The plasma transfusion finds its main indication in the correction of
coagulation deficits for which the specific concentrate is not available, in
patients with bleeding in progress. The available products:
- Frozen fresh plasma (PFC)
- Fresh plasma frozen inactivated with various methods or quarantined
The transfusion of fresh frozen plasma is indicated in the following situations:
• Correction of congenital coagulation factor deficits, for which there is no
specific concentrate or multiple acquired factor deficits of coagulation when PT
or aPTT. expressed as a ratio, are> 1.5, in the following circumstances:
- presence of bleeding in patients with liver disease (grade of recommendation:
1C +)
- prevention of bleeding in case of surgery or invasive procedures in patients
with liver disease (grade of recommendation: 2C)
- patients treated with vitamin K antagonists, in the presence of intracranial
or major bleeding, or in the preparation of an indifferent surgical intervention
(grade of recommendation: 1C +), if not available prothrombin complex, which is
the first therapeutic choice;
- in patients with acute disseminated intravascular coagulation (CID) and
ongoing bleeding, in association with correction of the triggering cause (recommendation
level: 1C +)
- correction of vascular microcirculation in patients undergoing massive
transfusion. If PT and aPTT can not be obtained within a reasonable time, the
PFC transfusion can still be implemented in an attempt to stop bleeding (recommendation
grade: 1C +), deficiency of the individual coagulation factors, in the absence
of specific concentrates (eg factor V deficiency), in the presence of bleeding
in place or to prevent it, in case of surgery or invasive procedures (recommendation
grade: 1C +)
• aferetic treatment of thrombotic microangiopathies (thrombotic purple
thrombocytopenia, uremic-hemolytic yesndrome, hemolitic syndrome, anemia
elevated iliver enzymes and low platelet count - HELLP) as a replacement fluid;
(recommendation grade: 1A)
• reconstitution of whole blood for exsanguino-transfusion (grade of
recommendation: 2C)
• hereditary angioedema due to deficiency of the C1-esterase inactivator, in the
absence of the specific derivative plasma (degree of recommendation: 2C +)
The coagulation times of the newborn, on average longer than the adult, are not
necessarily related to a risk of bleeding. This is true even more so in the
preterm infant; therefore, only the alterations of the coagulation tests, in the
absence of symptoms or haemorrhagic risk, do not constitute an indication for
PFC transfusion.
The PFC is indicated:
- in the bleeding induced by vitamin K deficiency and in the bleeding (or in the
serious risk of bleeding) from CID;
- in the treatment of congenital deficiencies of a single coagulation factor for
which the relative concentrate is not available (grade of recommendation: 2C)
PFC should preferably be inactivated or quarantine.
Further details can be found in the joint recommendations of the Italian Society
of Neonatology c of SIMT1.
Defrosting the PFC must be between 30 and 37 ° C in a bath with continuous
agitation or other suitable instrumentation, in order to allow temperature
control.
The rat thawing the plasma must be transfused as soon as possible and, in any
case, not later than 24 hours, if stored at 4 +/- 2 ° c.
For the maximum time that may elapse between the end of thawing and the
initiation of the inactivated PFC transfusion, refer to the technical data sheet.
PFC 'after thawing can not be refrozen (recommendation grade: 1C +).
recommended therapeutic dosage of PFC and 10 -15 ml / kg of body weight.
However, the dosage depends on the monitoring of the clinical situation and
laboratory parameters (degree of IC + recommendations) that may justify the
administration of higher doses.
ABO-compatible plasma must be used in according with the receiver such as into the table (recommendation
level: 1C +).
PFC can be administered without respecting Rh compatibility; anti-D prophylaxis
is not required in Rh D-negative recipients transfused with PFC Rh D-positive
(plasma should be free of red blood cells) (recommendation level: 1C +).
Inappropriate indications
• Expansion of the blood volume;
• hypoproteinemia;
• correction of immunodeficiency;
• for nutritional purposes;
• correction of congenital or acquired deficits of coagulation factors
unaccompanied by hemorrhage, or correction of hemostatic disorders in chronic
non-decompensated chronic hematopathies (grade of recommendation: 1C +).
Absolute contraindications to the use of PFC are documented intolerance to
plasma or its components and congenital IgA deficiency in the presence of
anti-IgA antibodies.
Relative contraindications are represented by heart failure and pulmonary edema.
• allergic reactions
- mild (urticaria): are observed in 1% of patients
- severe and anaphylactic: they are observed in less than one case out of
100,000
• TRALI: non-cariogenic pulmonary edema occurring within 4-6 hours of PFC
transfusion. Its prevention is feasible through the use for clinical use of
plasma from male donor never transfused or from donor never transfused and
nullipara, or through the use of inactivated PFC
• Febrile reactions: appear in less than 1% of patients transfused with PFC and
up to 10% of patients undergoing plasmaexchange
• Citrate toxicity: may appear after rapid transfusion of large volumes of
plasma and is especially important in newborns and liver disease patients
• Transmission of infections: the freezing process inactivates the bacteria;
contamination and growth
of bacteria with release of endotoxins before freezing is extremely unlikely.
There is still a risk, albeit minimal, of transmission of viral infections or
other unknown or untested pathogens.
• GvHD: Pv-associated GvHD cases have never been reported. Freezing is lithic
lymphocyte, therefore it is not necessary to irradiate the plasma
• Circulation overload: may occur mainly in patients with renal or
cardiopulmonary insufficiency
• Inhibitors against deficient proteins: can be developed after plasma
transfusions in patients with severe congenital deficiencies of coagulation
factors.
For the use of plasma see also regional guidelines contained in the DA April 4,
2006 "Operational plan for 'implementation of security levels within the
Sicilian Region".
Before the administration proceed with simple checks:
-verify the absolute ABO and Rh D compatibility of the unit with the receiver
- do not add medicines to the unit to be transfused
- use the special deflectors equipped with a filter (170 to 200 μm
- the unit in the ward, but immediately start the transfusion
- do not transfuse if it shows signs of hemolysis or other obvious abnormalities
Infuse the first 25 ml of blood (proportionally smaller volumes for pediatric
patients) slowly (no more than 25 gtt / min) to allow immediate recognition of
an acute reaction
Hematology