Dosing and uses of FFP, Octaplas (fresh frozen plasma)
Adult dosage forms and strengths
pooled human plasma solution (Octaplas)
- 45-70mg/mL (as human plasma protein)
Management/Prevention of Bleeding
FFP: 10-20 mL/kg of body weight will increase factor levels by 20-30%
Frequency of transfusion depends on the half-life of the deficient factor(s)
In adults and large children, dosing is rounded to the nearest number of units
Number of units = Desired dose (mL) / 200 mL/unit
Coagulation Factors Replacement
Indicated for replacement of multiple coagulation factors in patients with acquired deficiencies due to liver disease or those undergoing cardiac surgery or liver transplantation
Octaplas: 10-15 mL/kg IV initially; this should increase plasma coagulation factors by ~15-25%
If hemostasis not achieved, use higher doses and adjust dose based on desired clinical response
Monitor response, including measurement of aPTT, PT, and/or specific coagulation factors
Thrombotic Thrombocytopenic Purpura (TTP)
Indicated for plasma exchange in patients with TTp
Octaplas: Completely replace plasma volume removed during plasmapheresis with Octaplas; generally, 1-1.5 plasma volumes corresponds to 40-60 mL/kg IV
Administration (Octaplas)
Administer via infusion set with filter
Inspect visually for particulates and discoloration; do not use if turbid
Avoid shaking
Not to exceed IV infusion rate of 1 mL/kg/min
Dosing Considerations
Administer based on ABO-blood group compatibility
Other Indications & Uses
Fresh Frozen Plasma, Plasma Frozen within 24 hours, Thawed Plasma, Liquid Plasma (FFP, P24, TP, LP) may be used to treat bleeding due to acquired multiple factor deficiencies such as seen due to large volume bleeding or DIC.
Plasma transfusion is indicated for
- Management of bleeding or to prevent bleeding prior to an urgent invasive procedure in patients requiring replacement of multiple coagulation factors
- Massively transfused patients who have clinically significant coagulation deficiencies and hypovolemia
- Patients on warfarin therapy with bleeding or that need to undergo an invasive procedure before vitamin K could reverse the effects of warfarin or who need only transient reversal of warfarin effects
- For transfusion or plasma exchange in patients with thrombotic thrombocytopenic purpura (TTP) and some cases of hemolytic uremic syndrome (HUS)
- Management of patients with selected coagulation factor deficiencies, congenital or acquired, for which no specific coagulation concentrates are available (i.e., factors II (2), V (5), VII (7), X (10), XI (11), Proteins C or S*
- Management of patients with rare specific plasma protein deficiencies, such as C1 inhibitor, when recombinant products are unavailable*
- FFP is the product of choice for patients specifically requiring replacement of the labile clotting factors or other proteins with poor storage stability because the other plasma products may be deficient in these factors during liquid storage; deficiencies due to consumption/hemodilution rarely fall to levels that are inadequately treated with non-FFP plasma components; consultation with a hematologist or transfusion medicine physician is recommended for assistance with indications 3-6
Pediatric dosage forms and strengths
Management/Prevention of Bleeding
Octaplas: Safety and efficacy in children not established
Neonates and small children
- FFP: 10-15 mL/kg of body weight will increase factor levels by 15-25%
- Transfusion frequency depends on the half-life of the deficient factor(s)
- Depending on the dose requested, an aliquot of 1 unit, a whole unit or more than 1 unit of plasma may be issued
- Specific volume to be transfused should be specified to the transfusionist to prevent volume overload in neonates and small children or those at increased risk of volume overload
Large children
- Please see adult dosing
FFP, Octaplas (fresh frozen plasma) adverse (side) effects
≥1% (Octaplas)
Nervous system: Headache, paresthesia
Gastrointestinal: Nausea
Skin and subcutaneous tissue disorders: Pruritus, urticaria
Frequency not defined (FFP)
Hemolytic Transfusion Reactions
Febrile Non-Hemolytic Reactions
Allergic Reactions ranging from urticaria to anaphylaxis
Septic Reactions
Transfusion Related Acute Lung Injury (TRALI)
Circulatory Overload
Transfusion Associated Graft Versus Host Disease
Post-transfusion Purpura
Postmarketing Reports (Octaplas)
Blood system disorders: Hyperfibrinolysis
Immune system disorders: Hypersensitivity reactions including anaphylactoid and allergic type of reactions
Metabolic and nutritional disorders: Alkalosis
Cardiovascular disorders: Cardiac arrest, circulatory overload, thromboembolism, tachycardia
Respiratory, thoracic and mediastinal disorders: Respiratory arrest or failure, bronchospasm, pulmonary edema, dyspnea, tachypnea
Gastrointestinal disorders: Abdominal pain, vomiting
Skin and subcutaneous tissue disorders: Rash, erythema
General disorders and administration site conditions: Fever and/or chills, chest discomfort or pain
Investigations: Seroconversions (passive transfer of antibodies)
Injury, poisoning and procedural complications: Citrate toxicity
Warnings
Contraindications
FFP should not be used solely for volume expansion, or to "correct" a mildly prolonged PT or PTT without active bleeding; patients may have a mildly prolonged PT or PTT and yet have hemostatically stable levels of coagulation factors
Plasma should not be given for replacement of isolated factor or specific protein deficiencies if the appropriate factor concentrates are available
Plasma should not be given for vitamin K deficiency or warfarin reversal if correction can safely be achieved using vitamin K supplementation
Octaplas
- IgA deficiency
- Severe protein S deficiency
- History of hypersensitivity to fresh frozen plasma (FFP) or to plasma-derived products including any plasma protein
- History of hypersensitivity reaction to Octaplas
Cautions (FFP)
If a transfusion reaction is suspected, the transfusion should be stopped, the patient assessed and stabilized, the blood bank notified, and a transfusion reaction investigation initiated
Massive or rapid transfusion may lead to arrhythmias, hypothermia, hyperkalemia, hypocalcemia, dyspnea, and/or heart failure
Many blood banks utilize P24 and/or thawed plasma interchangeably with FFP; if FFP is specifically needed, it is advisable to inform your institution’s blood bank at the time of request to ensure appropriate product transfusion
Plasma components contain a significant amount of antibodies against the ABO blood group antigens and ABO compatible plasma must be used
Liquid plasma (please see pharmacology for description) may have a significant amount of viable lymphocytes and should be irradiated if the patient is at increased risk of TA-GVHD (see the irradiated blood product monograph)
All transfusions must be given via blood administration sets containing 170- to 260-micron filters or 20- to 40-micron microaggregate filters unless transfusion is given via a bedside leukocyte reduction filter; no other medications or fluids other than normal saline should be simultaneously given through the same line without prior consultation with the medical director of the blood bank
Patient’s should be monitored for signs of a transfusion reaction including vitals pre, during, and post transfusion.
Non-septic infectious risks include transmission of HIV (~1:2 mill), HCV (~1:1.5 mill), HBV (1:300k), HTLV, WNV, CMV, parvovirus B19, Lyme disease, babesiosis, malaria, Chaga’s disease, vCJd
Consult with blood bank medical director or hematologist if you have questions regarding special transfusion requirements
Cautions (Octaplas)
Transfusion reaction may occur with ABO mismatch
High infusion rates can induce hypervolemia with consequent pulmonary edema or cardiac failure
Excessive bleeding due to hyperfibrinolysis can occur due to low levels of alpha2-antiplasmin (ie, plasmin inhibitor); monitor for signs of excessive bleeding in patients undergoing liver transplantation
Thrombosis can occur due to low levels of Protein s
Octaplas is made from human plasma, it may carry a risk of transmitting infectious agents (eg, viruses, vCJD agent); undergoes solvent-detergent purification
Do not inject drugs containing calcium in the same IV line (precipitant may occur)
Citrate toxicity
- Citrate toxicity can occur with volumes exceeding 1 mL/kg/min of Octaplas
- Do not exceed infusion rate of 0.02-0.025 mmol/kg/min of citrate (ie, <1 mL/kg/min Octaplas)
- Symptoms attributable to citrate toxicity (hypocalcaemia) include fatigue, paresthesia, and muscle spasms, especially in patients with liver function disorders
- Administer calcium gluconate IV into another vein in order to minimize citrate toxicity
Pharmacology of FFP, Octaplas (fresh frozen plasma)
Mechanism of action
Each unit provides all plasma proteins and clotting factors to support adequate hemostasis to treat or prevent bleeding or to treat other protein deficiencies that cannot be replaced with protein specific concentrates
Description
Fresh frozen plasma (FFP): Plasma from a unit of whole blood separated by centrifugation and frozen within 8 hours of collection
P24 plasma: Essentially the same as FFP except that the separation and centrifugation occurred between 8 and 24 hours of collection
Thawed plasma: Either FFP or P24 plasma that has been relabeled after being stored thawed for 24 hr
Liquid plasma: Plasma that has been separated from whole blood and never frozen
Pooled plasma and solvent-detergent treated pooled plasma are now available in the United States (Octaplas)
Storage
FFp
- Stored at -18º C (negative 18º C) or colder for up to 12 months
- Thaw at 30-37ºC and kept at 1-6º C for no longer than 24 hours after thawing
- FFP contains an average of 1 IU/mL of each coagulation factor, including the labile factors V and VIII
P24 plasma
- May have decreased amounts of labile proteins such as factors VIII (8) and V (5)
Thawed plasma
- Thawed plasma may be stored for an additional 4 days reducing the wastage of untransfused FFP or P24; it contains sufficient amounts of stabile proteins and clotting factors for most indications of plasma transfusion
- By day 5 of storage the amount of factor VIII (8) is reduced by up to 40% and factors V (5) and VII (7) may be reduced by up to 20%
Liquid plasma
- Maximum storage of 5 days longer than the unit of whole blood it was collected from
- Like thawed plasma the amount of labile clotting factors are reduced with extended storage but contains sufficient amounts of stabile clotting factors
- This product is almost solely used in for emergency transfusions, such as in trauma cases, when plasma is needed more rapidly than frozen plasma products can be thawed and prepared for issue
- Not all institutions keep liquid plasma on stock
Octaplas
- Store at ≤-18°C (-0.4°F) protected from light
- Use thawed product with 12 hr if stored at 2 -4°C (35.6-39.2°F) or within 3 hr if stored at 20 - 25°C (68-77°F)
- Do not refreeze thawed product
- Discard unused product
