From the Guidelines
Fresh Frozen Plasma (FFP) can be used to treat angioedema, particularly in settings where more targeted therapies are unavailable or in emergency situations, as it contains C1 inhibitor that can help resolve angioedema attacks by replacing the missing or dysfunctional protein 1. The use of FFP in treating angioedema is supported by guidelines that suggest its use when first-line treatments, such as C1-INH, icatibant, or ecallantide, are not available 1. Key points to consider when using FFP for angioedema include:
- FFP is generally considered a second-line treatment due to the potential for worsening symptoms in some patients by providing additional substrate for bradykinin production 1.
- The typical dose of FFP is 2-4 units (approximately 10-15 mL/kg) administered intravenously during an acute attack.
- Modern treatment options like specific C1 inhibitor concentrates, icatibant, or ecallantide are preferred when available because they are more targeted therapies with fewer potential complications 1.
- The mechanism of action of FFP involves providing functional C1 inhibitor to regulate the complement, contact, and fibrinolytic pathways that are dysregulated in certain forms of angioedema 1. It is essential to weigh the potential benefits and risks of using FFP, considering the availability of alternative treatments and the individual patient's circumstances, including their values and preferences 1.
From the Research
Fresh Frozen Plasma (FFP) for Angioedema
- FFP has been used as a treatment option for patients with hereditary angioedema (HAE) because it contains C1 esterase inhibitor, an enzyme that helps regulate the immune system 2, 3.
- Studies have shown that FFP can be an effective treatment for acute attacks of HAE, particularly in cases where C1 esterase inhibitor concentrates are not available 2, 4.
- FFP has also been used as a prophylactic agent to prevent attacks of HAE, especially in pregnant women where other prophylactic methods may be contraindicated 5.
- In addition to HAE, FFP has been used to treat angioedema caused by angiotensin-converting enzyme (ACE) inhibitors, which can be resistant to conventional therapy 6.
- The use of FFP in treating angioedema is thought to be safe and effective, with no evidence of exacerbating symptoms or precipitating attacks 3.
Mechanism of Action
- FFP contains C1 esterase inhibitor, which helps to regulate the immune system and prevent the formation of bradykinin, a peptide that can cause blood vessels to dilate and lead to angioedema 2, 3.
- In the case of ACE inhibitor-induced angioedema, FFP may help to break down accumulated bradykinin, which can contribute to the development of angioedema 6.
Clinical Evidence
- Several studies have reported the successful use of FFP in treating acute attacks of HAE and preventing future attacks 2, 5, 3.
- A review of patient records and medical literature found no evidence that FFP exacerbates symptoms or precipitates attacks of HAE 3.
- A case report described the successful use of FFP in treating a patient with resistant ACE inhibitor-induced angioedema 6.