Plasma transfusion is a medical procedure involving the administration of a donor’s blood plasma, which is the liquid portion of whole blood, into a patient’s bloodstream. This therapy replaces components that are missing or deficient due to disease, injury, or medical treatments. Unlike a whole blood transfusion, this process delivers the acellular, yellowish fluid without red blood cells, white blood cells, or platelets. Plasma transfusion supplies the body with various proteins and factors necessary for proper bodily function and maintaining vascular integrity.
The Essential Components of Plasma
Plasma is an intricate fluid, making up about 55% of the total volume of blood, and it is largely composed of water and electrolytes. This fluid matrix carries numerous dissolved substances, including essential proteins that give it therapeutic value. Among the most important proteins are albumin, which helps regulate osmotic pressure, and immunoglobulins, which are the antibodies involved in the body’s immune defense.
The product most commonly used is Fresh Frozen Plasma (FFP), which is separated from whole blood and frozen within hours of collection to preserve unstable components. FFP contains a full complement of both pro-coagulant and anti-coagulant factors, which control the process of blood clotting. These clotting factors, such as Factor V and Factor VIII, are the primary reason plasma is transfused in many clinical scenarios. Without these factors, the body’s ability to stop bleeding is severely compromised.
Addressing Bleeding and Clotting Issues
The primary use of plasma transfusion is to correct deficiencies in coagulation factors that lead to active bleeding or a high risk of hemorrhage. Plasma provides a broad spectrum of these factors, which is beneficial when a patient is deficient in multiple factors simultaneously. This is often seen in cases of massive hemorrhage or traumatic injuries where blood loss and fluid replacement have diluted the remaining clotting factors.
In emergency situations, such as severe trauma where a massive transfusion protocol is activated, plasma is administered alongside red blood cells and platelets to restore a balanced clotting system. Severe liver disease is another major indication, as the liver synthesizes nearly all coagulation factors, and its failure results in a widespread clotting deficiency. Patients with impaired liver function often require plasma support before undergoing invasive procedures to prevent bleeding.
Plasma is also used to rapidly reverse the effects of certain anticoagulant medications, particularly Warfarin (Coumadin), when a patient is bleeding or requires urgent surgery. Warfarin interferes with the production of vitamin K-dependent clotting factors, and plasma infusion provides an immediate supply of these factors to restore normal hemostasis. While specific factor concentrates are sometimes preferred, plasma transfusion remains a broadly effective treatment option for factor deficiencies when alternatives are unavailable.
Plasma Use in Non-Trauma Settings
Beyond treating active bleeding, plasma transfusion plays a specialized role in certain non-traumatic medical conditions. A notable application is in the treatment of Thrombotic Thrombocytopenic Purpura (TTP), a rare disorder where a deficient enzyme causes small blood clots to form throughout the body. Plasma exchange, or plasmapheresis, is the standard treatment for TTP, where the patient’s faulty plasma is removed and replaced with donor plasma.
The donor plasma supplies the patient with the missing enzyme, ADAMTS13, effectively halting clot formation and preventing organ damage. Plasma transfusion may also be used in cases of severe burns, though this is less common today. In burn patients, plasma helps restore intravascular volume and supplies proteins that stabilize the lining of the blood vessels, which is often damaged in severe thermal injury.
In these specialized scenarios, the goal is not merely to stop bleeding but to deliver a specific protein or factor to address an underlying disease process. For example, in certain primary immunodeficiency syndromes, plasma is a source of replacement antibodies, or immunoglobulins, which help the patient fight off infection.