From the Guidelines
Fresh Frozen Plasma (FFP) can be effective for treating certain types of angioedema, particularly hereditary angioedema (HAE) and acquired C1 inhibitor deficiency, but it is generally considered a second-line treatment option due to its potential risks and the availability of more specific therapies 1. The typical dose of FFP is approximately 10-15 mL/kg body weight, administered intravenously during an acute attack, although the optimum dose is unknown and may be at least 20 ml/kg 1. FFP works by providing C1 esterase inhibitor, which is deficient in HAE patients. However, FFP carries risks of volume overload, allergic reactions, and potential for blood-borne pathogen transmission. Some key points to consider when using FFP for angioedema include:
- FFP may be effective in aborting most attacks, but the response can be slow, requiring prolonged hospitalization and resulting in increased overall management costs 1.
- FFP can cause transfusion reactions, including anaphylactic reactions, and may worsen angioedema in some cases due to the presence of complement proteins that can activate the contact system 1.
- The use of FFP may be limited by the need for hospitalization and the potential for adverse effects, highlighting the need for more accessible and effective treatment options for HAE, such as on-demand self-administered therapies 1. It is essential to weigh the potential benefits and risks of FFP in the treatment of angioedema and to consider alternative therapies, such as C1 inhibitor concentrates, icatibant, or ecallantide, which may be more effective and safer for some patients 1.
From the Research
Effectiveness of Fresh Frozen Plasma (FFP) for Angioedema
- FFP has been used as a treatment alternative for hereditary angioedema (HAE) in cases where C1-esterase inhibitor concentrates are not available 2.
- A study published in 2007 reported that three patients with acute exacerbations of HAE were effectively and safely treated with FFP 2.
- However, another study published in 2001 noted that intravenous administration of FFP can be useful in acute HAE, but it occasionally exacerbates symptoms 3.
- The use of FFP for angioedema is not as effective as C1 esterase inhibitor concentrates, which are recommended as the first-line therapy for HAE 4, 3.
- It is also important to note that FFP is not a recommended treatment for ACE inhibitor-induced angioedema, as it has limited efficacy in this context 5.
Comparison with Other Treatments
- C1 esterase inhibitor concentrates have been shown to be effective in treating acute abdominal and facial attacks in patients with HAE, with a rapid onset of relief 4.
- Gene therapy using an adeno-associated virus (AAV) gene transfer vector expressing the genetic sequence of the normal human C1 esterase inhibitor has also been explored as a potential treatment for HAE, with promising results in a murine model 6.
- Other treatments, such as corticosteroids, antihistamines, and epinephrine, are not typically efficacious in aborting acute attacks of HAE, but may be useful as adjuncts 3.