Blood Component Therapy

Introduction to Blood Component Therapy

Blood component therapy, including plasmapheresis and fresh frozen plasma (FFP) administration, is used to replace removed coagulation factors and prevent bleeding complications by maintaining hemostatic balance, as FFP contains all soluble coagulation factors, including the labile factors V and VIII 1, 2
FFP provides balanced replacement of both pro- and anticoagulant proteins, helping maintain hemostatic capacity in patients undergoing plasma exchange, as recommended by the AAGBI guidelines 1, 2

FFP is indicated for thrombotic thrombocytopenic purpura (TTP), usually with plasmapheresis, preferably using pathogen-inactivated FFP, and for replacement of multiple coagulation factors that are removed during the procedure and for maintaining hemostatic balance in patients undergoing plasma exchange 1
FFP is also indicated for major hemorrhage, often in a balanced ratio with red blood cells (1:1 or 1:1.5), and in disseminated intravascular coagulation (DIC) with active bleeding, as recommended by the American Society of Anesthesiologists and the American College of Chest Physicians 3

FFP should be ABO compatible with the patient, and if blood group is unknown, group AB FFP is preferred as it does not contain anti-A or anti-B antibodies, with a recommended therapeutic dose of 15 ml/kg 1
FFP can be thawed using a dry oven, microwave, or water bath, and once thawed, can be stored at 4°C for up to 24 hours, with extended storage of up to 5 days for trauma-related major hemorrhage 1

Transfusion-related acute lung injury (TRALI) is a risk, reduced by using male-donor plasma, and transmission of infectious diseases is a risk, though minimized with pathogen-inactivated plasma 1, 2
FFP should not be used simply for volume replacement or for prophylactic correction of mild-moderate coagulation abnormalities in non-bleeding patients, as recommended by the AAGBI guidelines 1
In patients with cirrhosis, FFP may increase portal pressure and potentially increase bleeding risk 2

Albumin solutions may be used when coagulation factor replacement is not necessary, and pathogen-inactivated plasma is preferred in TTP 1
Cryoprecipitate may be used when higher fibrinogen concentration is needed, with a dose of 2 units per 10 kg of body weight to raise plasma fibrinogen by 1 g/L, and fibrinogen concentrate is a virus-inactivated derivative of pooled plasma, providing more predictable amounts of fibrinogen than cryoprecipitate 4
Fibrinogen levels should be maintained above 2 g/L in obstetric hemorrhage, and targeted fibrinogen replacement with cryoprecipitate or fibrinogen concentrate is recommended for significant hypofibrinogenemia requiring fibrinogen replacement, with fibrinogen levels <1.5 g/L and clinically significant bleeding 3

Plasma frozen components (PFC) are obtained from plasma and frozen quickly to preserve the integrity of labile coagulation factors, containing all soluble coagulation factors, including factors V and VIII, with a volume of approximately 300 ml per unit 1, 3
PFC should be of the same blood group as the patient, and if the blood group is unknown, group AB is preferred, with primary indications for PFC use including major/massive hemorrhage, coagulopathies with active bleeding, reversal of anticoagulation, and specific hematological conditions 1, 3
The recommended therapeutic dose of PFC is 15 ml/kg, with administration guided by clinical response in actively bleeding patients, and PFC should be administered with careful clinical evaluation and monitoring of coagulation parameters to ensure appropriate and effective use 1