Fresh Frozen Plasma Transfusion - Guildelines For Practice

CAUTION: You must refer to the intranet for the most relevant version of this policy
Fresh Frozen Plasma Transfusion- Guideline for

practice
Sharepoint Location Clinical Policies and Guidelines
Sharepoint Index Directory General Policies and Guidelines
Sub Area Haematology and Blood Transfusion
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Central Index No 0329
Endorsing Body Blood Transfusion Committee
Endorsement Date 29th April 2009
Review Date 29th April 2012
Lead author and designation Dr Kanchan Rege, Martin Drury and Kaye Bowen
(if under review) Review led by
Fresh Frozen Plasma transfusion- Guideline for practice

Central index 0329 29th April 2009 1
Fresh Frozen Plasma Transfusion- Guideline for practice

Background
Fresh Frozen Plasma (FFP) for adult use is produced from voluntary blood donations
collected in the UK. FFP for use in paediatrics is collected from non UK donors, to
reduce the risk of transmission of variant CJD. The plasma is then virally inactivated
by treatment with Methylene Blue or solvent detergent, to reduce the risk of
transmission of pathogens.
The indications for the use of FFP are limited but are primarily to provide clotting
factors to prevent bleeding due to coagulopathy. The risks of transmitting infection
are similar to those of other blood components unless specialised pathogen reduced
plasma is used. Of particular concern are allergic reactions and anaphylaxis,
transfusion –related lung injury and haemolysis from transfused antibodies to blood
group antigens especially A and B.
Purpose of the document
The purpose of this document is to give guidance to clinical staff who may be
involved in the requesting, prescription or administration of Fresh Frozen Plasma in
Peterborough and Stamford Hospitals NHS Foundation Trust.
Content
1 Indications for use of Fresh Frozen Plasma

1.1 Replacement of a single clotting factor deficiency when a virus –free
fractionated product is not available.
1.2 Acute Disseminated Intravascular Coagulation (DIC) in the presence of

haemorrhage and a documented coagulopathy.
1.3 Thrombotic Thrombocytopenic Purpura (TTP) usually in conjunction with

plasma exchange.
1.4 Massive transfusion and surgical bleeding; the use of FFP should be guided
by timely tests of coagulation.
1.5 Haemorrhagic disease of the newborn; FFP 10-20ml/kg and Intravenous

Vitamin K should be given
1.6 Reversal of Warfarin effect. In the presence of life threatening bleeding, FFP
only has a partial effect and is not the optimal treatment; Prothrombin
Complex Concentrates (Octaplex) are preferred for life threatening bleeding.
Consideration should also be given to vitamin K administration- refer to trust
guidelines on the use of Octaplex (Prothrombin complex concentrate/PCC)
for rapid reversal of warfarin in association with life threatening bleeding for
more information on warfarin reversal.
1.7 There is no role for FFP to correct abnormal coagulation results in the
absence of bleeding unless before an invasive procedure.

Please note that FFP will only be thawed for immediate use, not on ‘standby’
2 Dose and group
2.1 FFP is issued according to weight at a dose of 12-15ml/kg, which equates to

2-4 packs for an adult (one pack has an approx volume of 270-320 mls and is
equivalent to 2 standard FFP units). For adults, FFP should be prescribed as
individual units/packs/or bags NOT as a quantity in millilitres.
Weight / kg Units of FFP to

be given
50 2
60 3
70 3
80 4
90 4
100 5
2.2 If profuse bleeding is encountered, 2 packs of FFP may be issued, but a FBC
and coagulation sample MUST be taken to ascertain future requirements
2.3 The PT and APTT should be monitored and kept below 1.5 x normal control
(refer to trust policy for massive blood loss)
2.4 Patients born after 1st January 1996, and all patients under 16 years old
should only receive virally inactivated FFP, this is Methylene blue or solvent
detergent treated FFP from non-UK donors
2.5 Group compatible FFP should be used where possible. FFP which is not of
the same ABO group should only be used if they contain no high-titre anti A
or anti B
2.6 RhD (D) positive plasma may be given to RhD (D) negative females of
childbearing potential. Anti D prophylaxis is not required
2.7 The prescription should ideally be made on the dedicated blood product
prescription chart.
3. Administration
3.1 FFP should be administered through a 170-200µm filter (standard blood

giving set). A filter is required for the giving of FFP via a syringe for neonatal
transfusion.
3.2 The FFP pack should be visually inspected for pack integrity and
discolouration prior to transfusion. Check that packs do not appear grainy or
more cloudy than usual. If in doubt, DO NOT TRANSFUSE and contact the
transfusion laboratory for advice.
3.3 All patients receiving FFP must wear a trust ID band. The patient’s identity
must be checked by 2 members of staff prior to commencement of the

transfusion. The details on the tag attached to the FFP pack must be checked
against the details on the patients ID band. In addition, the patient should be
asked to confirm their name and date of birth, if they are able to do so.
3.4 FFP takes approximately 20- 30 minutes to thaw, and for maximum efficacy.
should be administered as soon as possible after thawing. Start the
transfusion as soon as the pack is received from the blood fridge. Return
unused packs to the transfusion laboratory for safe storage if transfusion is
not started within 30 minutes of removal from the fridge. FFP packs are
stored at 4ºC once thawed, and must be used within 24 hours of thawing-
there will be a note to this effect on the compatibility form issued with the
pack.
3.5 In adults each pack should be given over 20-30 minutes, though more rapid
infusion may be required in major bleeding. In paediatrics, the recommended
rate of transfusion is 10-20ml/kg/hr.
3.6 Inform the patient of possible complications of transfusion, and the

importance of reporting any adverse effects. A number of reactions may
follow FFP transfusions. They are the same as those which can occur after
the transfusion of red cell concentrates including:-
Febrile Reactions
Urticarial Reactions
Anaphylactic Reactions
Reaction to a bacterially contaminated unit.
Follow the same baseline, 15 minute and post transfusion observation checks
as for red cell transfusions.
If a reaction is suspected, STOP THE TRANSFUSION, and inform medical
staff and the transfusion laboratory immediately. An adverse event and
transfusion reaction form must be completed.
References
British Committee for Standards in Haematology 2004 Guidelines for the use of
Fresh Frozen Plasma, Cryoprecipitate and Cryosupernatant. British Journal of
Haematology 126(1): 11-28
British Committee for Standards in Haematology 2007 Amendment to the Guidelines

for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant Available;-
http://www.bcshguidelines.com/pdf/FFPAmendment_1_17_Oct_2007.pdf
British Committee for Standards in Haematology 2006; Guidelines on the

Management of Massive Blood Loss British Journal of Haematology 135(5): 634-41
McClelland D (editor) (2007) Handbook of Transfusion Medicine (4th ed). London,

TSO


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CAUTION: You must refer to the intranet for the most relevant version of this policy

Fresh Frozen Plasma Transfusion- Guideline for

Sharepoint Location Clinical Policies and Guidelines

Sharepoint Index Directory General Policies and Guidelines

Sub Area Haematology and Blood Transfusion

Key words (for search purposes)

Central Index No 0329

Endorsing Body Blood Transfusion Committee

Endorsement Date 29th April 2009

Review Date 29th April 2012

(if under review) Review led by

Fresh Frozen Plasma transfusion- Guideline for practice

Fresh Frozen Plasma Transfusion- Guideline for practice

Purpose of the document

1 Indications for use of Fresh Frozen Plasma

1.2 Acute Disseminated Intravascular Coagulation (DIC) in the presence of

1.3 Thrombotic Thrombocytopenic Purpura (TTP) usually in conjunction with

1.5 Haemorrhagic disease of the newborn; FFP 10-20ml/kg and Intravenous

Fresh Frozen Plasma transfusion- Guideline for practice

2 Dose and group

2.1 FFP is issued according to weight at a dose of 12-15ml/kg, which equates to

Weight / kg Units of FFP to

3.1 FFP should be administered through a 170-200µm filter (standard blood

Fresh Frozen Plasma transfusion- Guideline for practice

3.6 Inform the patient of possible complications of transfusion, and the

British Committee for Standards in Haematology 2007 Amendment to the Guidelines

British Committee for Standards in Haematology 2006; Guidelines on the

McClelland D (editor) (2007) Handbook of Transfusion Medicine (4th ed). London,

Fresh Frozen Plasma transfusion- Guideline for practice

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