for prothrombin time (PT) and APTT < 1.5 of control. Coagulation tests should be monitored if following administration of blood products and may be necessary to give repeat doses of FFP. (NB if packed cells / platelets / FFP are mixed in a 1:1 ratio in a beaker the hematocrit would be 29%, the platelet count 88K, and the plasma coagulation factor activity would be 65%).
INDICATIONS FOR THE USE OF CRYOPRECIPITATE
Generally used to replace fibrinogen - usually aim to keep >1 g/l.
Dose: A typical adult dose is two five-unit pools( equivalent to the historical dose of 10 single donor units) containing 3-6g fibrinogen in a volume of 200 to
500 ml. One such treatment administered to an adult would typically raise the plasma fibrinogen to by about 1g/l. Repeat based on fibrinogen level.
Typical infusion rate 10-20ml/kg/hr (or 30 to 60 minutes per 5 unit pool)
Further reading
http://asheducationbook.hematologylibrary.org/content/2010/1/465.full