Fresh Frozen Plasma

Fresh frozen plasma is used to replace labile clotting factors in patients with coagulopathy and documented deficiency of clotting factors. This condition may derive from liver dysfunction, congenital absence of clotting factor, or transfusion of factor-deficient blood products. A unit of fresh frozen plasma contains near-normal levels of all clotting factors. A unit of fresh frozen plasma increases clotting factor levels by about 3%. Adequate clotting is usually achieved with factor levels above 30%, although higher levels are advisable in patients undergoing operative or invasive procedures. The pro-thrombin time and the activated partial thromboplastin time can be used to assess patients for fresh frozen plasma transfusion and to follow the efficacy of administered fresh frozen plasma.

Guidelines for administration of fresh frozen plasma are listed in Table 2. Documentation of factor deficiency or abnormal prothrombin time or activated partial thromboplastin time in a patient with clinical bleeding minimizes unnecessary use of fresh frozen plasma. Fresh frozen plasma should not be used routinely by preset

TABLE 2 ■ Suggested Transfusion Guidelines for Fresh Frozen Plasma

Treatment of multiple or specific coagulation factor deficiencies with abnormal prothrombin time and/or activated partial thromboplastin time

Abnormal specific factor deficiency in the presence of one of the following:

Congenital deficiency of antithrombin III; factors II, V, VII, IX, X, and XI; protein C or S; plasminogen or antiplasmin

Acquired deficiency related to warfarin therapy, vitamin K deficiency, liver disease, massive transfusion, or disseminated intravascular coagulation

Also indicated as prophylaxis for the above if a surgical/invasive procedure is planned Unwarranted indications

Empirical use during massive transfusion if patient does not exhibit clinical coagulopathy Volume replacement Nutritional supplement

Patients with severe cardiopulmonary diseases have higher surgical risks regardless of the approach. Due to their low cardiopulmonary reserve, these patients may develop important complications during and after laparoscopic surgery.

The cardiovascular effects of pneumoperitoneum are diverse and are exaggerated in patients with cardiovascular disorders.

formula after red blood cell transfusion. With the availability of equally effective but safer (albumin, hetastarch) and less expensive (crystalloids) solutions, fresh frozen plasma should not be used as a volume expander (11).

A new plasma product, solvent detergent plasma, has recently been approved by the U.S. Food and Drug Administration and is available from the American Red Cross. This product is essentially fresh frozen plasma that has been treated to inactivate enveloped viruses, particularly human immunodeficiency virus, hepatitis B, and hepatitis C. As a result, solvent detergent plasma should have a virtually zero risk of transmitting these infections. It is more expensive than fresh frozen plasma, and supplies are currently limited. solvent detergent plasma is prepared from pools of 2500 U of fresh frozen plasma. The treatment with solvent detergent inactivates lipid-enveloped viruses, but does not inactivate non-lipid-enveloped virus such as hepatitis A and parvovirus (such transmission has been documented). It does not have any effect on prions, if indeed these can be transmitted by plasma transfusions (12). The benefits of using such a product would be offset by the use of many products that have not undergone viral inactivation. It appears reasonable to consider solvent detergent plasma for patients receiving plasma exclusively (or nearly so): coagulation factor deficiency, warfarin reversal, microangiopathic hemolytic anemia (thrombotic throm-bocytopenic purpura, hemolytic uremic syndrome). solvent detergent plasma would be contraindicated in the following: pregnancy, except at the time of delivery; neonates; chronic hemolytic anemia; sickle cell disease; patients undergoing chemotherapy or radiation; and patients receiving large amounts of other untreated blood components.

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