What are the risks of administering fresh frozen plasma (FFP) through regular primary tubing without a filter?

Risks of Administering Fresh Frozen Plasma Without a Blood Filter

Administering fresh frozen plasma (FFP) through regular primary tubing without a filter poses significant risks including microaggregate embolism, transfusion-related acute lung injury (TRALI), and potential pulmonary complications that can increase morbidity and mortality. 1

Key Risks of Using Regular Primary Tubing Without a Filter

Microaggregate-Related Complications

• Freshly thawed FFP contains numerous particles smaller than 20 microns in diameter, including:
  • Aggregated triglyceride-rich lipoproteins
  • Fibrin-like precipitable aggregates 1
• These microaggregates can form emboli in pulmonary arterioles when not filtered properly
• Studies have shown significantly higher rates of pulmonary complications in patients receiving unfiltered FFP 1

Standard Transfusion Risks (Increased Without Proper Filtration)

• Transfusion-related acute lung injury (TRALI) - a major risk with plasma transfusions, though reduced with male-donor plasma 2, 3
• Transfusion-associated circulatory overload (TACO) - risk increases with rapid infusion through non-standard tubing 4
• Allergic and anaphylactic reactions - proper administration equipment helps monitor and manage these reactions 4
• Febrile non-hemolytic transfusion reactions
• Bacterial contamination risks

Proper Administration Requirements

According to current guidelines, FFP should be administered:

• Using a standard blood giving set with a 170-200 μm filter 2
• Transfusion should be completed within 4 hours of thawing 2
• If delay in transfusion occurs, FFP may be stored at 4±2°C if infusion is completed within 24 hours of thawing 2

Clinical Implications

The AAGBI guidelines clearly state that FFP should be transfused using a standard blood giving set with a 170-200 μm filter 2. This is particularly important because:

1. The filter removes potentially harmful microaggregates that form during freezing and thawing
2. Proper filtration significantly reduces the risk of pulmonary complications in critically ill patients 1
3. Patients receiving large volumes of FFP (such as in major hemorrhage) are at particularly high risk when proper filtration is not used

Special Considerations

• Major hemorrhage scenarios: When FFP is used for replacement of coagulation factors during major hemorrhage (trauma, obstetrics), proper filtration becomes even more critical as large volumes are administered 2
• Critically ill patients: Those with compromised pulmonary function are at higher risk for complications from microaggregates 1
• Repeated FFP transfusions: Patients requiring multiple FFP transfusions have cumulative risk from microaggregates if proper filtration is not used 1

Conclusion

The evidence strongly indicates that administering FFP without the appropriate blood filter significantly increases the risk of pulmonary complications due to microemboli formation. This practice contradicts established transfusion guidelines and unnecessarily increases patient risk, particularly in those requiring large or repeated plasma transfusions.