Preparation and administration

Fresh frozen plasma contains all the non-cellular elements of whole blood. It is either separated from anticoagulated whole blood or obtained from plasmapheresis, and it is frozen to a core temperature of -30 °C or below within 6 h of collection. It remains stable if stored for up to 12 months. To transfuse, the plasma is thawed at 37 °C and should be infused within 2 h to avoid loss of potency of clotting factors. Many transfusion centers now supply fresh frozen plasma in several different pack volumes, but the dose given is 10 to 15 ml/kg initially and its effect should always be monitored with coagulation screens pre- and post-transfusion.

ABO-compatible fresh frozen plasma should be used for group A, B, and AB patients, but compatibility testing is not required. Group O patients may be given A or B plasma. Group O plasma, if available, may only be given to group O patients. It is advisable to give females of child-bearing age RhD-compatible fresh frozen plasma, but if RhD-positive fresh frozen plasma has to be given to an RhD-negative female, anti-D immunoglobulin should be given as cover.

A solvent-detergent-treated product manufactured from pooled plasma is widely available in many European countries, and 'standard fresh frozen plasma' is no longer licensed in some (Germany, France, Austria, Belgium). The manufacturing process is highly effective at viral inactivation and also appears to remove the higher-molecular-weight von Willebrand multimers, which seems to be of therapeutic benefit when used for plasma exchange in thrombotic thrombocytopenic purpura.

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