Fresh frozen plasma - Wikipedia

Fresh frozen plasma (FFP) is a blood product made from the liquid portion of whole blood. ... It is used to treat conditions in which there are low blood clotting ... Freshfrozenplasma FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch FreshfrozenplasmaAbagcontainingoneunitoffreshfrozenplasmaClinicaldataOthernamesPlasmafrozenwithin24hoursafterphlebotomy(FP24)[1]AHFS/Drugs.comMicromedexDetailedConsumerInformationATCcodeB05AX03(WHO)IdentifiersChemSpidernone Freshfrozenplasma(FFP)isabloodproductmadefromtheliquidportionofwholeblood.[3]Itisusedtotreatconditionsinwhichtherearelowbloodclottingfactors(INR>1.5)orlowlevelsofotherbloodproteins.[3][1]Itmayalsobeusedasthereplacementfluidinplasmaexchange.[2][4]UsingABOcompatibleplasma,whilenotrequired,mayberecommended.[5][6]Useasavolumeexpanderisnotrecommended.[3]Itisgivenbyslowinjectionintoavein.[2] Sideeffectsincludenauseaanditchiness.[3]Rarelytheremaybeallergicreactions,bloodclots,orinfections.[1][3]Itisunclearifuseduringpregnancyorbreastfeedingissafeforthebaby.[2]GreatercareshouldbetakeninpeoplewithproteinSdeficiency,IgAdeficiency,orheartfailure.[2]Freshfrozenplasmaismadeupofacomplexmixtureofwater,proteins,carbohydrates,fats,andvitamins.[1]Whenfrozenitlastsaboutayear.[1] PlasmafirstcameintomedicaluseduringtheSecondWorldWar.[1]ItisontheWorldHealthOrganization'sListofEssentialMedicines,thesafestandmosteffectivemedicinesneededinahealthsystem.[7]IntheUnitedKingdomitcostsabout£30perunit.[8]Anumberofotherversionsalsoexistincludingplasmafrozenwithin24hoursafterphlebotomy,cryoprecipitatereducedplasma,thawedplasma,andsolventdetergentplasma.[1] Contents 1Definition 2Medicaluses 3Risks 4Chemistry 5Frequencyofuse 6Alternatives 7References 8Furtherreading 9Externallinks Definition[edit] IntheUnitedStatesitreferstothefluidportionofoneunitofwholebloodthathasbeencentrifuged,separated,andfrozensolidat−18 °C(0 °F)orcolderwithineighthoursofcollectionfromwholeblooddonationorwasotherwisecollectedviaapheresisdevice.[9]Thephrase"FFP"isoftenusedtomeananytransfusedplasmaproduct.Theothercommonlytransfusedplasma,plasmafrozenwithin24hoursafterphlebotomy(PF24),hassimilarindicationsasthoseforFFP.PF24hasslightlylowerlevelsofFactorsVandVIIIthanFFP.PF24isactuallymorecommonlyusedthanFFPintheUnitedStates. Medicaluses[edit] TherearefewspecificindicationsforFFP.Thesegenerallyarelimitedtothetreatmentofdeficienciesofcoagulationproteinsforwhichspecificfactorconcentratesareunavailableorundesirable.Ausualdoseofplasmais10–20mL/kgrecipientweight.[10] IndicationsfortheuseofFFPincludethefollowing: ReplacementofisolatedfactordeficienciesFFPisusedtotreatrarebleedingdisorderswhenspecificfactorconcentratesarenotavailable.FFPistheusualtreatmentforfactorVdeficiency.[11] ReversalofwarfarineffectWarfarinPatientswhoareanticoagulatedwithwarfarinaredeficientinthefunctionalvitaminKdependentcoagulationfactorsII,VII,IX,andX,aswellasproteinsCandS.ThesefunctionaldeficienciescanbereversedbytheadministrationofvitaminK.Foranticoagulatedpatientswhoareactivelybleedingorwhorequireemergencysurgery,prothrombincomplexconcentrate(ideally,fourfactorPCCs)shouldbeusedifavailable.[12]FFP/PF24/thawedplasmashouldonlybeusedifmoreeffectivealternativetreatmentsarenotavailable.TheASAtaskforcerecommendsstartingwith5–8mL/kgofFFPforwarfarinreversalandrecheckinglaboratoryvalues.[12] UseinantithrombinIIIdeficiencyFFPcanbeusedasasourceofantithrombinIIIinpatientswhoaredeficientofthisinhibitorandareundergoingsurgeryorwhorequireheparinfortreatmentofthrombosis.Therearepurified,humanderived,aswellasrecombinantformsofantithrombinIIIavailableintheUS. TreatmentofimmunodeficienciesFFPisusefulininfantswithsecondaryimmunodeficiencyassociatedwithsevereprotein-losingenteropathyandinwhomtotalparenteralnutritionisineffectual.FFPalsocanbeusedasasourceofimmunoglobulinforchildrenandadultswithhumoralimmunodeficiency.However,thedevelopmentofapurifiedimmuneglobulinforintravenoususe(i.e.,IVIG)largelyhasreplacedfreshfrozenplasma Treatmentofthromboticthrombocytopenicpurpura:TherapeuticplasmaexchangewithFFP/PF24orthawedplasmaasthereplacementfluidisconsideredthetreatmentofchoiceforpatientswithprovenorsuspectedthromboticthrombocytopenicpurpura(TTP). FFPisnotrecommendedunlessthereisongoingbleedingorthereisasignificantbloodclottingproblem.Thatis,FFPisnotusedinpeopletoreversewarfarinifthereisnobleeding,evenforanINR>9unlesstheyneedurgentsurgery.Itisalsonotusedinelectivesurgery,ornon-emergencysurgery.[13] ThawedplasmaismadefromFFPorPF24andkeptrefrigerated(at1–6 °C)afterthawingcanbestoredfor5dayspostthaw.[10] Prophylacticplasmatransfusionsmighthaveaneffectforpeoplethatsufferfromabloodclottingdisorderandreceiveaninvasiveprocedure. Forpeoplethatsufferfromabloodclottingdisorderandreceiveaplannedinvasivenon-cardiacprocedureitisnotcertainifprophylacticplasmatransfusionsimproveall-causemortalityupto30days,majorbleedingwithin24hours,numberoftransfusionsperparticipantswithinoneweek,numberofindividualsrequiringatransfusionwithinoneweekandseriousadverseeventsmeasuredbyplasma-relatedcomplicationswithin24hours.[14]Differenttriggersforfreshfrozenplasmamayhavelittletonoeffectonmajorbleedingwithin24hoursandseriousadverseeventsmeasuredbyplasmatransfusion-relatedcomplicationswithin24hours.Furthermore,differenttriggersforfreshfrozenplasmamayreducethenumberofindividualsrequiringatransfusionwithin7days.[14] Risks[edit] TherisksofFFPincludediseasetransmission,anaphylactoidreactions,andexcessiveintravascularvolume(transfusionassociatedcirculatoryoverload(TACO)),aswellastransfusionrelatedacutelunginjury(TRALI).Risksoftransfusiontransmittedinfectionsaresimilartothatofwholebloodandredbloodcells. Chemistry[edit] FFPismadebycentrifugationofwholebloodorapheresisdevicefollowedbyfreezingandpreservation. Frequencyofuse[edit] Theuseofplasmaanditsproductshasevolvedoveraperiodoffourdecades.TheuseofFFPhasincreasedtenfoldintheUnitedStatesfrombetweentheyears2000-2010andhasreachedalmost2millionunitsannually.[citationneeded]Thistrendmaybeattributabletomultiplefactors,possiblyincludingdecreasedavailabilityofwholebloodduetowidespreadacceptanceoftheconceptofcomponenttherapy. Alternatives[edit] Albumin Evidenceindicatesthatotherplasmacomponents(e.g.,single-donorplasma)thatdonotmeetthecriteriaofFFPmayhaveadequatelevelsofcoagulationfactorsandaresuitableforpatientsinwhomFFPisindicated.Single-donorplasmaisefficaciousinthetreatmentofmilddeficienciesofstableclottingfactors.Italsoisofvalueintreatmentofmultipledeficienciesasinreversalofwarfarineffectsorinliverdisease.[citationneeded] SafeandeffectivealternativetreatmentoftenexistssothatFFPisnolongerthetherapyofchoiceinmanyconditions.Cryoprecipitateorfibrinogenconcentratesshouldbeusedwhenfibrinogenisneeded.FortreatmentofhemophiliaA,recombinantfactorVIIIconcentratesareavailable.FortreatmentofseverehemophiliaB,recombinantfactorIXconcentratesareavailable. Crystalloidorcolloidsolutionssuchashumanserumalbuminorplasmaproteinfraction,arepreferabletoFFPforvolumereplacement. Fornutritionalsupport,aminoacidsolutionsanddextroseareavailable.[citationneeded]ThemostimportantalternativetotheuseofFFPisacomprehensiveprogramofbloodconservation.Thisincludesmeasuressuchasintraoperativecellsalvage[10]andtherealizationthatinmanypatientsnormovolemicanemiaisnotanindicationfortransfusion.[citationneeded] References[edit] ^abcdefgShaz,BethH.;Hillyer,ChristopherD.;Roshal,Mikhail;Abrams,CharlesS.(2013).TransfusionMedicineandHemostasis:ClinicalandLaboratoryAspects.Newnes.pp. 209–212.ISBN 9780123977885.Archivedfromtheoriginalon2017-09-23. ^abcde"PlasmaIntravenousAdvancedPatientInformation-Drugs.com".www.drugs.com.Archivedfromtheoriginalon11January2017.Retrieved10January2017. ^abcdeBritishnationalformulary :BNF69(69 ed.).BritishMedicalAssociation.2015.p. 172.ISBN 9780857111562. ^Schwartz,Joseph;Padmanabhan,Anand;Aqui,Nicole;Balogun,RasheedA.;Connelly-Smith,Laura;Delaney,Meghan;Dunbar,NancyM.;Witt,Volker;Wu,Yanyun(June2016)."GuidelinesontheUseofTherapeuticApheresisinClinicalPractice-Evidence-BasedApproachfromtheWritingCommitteeoftheAmericanSocietyforApheresis:TheSeventhSpecialIssue".JournalofClinicalApheresis.31(3):149–338.doi:10.1002/jca.21470.ISSN 0733-2459.PMID 27322218.S2CID 866923. ^Sikka,PaulK.;Beaman,ShawnT.;Street,JamesA.(2015).BasicClinicalAnesthesia.Springer.p. 102.ISBN 9781493917372. ^Aglio,LindaS.;Lekowski,RobertW.;Urman,RichardD.(2015).EssentialClinicalAnesthesiaReview:Keywords,QuestionsandAnswersfortheBoards.CambridgeUniversityPress.p. 218.ISBN 9781107681309. ^WorldHealthOrganization(2019).WorldHealthOrganizationmodellistofessentialmedicines:21stlist2019.Geneva:WorldHealthOrganization.hdl:10665/325771.WHO/MVP/EMP/IAU/2019.06.License:CCBY-NC-SA3.0IGO. ^Yentis,StevenM.;Hirsch,NicholasP.;Ip,James(2013).AnaesthesiaandIntensiveCareA-Z:AnEncyclopediaofPrinciplesandPractice.ElsevierHealthSciences.p. 147.ISBN 9780702053757.Archivedfromtheoriginalon2017-09-23. ^SallyV.Rudmann(18February2005).Textbookofbloodbankingandtransfusionmedicine.ElsevierHealthSciences.pp. 247–.ISBN 978-0-7216-0384-1.Archivedfromtheoriginalon30May2013.Retrieved16November2010. ^abcTechnicalmanual.Fung,MarkK.,Grossman,BrendaJ.,Hillyer,ChristopherD.,Westhoff,ConnieM.,AmericanAssociationofBloodBanks.(18th ed.).Bethesda,Md.:AmericanAssociationofBloodBanks.2014.ISBN 978-1563958885.OCLC 881812415.CS1maint:others(link) ^Mumford,AndrewD.;Ackroyd,Sam;Alikhan,Raza;Bowles,Louise;Chowdary,Pratima;Grainger,John;Mainwaring,Jason;Mathias,Mary;O'Connell,Niamh(2014-11-01)."Guidelineforthediagnosisandmanagementoftherarecoagulationdisorders".BritishJournalofHaematology.167(3):304–326.doi:10.1111/bjh.13058.ISSN 1365-2141.PMID 25100430.S2CID 5561358. ^abKeeling,David;Baglin,Trevor;Tait,Campbell;Watson,Henry;Perry,David;Baglin,Caroline;Kitchen,Steve;Makris,Michael;BritishCommitteeforStandardsinHaematology(2011-08-01)."Guidelinesonoralanticoagulationwithwarfarin–fourthedition".BritishJournalofHaematology.154(3):311–324.doi:10.1111/j.1365-2141.2011.08753.x.ISSN 1365-2141.PMID 21671894.S2CID 14749058. ^"SocietyfortheAdvancementofBloodManagement|ChoosingWisely".www.choosingwisely.org.Retrieved1August2018. ^abHuber,Jonathan;Stanworth,SimonJ;Doree,Carolyn;Fortin,PatriciaM;Trivella,Marialena;Brunskill,SusanJ;Hopewell,Sally;Wilkinson,KirstinL;Estcourt,LiseJ(2019-11-28).CochraneHaematologyGroup(ed.)."Prophylacticplasmatransfusionforpatientswithoutinheritedbleedingdisordersoranticoagulantuseundergoingnon-cardiacsurgeryorinvasiveprocedures".CochraneDatabaseofSystematicReviews.11:CD012745.doi:10.1002/14651858.CD012745.pub2.PMC 6993082.PMID 31778223. Furtherreading[edit] BritishCommitteeforStandardsinHaematology,BloodTransfusionTaskForce(J.Duguid,Chairman);O'Shaughnessy,D.F.;Atterbury,C.;BoltonMaggs,P.;Murphy,M.;Thomas,D.;Yates,S.;Williamson,L.M.(1July2004)."Guidelinesfortheuseoffresh-frozenplasma,cryoprecipitateandcryosupernatant".BritishJournalofHaematology.126(1):11–28.doi:10.1111/j.1365-2141.2004.04972.x.ISSN 1365-2141.PMID 15198728.S2CID 27980310. Externallinks[edit] NIHConsensusDevelopmentProgram:FreshFrozenPlasma:IndicationsandRisks(publicdomain) CircularofInformationdescribingintendedusesoftransfusionproductsintheUnitedStates vteBloodtransfusionandtransfusionmedicineBloodproducts Wholeblood Platelets Platelettransfusion Redbloodcells Plasma Freshfrozenplasma PF24 Cryoprecipitate Cryosupernatant Whitebloodcells Granulocytetransfusion Bloodsubstitutes Generalconcepts Bloodbank Blooddonation Bloodmanagement Methods Apheresis(plasmapheresis,plateletpheresis,leukapheresis) Exchangetransfusion Intraoperativebloodsalvage Tests Bloodcompatibilitytesting Cross-matching Coombstest Kleihauer–Betketest InternationalSocietyofBloodTransfusion ISBT128 Transfusionreactionsandadverseeffects Transfusionhemosiderosis Transfusionrelatedacutelunginjury Transfusionassociatedcirculatoryoverload Transfusion-associatedgraftversushostdisease Febrilenon-hemolytictransfusionreaction Hemolyticreaction acute delayed Serumsickness Transfusiontransmittedinfection Bloodgroupsystems Bloodtypes ABO Secretorstatus Augustine CD59 Chido-Rodgers Colton Cromer Diego Dombrock Duffy Er FORS Gerbich GIL GLOB Hh Ii Indian JR JMH KANNO Kell(Xk) Kidd Knops Lan Lewis Lutheran LW MNS OK P Raph RhandRHAG Scianna Sid T-Tn Vel Xg Yt Other vteIntravenoustherapyInfusedsubstancesBlood-basedproduct Wholeblood PF24/Freshfrozenplasma(Cryosupernatant+Cryoprecipitate) Bloodsubstitute Hemoglobin-based Volumeexpander LactatedRinger's Normalsaline Sugarsolution Buffers LactatedRinger's,Sodiumbicarbonate Medications Intravenousimmunoglobulin Parenteralnutrition Sugar Other Druginjection Ascorbicacid Accesspoints Peripheralvenouscatheter Peripherallyinsertedcentralcatheter(Seldingertechnique) Centralvenouscatheter Otherequipment Infusionpump CVC SLC MLC PICC Implantablecatheters Ports Thermodilutioncatheters Hemodialysiscatheters Specificrisks Airembolism Extravasation Medicineportal Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Fresh_frozen_plasma&oldid=1000239803" Categories:BloodproductsTransfusionmedicineWorldHealthOrganizationessentialmedicinesHiddencategories:CS1maint:othersChemicalsthatdonothaveaChemSpiderIDassignedChemicalarticleswithoutCASregistrynumberArticleswithoutEBIsourceChemicalpageswithoutDrugBankidentifierArticleswithoutKEGGsourceArticleswithoutInChIsourceArticleswithoutUNIIsourceDrugswithnolegalstatusArticlescontainingunverifiedchemicalinfoboxesAllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromJuly2010ArticleswithunsourcedstatementsfromJuly2017ArticleswithunsourcedstatementsfromOctober2016Wikipediamedicinearticlesreadytotranslate Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk Variants expanded collapsed Views ReadEditViewhistory More expanded collapsed Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Languages العربيةDeutschEspañolفارسیFrançaisՀայերենItalianoעבריתNederlandsଓଡ଼ିଆPolskiTiếngViệt中文 Editlinks