Guideline for the Use of Platelets in Transfusion



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|Guideline for the Use of Fresh Frozen Plasma & Cryoprecipitate in Transfusion (Adults, Children and Neonates) |

| |Jennifer Rock (Responsible for Review) |

|Author(s) |Hospital Transfusion Team |

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| |Dr Derek Norfolk, Consultant in Transfusion Medicine |

| |Dr Marina Karakantza, Consultant in Transfusion Medicine |

| |Lyeanda Berry, Transfusion Practitioner |

| |Sue Rabett, Transfusion Practitioner |

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|Date published: |October 2010 |

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|Review date: |July 2023 |

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|Summary |To give general guidance to clinical staff about the appropriate and safe use of FFP and cryoprecipitate|

| |transfusion. |

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| |To give guidance on the correct procedures for prescribing, requesting, ordering and administering FFP |

| |and cryoprecipitate. |

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|Aims and Objective |To provide guidance on the appropriate and safe use of Fresh Frozen Plasma (FFP), Cryoprecipitate and |

| |Pathogen Reduced Plasmas (PRP). To guide clinicians on the correct procedures for requesting, |

| |prescribing and administering the above. |

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|Clinical condition |Single coagulation factor deficiencies, multiple coagulation factor deficiencies, thrombotic |

| |thrombocytopenic purpura and massive haemorrhage. |

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|Target Patient Group |All patients requiring treatment for coagulopathy. |

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|Target Professional |Intensivists and medical / surgical clinicians. |

|Group | |

|Adapted from |British Committee for Standards in Haematology (2004) |

| |Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant |

| |British Journal of Haematology 126, 11-28 |

| |Multidisciplinary clinical team review including Consultants in Haematology, Surgery and Intensive Care.|

|Review Group | |

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|Authorised by | |

|Location of master copies |Signature |Date |

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|Intranet version available at: |

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CONTENTS

1. Introduction…………………………………………………………………………… 3

1.1 Rationale for guideline.………………………………………………..…… 3

1.2 About Fresh Frozen Plasma…………………………………..………….. 3

1.3 Solvent Detergent FFP……………………………….………………….. 4

1.4 Thresholds and Targets of FFP ……………………………..…………… 4

1.5 Cryoprecipitate…………………………………………………………….. 5

2. Storage and Shelf life……………………………………………………..….…...… 5

2.1 FFP & Cryoprecipitate…………………………………………….….…….. 6

3. Compatibility recommendations

3.1 Compatibility table for adults ……………………………………………… 6

4. Clinical Indications for the use of FFP and cryoprecipitate………………….. 6

4.1 Single Factor Deficiencies …………………………………………………… 6

4.2 Multiple Factor Deficiencies / Disseminated Intravascular Coagulation... 6

4.3 Massive Transfusion ………………………………………………..……….. 6

4.4 Liver Disease ………………………………………………………………….. 7

4.5 Thrombotic Thrombocytopenic Purpura ……………………………………. 7

5. Dosage ……………………………………..………………………………………….. 8

6. Administration of FFP and Cryoprecipitate………………………………….… 8

7. Children and Neonatal use of FFP and cryoprecipitate ……………..………… 9

7.1 Compatibility table for Paediatrics and Neonates………………….…….. 9

7.2 Neonatal and children < 1 year – indications for use…………………….. 9

8. Risks associated with the use of FFP ……………………….…………………… 9

8.1 Transfusion Transmitted Infections……………………………….………. 9

8.2 Transfusion Associated Graft versus Host Disease …………………….. 10

8.3 Transfusion Related Acute Lung Injury (TRALI)………….……..………. 10

8.4 Allergic reaction and anaphylaxis…………………………………………. 10

9. Written Informed Consent for Transfusion of FFP........………………….……. 10

10. Requesting & Documentation………………………..……………………….…… 11

11. Clinical audit …………………………………………………………………………. 11

12. References…………………………………………………………………………… 11

1. Introduction

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1 Rationale for guideline

The purpose of this document is:

• To give general guidance to clinical staff about the appropriate and safe use of FFP and cryoprecipitate transfusion.

• To give guidance on the correct procedures for prescribing, requesting, ordering and administering FFP and cryoprecipitate.

NB: FFP is not indicated for the reversal of warfarin therapy – prothrombin complex is safer and more effective.

For information on the management of Warfarin Reversal go to:

LTHT Guidelines for Warfarin Reversal



British Society for Haematology (2011).

Guidelines on oral anticoagulation (warfarin): 4th edition

British Journal of Haematology, 154, 311-324



1.2 Fresh Frozen Plasma (FFP)

FFP is donor plasma that has been frozen rapidly to 75% packs |

|Other clotting factors |Variable |

1.3. Solvent-detergent FFP

Solvent detergent treated FFP (SD-FFP) is available as a licensed medicinal product OctaplasLG®). OctaplasLG® is prepared from over 1500 plasma donations. The pooling process allows the clotting factors concentrations to be of a standardised concentration.

The solvent detergent (SD) process inactivates the bacteria and a number of encapsulated viruses3. SD FFP is recommended for high volume plasma exchange in patients with Thrombotic Thrombocytopenic Purpura (TTP) because of its increased efficacy compared to standard FFP in this setting.

The decision to transfuse OctaplasLG® is a clinical decision. The clinical team must communicate with the Blood Bank staff if OctaplasLG® is required.

Based on evaluation of the risk of transmission of vCJD, SaBTO recommends that the current risk reduction measures of the provision of imported plasma and apheresis platelets for individuals born on or after 1st January 1996 can be removed.

Please refer to SaBTO-Paediatric Components Working Group report for further advice:



1.4 Thresholds and Targets

1.4.1 Only consider fresh frozen plasma transfusion for patients with clinically significant bleeding but without major haemorrhage if they have abnormal coagulation test results (for example, prothrombin time ratio or activated partial thromboplastin time ratio above 1.5).

1.4.2 Do not offer fresh frozen plasma transfusions to correct abnormal coagulation in patients who:

• Are not bleeding (unless they are having invasive procedures or surgery with a risk of clinically significant bleeding)

• need reversal of a vitamin K antagonist

1.4.3 Consider prophylactic fresh frozen plasma transfusions for patients with abnormal coagulation who are having invasive procedures or surgery with a risk of clinically significant bleeding.

Doses

1.4.4 Reassess the patient’s clinical condition and repeat the coagulation tests after fresh frozen plasma transfusion. The coagulation results will guide if the patient has received an adequate dose of FFP or require further doses.

1.5 Cryoprecipitate

Cryoprecipitate is obtained by thawing FFP at 4(C. The cryoprecipitate remains the supernatant plasma as a gel like precipitate; this is then rapidly frozen to -25(C. It consists of the cryoglobulin fraction of plasma containing the major portion of Factor VIII and fibrinogen. It is issued by National Heath Service Blood & Transplant (NHSBT) and primarily used as a concentrated source of fibrinogen.

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|Constituents of Cryoprecipitate2 | |

|WBC count | ................
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