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.
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 and not used it should be returned to the blood bank fridge within 30 minutes.
Thawed cryoprecipitate is stored at room temperature and must be infused within 4 hours of thawing.
For further advice please contact Haem.SpR or Consultant Haematologist
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).
Also the 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
1. Replacement of single coagulation factors, where a specific factor concentrate is unavailable (use virally inactivated FFP)
F.2 Immediate reversal of Warfarin effect in the presence of life-threatening bleeding. . NOTE: A prothrombin complex concentrate ( Beriplex) should
be used in preference to fresh frozen plasma.
FFP should never be used to reverse the effect of Warfarin in the absence of
bleeding. However it may be necessary to reverse warfarin in patients
needing urgent surgery or when the INR is very high, particularly in elderly
patients.
F.3 Acute disseminated intravascular coagulation (DIC) only in the presence
of bleeding and abnormal coagulation results. There is no evidence that
prophylactic replacement regimes prevent or reduce transfusion
requirements.
F.4 Thrombotic thrombocytopenic purpura (TTP) usually in conjunction with
plasma exchange. Virally inactivated (FFP) is preferable. Daily plasma
exchange should continue for a minimum of 2 days after remission.
F.5 Massive transfusion – FFP should never be used as a simple volume
replacement. Coagulation factor deficiency can be expected after rapid
replacement of one blood volume within 6 hours. FFP can be used at initial
dose of 15ml/kg BW aiming for prothrombin time (PT) and APTT < 1.5 of
control. Coagulation test should be monitored if bleeding continues and
may be necessary to repeat FFP transfusion. If the major source of bleeding
has been controlled and there is no evidence of microvascular bleeding, there
is no need to give blood components.
F.6 Liver disease to correct bleeding or as prophylaxis prior to surgery when the
PT is > 1.5 of the control. For liver biopsy PT should be within 4 seconds of
the control.
INDICATIONS FOR THE USE OF CRYOPRECIPITATE
Useful only if fibrinogen <1g/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)
C1. Hypofibrinogenaemia (fibrinogen level < 1.0g/l) secondary to massive
transfusion. Early use of FFP may avoid the need for cryoprecipitate. Repeat
fibrinogen level after the initial dose.
C2. Inherited hypofibrinogenaemia. This is an uncommon bleeding disorder.
(Recombinant fibrinogen can be used on a named basis)
C3. Acute disseminated intravascular coagulation (DIC) where there is
bleeding and a fibrinogen level < 1g/l. This can be used in combination with
FFP and platelets if indicated.
Note: Treating the underlying cause is the cornerstone of managing DIC.
C4. Advanced liver disease to correct bleeding or as prophylaxis before surgery
when fibrinogen level is < 1.0g/l.
C5. Renal failure or liver failure associated with abnormal bleeding where DDAVP
is contra-indicated or ineffective and fibrinogen level < 1g/l.
C6. Bleeding associated with thrombolytic therapy causing hypofibrinogenaemia.
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