Fresh Frozen Plasma in Plasmapheresis
Fresh frozen plasma (FFP) is administered during plasmapheresis to replace removed coagulation factors and prevent bleeding complications by maintaining hemostatic balance.
Rationale for FFP in Plasmapheresis
Plasmapheresis involves the removal of patient plasma and replacement with a substitute fluid. When plasma is removed, essential coagulation factors are also removed, creating a potential risk for coagulopathy. FFP serves as the ideal replacement fluid because:
- It contains all soluble coagulation factors, including the labile factors V and VIII 1
- It provides balanced replacement of both pro- and anticoagulant proteins 1
- It helps maintain hemostatic capacity in patients undergoing plasma exchange
Components of FFP
FFP contains:
- All factors of the soluble coagulation system
- Approximately 2.5-3.0 g/L of fibrinogen 2
- Other plasma proteins necessary for normal hemostasis
- Volume of approximately 300 ml per unit 1
Specific Indications for FFP During Plasmapheresis
FFP is specifically indicated for:
- Thrombotic thrombocytopenic purpura (TTP) - The AAGBI guidelines explicitly state that FFP is indicated for "thrombocytopenic purpura usually with plasmapheresis preferably using pathogen-inactivated FFP" 1
- Replacement of multiple coagulation factors that are removed during the procedure
- Maintaining hemostatic balance in patients undergoing plasma exchange
Administration Considerations
When administering FFP during plasmapheresis:
- FFP should be ABO compatible with the patient
- If blood group is unknown, group AB FFP is preferred as it does not contain anti-A or anti-B antibodies 1
- The recommended therapeutic dose is 15 ml/kg 1
- FFP can be thawed using a dry oven (10 min), microwave (2-3 min), or water bath (20 min) 1
- Once thawed, FFP can be stored at 4°C for up to 24 hours 1
Potential Risks and Complications
FFP administration is not without risks:
- Transfusion-related acute lung injury (TRALI) - reduced by using male-donor plasma 1
- Transfusion-associated circulatory overload
- Allergic reactions
- Transmission of infectious diseases (though risk is minimized with pathogen-inactivated plasma) 1
- In patients with cirrhosis, FFP may increase portal pressure and potentially increase bleeding risk 1
Common Misconceptions
It's important to note that FFP should not be used:
- Simply for volume replacement 1, 3
- For prophylactic correction of mild-moderate coagulation abnormalities in non-bleeding patients 1, 4
- As nutritional support 5
Alternative Replacement Fluids
While FFP is often the preferred replacement fluid in plasmapheresis, alternatives may include:
- Albumin solutions (when coagulation factor replacement is not necessary)
- Pathogen-inactivated plasma (preferred in TTP) 1
- Cryoprecipitate (when higher fibrinogen concentration is needed) 2
By providing all necessary coagulation factors in a balanced ratio, FFP remains the optimal replacement fluid for plasmapheresis when maintenance of hemostatic function is required, particularly in conditions like TTP where specific plasma factors are needed for therapeutic effect.