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Chapter 140: Using Plasma and Plasma Component Therapy

Jerrold H. Levy; Beth Shaz

INTRODUCTION

SUMMARY

Plasma and plasma component therapy includes fresh frozen plasma, plasma, and cryoprecipitate. Although plasma is used extensively in many clinical applications that include coagulopathy and coagulation factor correction and surgical and traumatic bleeding resuscitation, data supporting its efficacy are limited. Plasma-based transfusions also pose multiple risks, including circulatory overload and transfusion-related acute lung injury. Indications for plasma and cryoprecipitate vary between countries, and the use of factor concentrates including prothrombin complex concentrates and fibrinogen are increasingly used as potential replacements. Strategies are available for pathogen reduction for plasma and plasma products, but additional cost and loss of factors are considerations for their use.

PLASMA/FRESH FROZEN PLASMA

PLASMA PRODUCTS

Plasma is the soluble protein containing solution of blood that contains the clotting factors, as listed in Table 140–1. There are multiple plasma products used clinically that include fresh frozen plasma (FFP), 24-hour plasma (FP24), thawed plasma, liquid plasma, solvent/detergent–treated plasma, and pathogen-reduced plasma.1 As per the FDA, except for liquid plasma and plasma cryoprecipitate–reduced, these products are all therapeutically equivalent, and throughout this chapter are simply termed plasma. Notably, the term FFP is used to encompass many of these products outside of the United States.

TABLE 140–1.Contents of Plasma, Cryoprecipitate, and Fibrinogen Concentrates
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TABLE 140–1. Contents of Plasma, Cryoprecipitate, and Fibrinogen Concentrates
  FFP Cryoprecipitate Fibrinogen Concentrates
Coagulation Factor Relative Content (%) vs Normal Plasma (% range) Relative Content per Single Donor Unit (20–50 mL) ‡Riastap (per 50 mL) (CSL Behring) §Clottafact (LFB-biomedicaments) (per 100 mL)# Fibryga (per 50 mL) (Octapharma)
Fibrinogen 2.0 mg/mL (0.9–3.2) †388 mg (range, 120–796) 900–1300 mg ~1500 mg ~1000 mg
FII 90 (72–108) — — — —
FV 88 (72–108) — — — —
FVII 90 (59–120) — — — —
FVIII 53 (32–92) — — — —
FIX 68 (45–87) — — — —
FX 88 (72–108) — — — —
FXI 100 — — — —
FXII 83 — — — —
FXIII 100 — — — —
Antithrombin III 100 — — — —
VWF 80 — — — —
FVIII and vWF* — 5% — — —
Fibronectin 100% 20–25% — — —
IgG Variable 5–8% — — —
IgM Variable 1–2% — — —
Albumin 3300 mg 5–8% 400–700 mg — 400–700 mg
L-arginine — — 375–660 mg — 375–660 mg

*Reported jointly. With some loss of HMW (high molecular weight) multimers, particularly if SD (solvent detergent) treated.

†Median.

‡Licensed in European countries and US for congenital fibrinogen deficiency.

§Licensed in France for acquired bleeding.

Licensed in Austria, Brazil, Bulgaria, Germany, the Czech Republic, Hungary, Kuwait, the Netherlands, Portugal, Romania, Switzerland, Taiwan, and Turkey for acquired bleeding.

#Not available in the United States.

F, Factor; FFP, fresh frozen plasma; Ig, immunoglobulin; vWF, Von ...

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