بسم ا الرحمن الرحيــــــــــــم
LIQUID PLASMA Sources, Storage and utilization Akram Al-Hilali 2012
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DEFINITION OF LIQUID PLASMA
Plasma that is to be infused to patients is obviously always in liquid state. It could have been obtained by thawing of frozen plasma or could have been liquid from the start. Such liquid-state plasmas differ widely in their properties, shelf life, storage requirements, clinical utilization and benefits.
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SOURCES OF LIQUID PLASMA
Thawed FFP and FFP-24. Plasma separated more than 24 hours after whole blood unit collection. FFP thawed for infusion but not infused. Cryoprecipitate-depleted (coagulationdepleted) plasma. Aphaeresis-derived plasma intended for infusion. PPF, also named 5% albumin solution
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FRESH FROZEN PLASMA- FFP
Plasma separated within 8 hours of collection of whole blood unit. Plasma separated after passage of 8 hours but at less than 24 hours after collection (FFP-24). Stored at -18oC or less for a year and at -65oC or less for 7 years (USA). In Europe 3 months at -18 to -25 or 36 months at temperatures below -25. After thawing, if stored at 1-6oC it can be used within 24 hours, with little deterioration in coagulation factor content. Transport frozen if unthawed and at 1-10oC if thawed. Dose is 10-20 ml/kg. Rate of infusion is critical. Unit should be infused in less than 30 minutes.
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Thawed FFP vs. FFP-24 FFP
Basically used to correct coagulation defects- Pan specific Controversy on prophylactic use to prevent bleeding, except for patients going for surgery/tooth extraction. Contains almost full complement of FVIII and other labile factors Stored frozen at -18 or less Keeps for a year or more, depending on temperature of storage.
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FFP-24
Can be used to correct coagulation defects. Pan specific. Prophylactic use to correct coagulation is controversial, except for surgery and tooth extraction. Contains a little less FVIII and FV Stored frozen at -18 or less Keeps for a year
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COAGULATION FACTORS IN FFP
In FFP: at thawing, FVIII is 70-75% of original. In FFP-24 at thawing: FVIII is 64 to 76% in various publications. Factor V levels are in the same range. Coagulation factors drop to unacceptable levels after 24 hours of thawing. Little difference in levels between FFP and FFP-24. Both contain full complement of vW factor
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CRYO-DEPLETED PLASMA
Coagulation-depleted plasma CDLP Particularly deficient in FVIII Also deficient in FXIII. However, it does contain some fibrinogen. It is a colloid solution due to presence of albumin. Level is not different from FFP. Store as for thawed FFP at fridge temperature. Keeps for 5 days at 1-6oC. If frozen immediately after CP extraction it keeps like FFP.
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FFP vs Cryo-depleted Liquid Plasma CDLP
FFP
Contains full complement of FVIII (70 units or more per FFP unit). Contains full complement of vW factor and ADAMTs Contains full complement of Fibrinogen Volume of unit is 150-300 ml
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Contains trace of FVIII only. Contains very little vW factor FV level is normal Contains reasonable fibrinogen amount (~200 mg/dL.) Volume of unit is on average less than FFP 8
OTHER LIQUID PLASMAS
FFP thawed for infusion but not infused for some reason.
It should not be re-frozen. Discard if kept at room temperature for 5 hours or more. Otherwise, it should be kept at 1-6oC and can be used within 24 hours as FFP or 5 days as just liquid plasma.
Aphaeresis plasma, not frozen. Can keep for a month at 1-6oC. Plasma drawn from whole blood unit after 24 hours of donation, not frozen. Kept at 1-6oC. Expires 5 days after expiry of the unit of whole blood from which it was extracted (40 days or more)
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VOLUME OF LIQUID PLASMA -
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FFP and FFP-24 units are 150-300 ml. Other plasma units can be equal to FFP in volume They can also be a little smaller due to removal of some components. Aphaeresis-derived plasma (plasmapheresis) is usually larger in volume (could be 500 to 800 ml).
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FFP vs other Liquid Plasmas LIQUID PLASMA, OTHER THAN CDLP
FFP & FFP24
Volume 150-300 ml Contains full complement of coagulation factors. Contains normal level of vWF and ADAMTS Standard levels of factor VIII checked by QC (≥ 70 units per bag)
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Volume 150-800 ml Coagulation factors are reduced, particularly labile ones. vWF is a little reduced and is good for replacement therapy. Thawed plasma prepared from FFP but kept for 5 days has reduced FV, FVIII No standard levels. No QC for coagulation factors 11
Therapeutic Plasma Products Product
FFP FFP-24
Volume of unit (ml)
150-300 150-300
Storage temp -18oC or lower -18oC or lower
CDLP
120-250
1-6oC
Other LP
150-300
1-6oC Or frozen at -18 or lower
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Shelf life 12 months 24 hours after thawing
12 months 24 hours after thawing
FVIII At least 70 u/ FFP unit Equal or a little less than FFP
5 days. 12 months if frozen
Not tested
5 days from thawing or 5 days after expiration of whole blood
Not tested
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Storage of Liquid Plasma
No need to freeze, or re-freeze. Some centers do freeze LP. Freezing is more involved and expensive than cooling. Freezing is meant for coagulation factors preservation in FFP and FFP-24. However, they should not be refrozen after thawing. In LP our aim is not the coagulation factors replacement. Stored at 1-6oC. However, if frozen shelf life will be like FFP. Transported at 1-10oC
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THERAPEUTIC USES OF LIQUID PLASMA
As a colloid solution. There is roughly 3 g albumin per 100 ml. of LP (6-10 g/bag). As a replacement fluid in cases of extensive burns. Some FFP must be added to supply coagulation factors in such cases. As part of the replacement fluid in plasma exchange process. If vW factor is the target of the exchange then some LP products are not good (CDLP). Blood group compatibility is a must.
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ADVANTAGES OF HAVING THE STOCK OF LP AND USING IT
Discarding a useful product is a waste. Storage is not usually at freezing temperature. Conservation of some of FFP stock. FFP stock of certain blood groups may be of short supply or used up on certain cases needing plasma exchange. Supplementing by other LP products may be possible.
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WHAT IS PPF?
Originally, plasma from which coagulation factors and immunoglobulins were removed at factory level to produce specific products. Manufacturers claim that blood group antibodies (anti-A and anti-B) are removed from this product. Incidents of reaction due to BG antibodies have been reported. Basically a colloid solution of 5% albumin. Provided in liquid state or lyophilized state.
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PREPARATION OF LIQUID PLASMA
No thawing is involved (usually). It will be transported in exactly same manner as for packed red cells. It has to be discarded if it reaches room temperature and stays so for 5 hours. Same applies for FFP after thawing. Thawed FFP kept at 1-6oC for more than 24 hours and less than 5 days is not FFP any more. It is an LP.
SOLVENT-DETERGENT-TREATED PLASMA (SD-PLASMA)
Treated to eliminate pathogens. Prepared from pooled plasma in factories. Coagulation factors are reduced by 10-20% Stored frozen at -18 or less. Not used in USA any more. ABO group labeled
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QUALITY CONTROL FOR PLASMAS
FVIII level for FFP and FFP-24. This is a must in UK and EU, but not by FDA. Dubai Blood Donation Center performs this QC procedure for FFP, with the help of RH coagulation laboratory. 70 u or more per Unit of plasma is minimum content acceptable. FVIII can be assayed on a pooled sample from 5 units and the level taken as mean for QC assessment.
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Dubai Blood Donor Center FFP and FFP-24
Thawing is performed in hospital blood banks at temperature 30-37oC. FFP is currently the only plasma available for therapeutic use, and is used for all plasma purposes, coagulation or otherwise. FFP-24 is not available yet but will be soon with the installation of the alarm system of the freezer walk-in room. SOP draft prepared and we await a code to be introduced by LIS. It will consider that FFP-24 was part of the salvaged plasma and modified to FFP-24 All its procedures and QC will be identical to FFP. However, FVIII will not be checked.
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DBDC OTHER LIQUID PLASMAS
Other liquid plasma products will be introduced subsequently, one after the other, when cold room is ready for storage. QC on other liquid plasma products will include volume, storage temperature and transport condition. No check will be carried out on coagulation factors or albumin. PPF and solvent-detergent treated plasmas are not dealt with by DBDC or any other blood bank. PPF is a pharmacy item.
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BLOOD GROUP COMPATIBILITY
All plasmas have to be ABO-compatible (not necessarily identical) with patient. AB plasma is safe to give to all. There is no need to think about Rh compatibility. AB plasma is not an abundant product. There could be a supply problem if an AB patient needs large amounts for many days. FFP-24 can complement FFP in such cases. If indication is not TTP liquid plasmas con also be partly used (except CDLP) There are commercial standardized FFP units (Octaplasm). A stock of AB commercial plasma can be kept for special cases.
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DOSING OF THERAPEUTIC PLASMA
FFP and FFP-24: 10-20 ml/kg. Rate of infusion should be noted. Infuse a unit in less than 30 minutes to have an effect. May have to be repeated after 12 hours in cases of correction of warfarin over dosage or very high INR, due to short half-life of FVII. Liquid plasma has no dose control. Fluid overload should be monitored.
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