Fresh frozen plasma contains the plasma proteins and labile clotting factors. It is obtained by separating and freezing plasma at minus thirty degrees centigrade from a donor unit of blood.
FFP should be used within six hours after thawing, ideally within two hours, in order to prevent deterioration of clotting factors. The most common volume is 250-300 ml although volumes ranging from 20 to 650 ml may be available.
FFP does not need to be cross-matched but should be ABO compatible. Group O FFP only should be transfused to group O recipients
- the BCSH guideline states that (1):
- with regard to ABO blood groups, the first choice of FFP is that of the same ABO group as the patient
- if this is not available, FFP of a different ABO group is acceptable so long as it has been shown not to possess anti-A or anti-B activity above a limit designed to detect 'high titres'. FFP of group O should only be given to O recipients (grade B recommendation, level III evidence)
- for infants and neonates, plasma should be free of clinically significant irregular blood group antibodies. FFP from group AB donors has no anti-A or anti-B antibodies, and is frequently preferred
FFP needs to be ABO compatible but not RhD compatible as it is unlikely to cause RhD sensitisation and therefore Anti-D prophylaxis is not required if an RhD negative recipient is transfused with RhD positive plasma
- recommendation from BCSH guideline on FFP (1) regarding this issue is as follows:
- Rh blood group compatibility
- although FFP and MBFFP may contain small amounts of red cell stroma, sensitization following the administration of Rh D-positive FFP to Rh D-negative patients is most unlikely as stroma is less immunogenic than intact red cells
- the 10th edition of the Council of Europe Guidelines do not require FFP packs to be labelled according to their Rh status (Council of Europe, 2004)
- the guideline recommendation is that Fresh-frozen plasma, MBFFP and SDFFP of any Rh type may be given regardless of the Rh status of the recipient. No anti-D prophylaxis is required if Rh D-negative patients receive Rh D-positive FFP (grade B recommendation, level IIa evidence)
NICE guidelines recommendations regarding FFP transfusion are:
- transfusion of FFP should only be considered for patients with clinically significant bleeding but without major haemorrhage if they have abnormal coagulation test results (for example, prothrombin time ratio or activated partial thromboplastin time ratio above 1.5)
- do not offer fresh frozen plasma transfusions to correct abnormal coagulation in patients who:
- are not bleeding (unless they are having invasive procedures or surgery with a risk of clinically significant bleeding)
- need reversal of a vitamin K antagonist
- consider prophylactic fresh frozen plasma transfusions for patients with abnormal coagulation who are having invasive procedures or surgery with a risk of clinically significant bleeding
- reassess the patient's clinical condition and repeat the coagulation tests after fresh frozen plasma transfusion to ensure that they are getting an adequate dose, and give further doses if needed
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