What are the guidelines for storing Fresh Frozen Plasma (FFP)?

Fresh Frozen Plasma Storage Guidelines

Fresh frozen plasma must be stored frozen at -25°C or below, and once thawed can be stored at 4°C for up to 24 hours for general use, with an extended 5-day storage period specifically for major hemorrhage associated with trauma. 1

Initial Storage Requirements

• FFP is rapidly frozen to below -25°C to maintain the integrity of labile coagulation factors V and VIII 1
• The frozen state must be maintained at -18°C or colder until the time of use 2
• This freezing process preserves all factors of the soluble coagulation system 1

Thawing Methods

FFP can be thawed using three acceptable methods 1:

• Dry oven: 10 minutes
• Microwave: 2-3 minutes
• Water bath: 20 minutes at 37°C

Research suggests thawing at 45°C reduces thawing time by 17% without affecting coagulation factor activity, though 37°C remains the standard guideline recommendation 3

Post-Thaw Storage: Critical Time Limits

Standard Storage (General Use)

• Thawed FFP can be stored at 4°C for up to 24 hours 1, 4
• Once removed from refrigeration, FFP must be used within 30 minutes 1
• Never refreeze thawed FFP 1

Extended Storage (Trauma-Specific)

• For major hemorrhage associated with trauma, storage time has been extended to 5 days at 4°C 1
• This extended storage maintains adequate coagulation factor levels above minimum release criteria 2

Coagulation Factor Stability During Storage

The evidence demonstrates differential stability of clotting factors during refrigerated storage:

• Factor II and fibrinogen: Highly stable, with only 5% and 1% reduction respectively at 5 days 2
• Factor VIII: Significant decline of approximately 60% by day 5, though still above minimum therapeutic levels 2
• Factor V: Remains within normal range through 10 days of storage 3
• Factor VII: Stable or may increase during storage 5

Clinical caveat: While Factor VIII declines substantially, the remaining activity still exceeds minimum release criteria for general hemostatic support, though may be suboptimal for specific factor replacement 2

Storage Temperature Considerations

• Storage at 4°C is mandatory - room temperature storage is not recommended 5
• Room temperature storage causes more pronounced decreases in Factor VIII (to 59%) and Factor VII (to 69%), and dramatic reduction in Protein S (to 20%) by day 7 5
• The 4°C storage temperature maintains better overall coagulation factor stability 5

Blood Group Compatibility Requirements

• FFP should be ABO-compatible with the recipient 1, 4
• If blood group is unknown, use group AB FFP as it contains no anti-A or anti-B antibodies 1, 4
• For group O FFP given to non-group O children, it must be high-titre (HT) negative 1

Volume and Dosing Context

• Approximate volume per bag is 300 mL 1
• Recommended therapeutic dose is 15 mL/kg to achieve minimum 30% concentration of plasma factors 1, 4

Critical Safety Points

• Patient identification must be verified against the bag label before administration 1
• Every effort must be made to avoid wastage given specific storage constraints 1
• Male-only plasma is preferentially used in the UK to reduce transfusion-related acute lung injury (TRALI) risk 1