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Chapter 94: Plasma and Plasma Component Therapy

INTRODUCTION

Plasma and its derivatives are important products in medical therapy. Plasma is the soluble protein-containing solution of blood that contains albumin, immunoglobulins, and the clotting factors and, thus, can be used for therapeutic purposes in which there are deficiencies of those plasma proteins, as listed in Table 94–1. Convalescent plasma is a particular rich source of protective antibodies used in passive immunity for dangerous infectious diseases and from which concentrates of hyperimmune gamma globulins can be made. This chapter focuses on the use of plasma and its derivatives for hematologic disorders, principally bleeding disorders and hematologic diseases responding to plasma exchange therapy.

TABLE 94–1CONTENTS OF PLASMA, CRYOPRECIPITATE, AND FIBRINOGEN CONCENTRATES
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TABLE 94–1 CONTENTS OF PLASMA, CRYOPRECIPITATE, AND FIBRINOGEN CONCENTRATES
  FFP Cryoprecipitate Fibrinogen Concentrates
Protein Component Relative Content (%) vs Normal Plasma (% range) Relative Content per Single Donor Unit (20–50 mL) RiaSTAPa (per 50 mL) (CSL Behring) Clottafactb (LFB-biomedicaments) (per 100 mL)c Fibrygad (per 50 mL) (Octapharma)
Fibrinogen 2.0 mg/mL (0.9–3.2) 388 mge (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 vWFf — 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

F, factor; FFP, fresh-frozen plasma; Ig, immunoglobulin; vWF, von Willebrand factor.

aLicensed in European countries and United States for congenital fibrinogen deficiency.

bLicensed in France for acquired bleeding.

cNot available in the United States.

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

eMedian.

fReported jointly. With some loss of high-molecular-weight multimers, particularly if solvent detergent treated.

Data from Levy JH, Szlam F, Tanaka KA, et al: Fibrinogen and hemostasis: a primary hemostatic target for the management of acquired bleeding, Anesth Analg. 2012;114(2):261-274 and Levy JH, Welsby I, Goodnough LT. Fibrinogen as a therapeutic target for bleeding: a review of critical levels and replacement therapy, Transfusion. 2014;54(5):1389-1405.

PLASMA/FRESH-FROZEN PLASMA PRODUCTS

There are multiple plasma products used clinically for treatment of coagulation disorders that include fresh-frozen plasma (FFP), 24-hour plasma (FP24), thawed plasma, liquid plasma, solvent/detergent–treated plasma, and pathogen-reduced plasma. As per the Food and Drug Administration (FDA), except for liquid plasma and plasma cryoprecipitate–reduced, these products ...

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