A plasma transfusion is a medical procedure involving the transfer of plasma, the liquid component of blood, from a donor to a recipient. This intervention is employed to address various medical conditions where a patient’s own plasma is deficient or contains harmful substances. The process aims to replenish necessary components or remove detrimental elements from the patient’s bloodstream, supporting different bodily functions.
Understanding Plasma
Plasma comprises approximately 55% of the total blood volume and appears as a light yellowish or straw-colored fluid. It is primarily composed of water, making up about 90% to 92% of its volume. The remaining portion consists of dissolved solids, including various proteins, electrolytes, hormones, nutrients, and waste products.
Key proteins found in plasma include albumin, globulins, and fibrinogen. Albumin helps maintain the colloidal osmotic pressure, which balances fluid between blood vessels and tissues. Globulins contribute to immune defense and transport substances, while fibrinogen is essential for blood clotting. Plasma also transports gases like oxygen and carbon dioxide, as well as metabolic waste products to organs responsible for their excretion.
Primary Applications of Plasma Transfusion
Plasma transfusions are utilized across a range of medical situations, particularly when patients experience deficiencies in plasma components or require the removal of harmful substances. One common use is to provide essential clotting factors for individuals with bleeding disorders or those experiencing significant blood loss.
Fresh Frozen Plasma (FFP) contains all coagulation factors, except platelets. It is administered in cases of severe bleeding due to trauma, surgery, or liver disease. FFP is also used to reverse the effects of certain anticoagulant medications, such as warfarin, especially in emergency situations or before invasive procedures.
Liver disease can impair the liver’s ability to produce clotting factors, making plasma transfusions necessary to manage or prevent bleeding complications. In massive transfusion protocols, plasma is a component used to manage patients with severe hemorrhage who require large volumes of blood products.
Cryoprecipitate, a specific plasma derivative, is rich in several key clotting factors including fibrinogen, Factor VIII, Factor XIII, and von Willebrand factor. It is often used when there is a specific deficiency in these factors, such as low fibrinogen levels, to help control bleeding.
Plasma exchange, also known as plasmapheresis, is a distinct procedure where a patient’s plasma is removed and replaced with donor plasma or a plasma substitute. This method is employed to remove harmful antibodies or toxins from the patient’s blood. Conditions treated with plasma exchange include Guillain-Barré syndrome, where the immune system attacks nerve insulation, and thrombotic thrombocytopenic purpura (TTP), a disorder involving harmful antibodies that affect a specific enzyme. For TTP, plasma exchange removes antibodies against the ADAMTS13 enzyme, which is involved in blood clotting regulation.
The Transfusion Procedure
Before a plasma transfusion, healthcare professionals ensure the donor plasma is compatible with the recipient’s blood type. Patients also provide informed consent for the procedure. The plasma, which has been separated from whole blood and frozen, is thawed just before administration.
The transfusion typically involves placing a small needle into a vein, usually in the arm or hand. The thawed plasma then flows through tubing into the patient’s bloodstream. The duration of a plasma transfusion can vary, often taking between 30 minutes to one hour per unit, but it may last up to four hours depending on the volume required. Throughout the transfusion, the patient’s vital signs are closely monitored for any reactions or changes in condition.
Important Considerations for Patients
Patients receiving plasma transfusions are closely monitored for potential reactions, which can range from mild to more severe. Common reactions include a slight rise in temperature, itching, or a rash, which are often manageable by adjusting the transfusion rate or with medication. Although rare, more serious reactions can occur, such as anaphylaxis, a severe allergic response.
Another potential complication is transfusion-related acute lung injury (TRALI), characterized by sudden breathing difficulties and fluid in the lungs. Transfusion-associated circulatory overload (TACO) can also occur, particularly in vulnerable patients, leading to fluid accumulation in the body. Citrate toxicity is a less common reaction. Healthcare providers continuously observe patients during and after the transfusion to promptly address any adverse effects.
To ensure the safety of transfused plasma, rigorous testing protocols are in place for all donated plasma. This screening includes testing for infectious diseases such as HIV, hepatitis B, and hepatitis C, among other pathogens. Donors undergo strict screening processes before donation, and each unit of plasma is meticulously tested to minimize the risk of disease transmission to recipients.