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Plasma Products

Three plasma products are generally available today: Fresh Frozen Plasma (FFP), Plasma frozen within 24 hours after Phlebotomy (FP24) and Thawed Plasma.  All of these products are usually prepared from a unit of whole blood, but may also be collected by apheresis. Each bag of plasma prepared from whole blood has a volume between 200 and 250 mL. Plasma prepared by apheresis contains a volume of 400 to 600 mL.

The major difference between FFP and FP24 is that FFP is separated from a unit of whole blood and frozen at -18oC within 8 hours after collection, whereas a unit of FP24 is frozen within 8 to 24 hours after collection. Because of the delay in freezing, the Factor VIII content of FP24 is 20 to 40% lower than the pre-storage concentration. The decreased level of Factor VIII does not prevent FP24 from correcting a coagulopathy because the Factor VIII concentration of the unit remains above the minimal hemostatic level of 30% and many patients have elevated Factor VIII levels because it is an acute phase reactant.  Because of the logistical difficulties encountered with transporting and processing of blood from remote mobile collection sites, FFP has been replaced by FP24.

FFP and FP24 are thawed in a warm water bath (30 to 37oC) and should be transfused within 24 hours after thawing. If a unit of FFP or FP24 is not transfused within 24 hours after thawing, it can be relabeled as Thawed Plasma and stored for an additional 4 days at 1 to 6o C. The FDA has not issued guidance on conversion of FP24 to Thawed Plasma, but this appears to be common practice.  All coagulation factors are maintained at relatively normal levels, except for Factor VIII which declines to 40% of the prestorage level.  Conversion of FFP or FP24 decreases product wastage and improves turnaround time in emergency situations because it has already been thawed and can be issued immediately.

In the United States, most plasma for transfusion is collected from male donors or female donors who have never been pregnant to reduce the risk of transfusion related acute lung injury (TRALI). These donors are less likely to have developed human leukocyte (HLA) or human neutrophil (HNA) antibodies.  Alternatively, for products often in short supply, such as AB plasma, some blood centers have elected to screen female donors who have been pregnant for HLA  and HNA  to increase their plasma supply. These efforts have significantly decreased the incidence of TRALI.

Pre-transfusion crossmatching of plasma is not necessaryUnits of FFP should be ABO compatible whenever possible. Alternative ABO groups may be substituted as long as the recipients’ red blood cells are compatible with anti-A or B antibodies present in the donor plasma.  The following table provides guidelines for selection of compatible FFP units:           

ABO Compatible FFP

Recipient’s ABO Group

Compatible FFP

O

O, A, B, AB,

A

A, AB

B

B, AB

AB

AB

 

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