Fresh Frozen Plasma (FFP) is a blood product derived from whole blood donations. It is the liquid portion of blood, collected and frozen to preserve its therapeutic properties. FFP plays a significant role in medical transfusions, primarily used to address various bleeding disorders and support the body’s natural clotting mechanisms. It is an important resource in managing certain patient conditions.
Composition and Characteristics
Fresh Frozen Plasma is a complex mixture containing water, proteins, carbohydrates, fats, and vitamins. Its primary therapeutic value comes from its rich content of plasma proteins, particularly a wide array of clotting factors. These include fibrinogen (Factor I), Factor V, Factor VIII, and other factors such as II, VII, IX, X, XI, and XIII. FFP also contains natural anticoagulant proteins like protein C, protein S, and antithrombin, along with albumin and immunoglobulins.
These clotting factors are essential for hemostasis, the process of stopping blood flow from an injured vessel. Fibrinogen, for instance, is a glycoprotein produced in the liver that converts into insoluble fibrin, forming the mesh-like network that stabilizes a blood clot. Factor V and Factor VIII are considered labile factors, meaning their activity can decrease over time if not properly preserved. When thawed, FFP appears as a pale yellow liquid, reflecting its plasma origin.
Preparation and Storage
Preparation of Fresh Frozen Plasma begins with whole blood collection from a donor. The plasma component is then separated from red blood cells and other cellular elements. To preserve the activity of its coagulation factors, especially labile ones, this plasma must be rapidly frozen. This crucial freezing step occurs within eight hours of donation, which is why it is termed “fresh frozen.”
FFP is stored at ultra-cold temperatures, typically -18°C or colder, with many facilities maintaining temperatures around -25°C to -30°C for optimal preservation. In this state, FFP can maintain its integrity and potency for up to one year. Some specialized storage conditions, such as temperatures of -65°C, can extend its shelf life to several years. Before administration, FFP is thawed in a controlled manner, usually in a water bath at 30°C to 37°C or using an FDA-cleared thawing device, a process taking 20 to 30 minutes. Once thawed, FFP should be transfused promptly, as the activity of certain clotting factors, particularly Factor V and Factor VIII, gradually declines.
Medical Applications
Fresh Frozen Plasma is primarily used to treat patients experiencing bleeding or at risk of bleeding due to deficiencies in multiple coagulation factors. It replenishes these missing or deficient factors, restoring the body’s ability to form clots and control hemorrhage. This therapeutic approach is particularly beneficial in clinical scenarios where specific factor concentrates are unavailable or not suitable.
One common indication for FFP transfusion is in patients with severe liver disease, where the liver’s impaired function leads to reduced production of many clotting factors. It is also used for disseminated intravascular coagulation (DIC), a condition characterized by widespread activation of the clotting system that consumes clotting factors and can lead to severe bleeding. For patients taking warfarin, a blood thinner, FFP can rapidly reverse its anticoagulant effects during active bleeding or before urgent invasive procedures, especially when vitamin K reversal is too slow or insufficient. FFP is also a component of massive transfusion protocols for significant blood loss, such as severe trauma. Additionally, it serves as a replacement fluid in plasma exchange for conditions like thrombotic thrombocytopenic purpura (TTP), where it replaces a missing enzyme that prevents dangerous blood clots.
Safety and Administration
Fresh Frozen Plasma is typically administered via intravenous (IV) transfusion, infused directly into a patient’s vein. A single unit of FFP usually contains 200 to 250 milliliters, and the transfusion generally takes about 30 minutes. For safe transfusion, it is important that the FFP is ABO-compatible with the recipient’s blood type.
Before release for transfusion, donated blood undergoes rigorous screening for infectious diseases, including HIV, Hepatitis B, and Hepatitis C, to minimize transmission risks. Despite these precautions, potential transfusion reactions, though rare, can occur. These may include allergic reactions, or more serious complications like transfusion-associated circulatory overload (TACO) or transfusion-related acute lung injury (TRALI). During and after transfusion, healthcare providers closely monitor vital signs and may perform blood clotting tests to assess treatment effectiveness. FFP transfusion is widely considered a safe and life-saving procedure when medically indicated.