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Draft:Plasma

  • Comment: There is nothing of substance that isn't already covered in the linked article. I suggest you look to expand that article rather than create a new one. MarcGarver (talk) 15:33, 12 December 2024 (UTC)

Plasma

Plasma is a blood product made from the liquid portion of whole blood that has been centrifuged, separated, and frozen solid at −18 °C (0 °F) or colder.

Plasma for transfusion or for fractionation can be prepared from whole blood or collected by apheresis. It is used to treat conditions in which there are low blood clotting factors (INR > 1.7) or low levels of other blood proteins.[1][2] Plasma is used for the treatment of deficiencies of coagulation proteins or rare bleeding disorder for which specific factor concentrates are unavailable or undesirable. Plasma is the usual treatment for factor V deficiency.[3]  A usual dose of plasma is 10–20 mL/kg recipient weight.[4] It may also be used as the replacement fluid in plasma exchange.[5][6] Using ABO-compatible plasma, while not required, may be recommended.[7][8] Use as a volume expander is not recommended.[2]

Risks of plasma transfusion

The risks of plasma transfusion include disease transmission, anaphylactic reactions, and excessive intravascular volume (transfusion associated circulatory overload (TACO)), as well as transfusion related acute lung injury (TRALI). Risks of transfusion transmitted infections are similar to that of other blood products.

A number of different plasma products exist, including fresh frozen plasma (FFP), liquid and thawed plasma, cryoprecipitate reduced plasma. Depending on the jurisdiction, plasma freezing times and temperatures vary. In general plasma frozen within 24 hours of collection is considered FFP.

The phrase "FFP" is used to refer to any frozen blood plasma product intended for transfusion. FFP is frozen to -18˚C or below within 24 hrs of collection, and can be stored in Europe for up to 36 months at − 25 °C.[1]  In the US plasma is stored at  -18˚C or colder for 12 months, or at -65˚C or colder for 7 years [2,3]. After thawing FFP needs to be transfused within 24 hrs. FFP units contain Factor VIII levels above 70 IU, fibrinogen above 140 mg and von Willebrand factor above 100 IU.[1] Depending on the jurisdiction, plasma freezing times, temperatures, shelf-lives and quality control requirements vary.

Plasma frozen within 24 hours (PF24)

In the United States, FFP is considered plasma frozen within 8 hrs of collection and plasma frozen within 24 hours of collection is considered PF24.[5][2][6] PF24 has slightly lower levels of Protein C, Factors V and VIII than FFP. PF24 is more commonly used than FFP in the United States. PF24 can be stored at -18˚C or colder for 12 months.

The production of PF24 began in response to an increase in reported cases of transfusion-related acute lung injury, or TRALI. The proposed mechanism of TRALI involves antibodies from donor blood components (predominantly plasma) that are directed against human leukocyte antigens (HLA).[9] These antibodies are most numerous in women who have been pregnant more than once. Thus, removing these women from the donor pool for frozen plasma was proposed as a solution to the TRALI problem (the women's plasma could still be used for production of other components, including cryoprecipitate and fractionation). The use of PF24 has been accompanied by a decrease in the incidence of TRALI—a roughly 50% reduction in reported cases.[10]

Thawed plasma is made from FFP or PF24, and kept refrigerated (at 1–6 °C) after thawing can be stored for 5 days post thaw [8]. Thawed Plasma contains stable coagulation factors such as Factor II and fibrinogen in concentrations clinically similar to those of FFP, but variably reduced amounts of other factors.[2]

Cryoprecipitate reduced plasma

Plasma can be thawed slowly at 2-6˚C or by the rapid thaw-siphon technique resulting in cryoprecipitate formation. The supernatant is known as cryoprecipitate-poor plasma or cryoprecipitate-reduced plasma, and is reduced in fibrinogen, Factor VIII, Factor XIII, vWF, and cryoglobulin. Proteins such as albumin, ADAMTS13, and Factors II, V, VII, IX, X, and XI remain at levels similar to the plasma product used to prepare the cryoprecipitate.[2] It can be stored at -18 ˚C or colder for 12 months.

Plasma Cryoprecipitate Reduced is used for transfusion or plasma exchange in patients with TTP. It may be used to provide clotting factors except fibrinogen, Factor VIII, Factor XIII, and vWF for transfusion support of patients with appropriate clinical indications when specific plasma concentrates and/or other plasma products are not available.[2]

Further reading

  • O'Shaughnessy DF, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, Yates S, Williamson LM (July 2004). "Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant". British Journal of Haematology. 126 (1): 11–28. doi :10.1111/j.1365-2141.2004.04972.x. PMID 15198728. S2CID 27980310.
  • Green L, Cardigan R, Beattie C, Bolton-Maggs P, Stanworth SJ, Thachil J, Kallis Y, Zahra S. (August 2017).  Amendments and corrections to the 'Transfusion Guidelines for neonates and older children' (BCSH, 2004a); and to the 'Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant' (BCSH, 2004b). Br J Haematol. 2007 Feb;136(3):514-6. doi: 10.1111/j.1365-2141.2006.06451.x.

References

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  1. ^ a b c Mayr, Wolfgang R. (2007-09-05). "Guide to the Preparation, Use and Quality Assurance of Blood Components, 13th edition". Vox Sanguinis. 93 (3): 279. doi:10.1111/j.1423-0410.2007.00965.x. ISSN 0042-9007.
  2. ^ a b c d e f AABB Circular of Information for the Use of Human Blood and Blood Components June 2024, Product Code: 243011, ISBN: 978-1-56395-501-3
  3. ^ Mumford, Andrew D.; Ackroyd, Sam; Alikhan, Raza; Bowles, Louise; Chowdary, Pratima; Grainger, John; Mainwaring, Jason; Mathias, Mary; O'Connell, Niamh; the BCSH Committee (November 2014). "Guideline for the diagnosis and management of the rare coagulation disorders: A United Kingdom Haemophilia Centre Doctors' Organization guideline on behalf of the British Committee for Standards in Haematology". British Journal of Haematology. 167 (3): 304–326. doi:10.1111/bjh.13058. ISSN 0007-1048. PMID 25100430.
  4. ^ Fung MK, Grossman BJ, Hillyer CD, Westhoff CM (2014). Technical manual (18th ed.). Bethesda, Md.: American Association of Blood Banks. ISBN 978-1563958885. OCLC 881812415.
  5. ^ a b AABB Technical Manual (21st ed.). 2023. ISBN 978-1-56395-464-1.
  6. ^ a b Yazer MH, Triulzi DJ, Hassett AC, Kiss JE (May 2010). "Cryoprecipitate prepared from plasma frozen within 24 hours after phlebotomy contains acceptable levels of fibrinogen and VIIIC". Transfusion. 50 (5): 1014–8. doi:10.1111/j.1537-2995.2009.02535
  7. ^ Transfusion-Related Lung Injury (TRALI). Karp, Julie Katz. NewsPath (College of American Pathologists online newsletter). Posted Jan. 1, 2010.
  8. ^ Mostly male plasma sends TRALI rates south. Paxton, A. CAP Today (lead article). College of American Pathologists. October 2009.
  9. ^ Joy MA, Eshraghi Y, Novikov M, Bauer A (2015). "Transfusion Medicine". In Sikka PK, Beaman ST, Street JA (eds.). Basic Clinical Anesthesia. Springer. p. 102. ISBN 9781493917372.
  10. ^ Joy MA, Eshraghi Y, Novikov M, Bauer A (2015). "Transfusion Medicine". In Sikka PK, Beaman ST, Street JA (eds.). Basic Clinical Anesthesia. Springer. p. 102. ISBN 9781493917372.
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