Update on Plasma and
Kelley, MD, MBA
Assistant Medical Director
Centralized Transfusion Service
FRESH FROZEN PLASMA (FFP)
FFP is derived from whole blood donations. It is stored at -18º
C or less to maintain hemostatic levels of all coagulation factors, including
the labile factors V and VIII. For transfusion, FFP must be thawed in a 37º C
water bath for approximately 30 minutes. Each unit contains between 200 and 250
ml of plasma and will raise plasma factor levels by 3-5%. Cross-matching is not
required for transfusion, but type-specific or ABO-compatible plasma must be
CRYO- REDUCED PLASMA
Cryo-reduced plasma is used as an alternative to FFP as a
replacement fluid in plasmapheresis for TTP, either for initial treatment or for
cases not responding to plasma exchange with FFP.
transfusion should not be used for volume expansion or as a nutritional
supplement, as other products are available that are both effective and do not
carry the viral transmission risk of blood product transfusion. In addition,
plasma should not be transfused prophylactically in cases of massive red cell
transfusion or after cardiopulmonary bypass.
coagulation factors that are commercially available as recombinant or virally
inactivated concentrates (VII, VIII, IX, Anti-Thrombin III), plasma should be
transfused only in emergencies when concentrates are unavailable. Similarly,
transfusion of CRYO for von Willebrand’s disease should be reserved for emergent
situations when vWF-containing Factor VIII concentrates cannot be obtained in a
DOSAGE and ADMINISTRATION
Correction of a
significant coagulopathy requires 10-20 ml/Kg of plasma (4-7 units for a 70 Kg
adult). Smaller volumes do not reliably provide correction and larger volumes
are unnecessary. Each unit may be transfused over as little as 20-30 minutes,
provided the recipient’s cardio-respiratory system can tolerate that rate.
CRYO is generally transfused in pools of 6 units each, which
should increase an adult recipient’s fibrinogen level by 30-60 mg/dL. For
uremic bleeding, the dose of CRYO is 6-10 units.
Downes KA, et al. Transfusion 2001; 41: 570.
McVay PA, et al. Am J Clin Path, 1990; 94: 747-753.
M, et al. Radiology 1992; 184: 841-843.
McVay PA, et al. Transfusion 1991; 31: 164-171.
Squillante CE, et al. Liver 1993; 13: 270-272.
Wachtel S, et al. Blood 1994; 84: Suppl:682a.
Janson PA, et al. NEJM 1980; 303: 1318-22.
For questions regarding this
TMU, please contact
Donald L. Kelley, MD, MBA. at: (412) 209-7483.
©2004, Institute For Transfusion
Editor: Donald L. Kelley, M.D., MBA: