Guidelines for the use of fresh‐frozen plasma, cryoprecipitate and cryosupernatant

Abstract

The indications for transfusing fresh‐frozen plasma (FFP), cryoprecipitate and cryosupernatant plasma are very limited. When transfused they can have unpredictable adverse effects. The risks of transmitting infection are similar to those of other blood components unless a pathogen‐reduced plasma (PRP) is used. Of particular concern are allergic reactions and anaphylaxis, transfusion‐related acute lung injury, and haemolysis from transfused antibodies to blood group antigens, especially A and B. FFP is not indicated in disseminated intravascular coagulation without bleeding, is only recommended as a plasma exchange medium for thrombotic thrombocytopenic purpura (for which cryosupernatant is a possible alternative), should never be used to reverse warfarin anticoagulation in the absence of severe bleeding, and has only a very limited place in prophylaxis prior to liver biopsy. When used for surgical or traumatic bleeding, FFP and cryoprecipitate doses should be guided by coagulation studies, which may include near‐patient testing. FFP is not indicated to reverse vitamin K deficiency for neonates or patients in intensive care units. PRP may be used as an alternative to FFP. In the UK, PRP from countries with a low bovine spongiform encephalopathy incidence is recommended by the Departments of Health for children born after 1 January 1996. Arrangements for limited supplies of single donor PRP of non‐UK origin are expected to be completed in 2004. Batched pooled commercially prepared PRP from donors in the USA (Octaplas) is licensed and available in the UK. FFP must be thawed using a technique that avoids risk of bacterial contamination. Plastic packs containing any of these plasma products are brittle in the frozen state and must be handled with care.

Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage

“…) [17] is around half that of the median (IQR) concentration of 5 g.l À1 (4.4-5.8) seen in the third trimester of pregnancy [26]. Administration of FFP to a pregnant patient at term may thus result in a reduction in fibrinogen levels.…”

“…A pooled bag of cryoprecipitate from five donors contains 1.552 g in a mean volume of 189 ml [16]. The fibrinogen content of FFP is more variable; a typical unit contains 0.8 g in a volume of 300 ml [17].…”

Approach to and management of the acute stroke patient with atrial fibrillation: A literature review

“…41 PCCs are widely used in the European community and have previously been cited as the agent of choice for urgent warfarin reversal. 42,47,48 A recent study comparing PCCs with FFP and vitamin K has demonstrated that PCCs may be superior to FFP and vitamin K by reducing the risk of hematoma growth. 49 Recombinant Factor VIIa Recombinant factor VIIa is a preparation of activated coagulation factor VII (factor VIIa) that is produced by recombinant DNA technology.…”

Haemostatic management of cardiac surgical haemorrhage

“…In the 2004 British Committee for Standards in Haematology (BCSH) guidelines [35], a target of 1 g.l À1 was suggested; in recognition of the changes in major bleeding management. A new guideline is due to be published, and this is likely to set a trigger for giving fibrinogen (in the form of cryoprecipitate) at 1.5-2.0 g.l À1 .…”