4. WHAT IS PLASMA??
Clear, straw-coloured liquid portion of blood that suspends all the
other parts of the blood.
It is the single largest component of human blood, comprising
about 55 percent.
It contains water, salts, enzymes, antibodies and other proteins.
4
7. ACTIONS
Intravascular fluid part of extracellular fluid.
Protein reserve.
Solvent for nutrients, electrolytes, gases and other substances.
Plays a vital role in an intravascular osmotic effect that keeps
electrolytes in balanced form and protects the body from infection and
other blood disorders.
Helps maintain blood pressure and regulates body temperature.
7
9. Different specific gravities of blood components.
RBCs: 1.08 – 1.09
Platelets: 1.03 – 1.04
Plasma: 1.02 – 1.03
9
10. DIFFERENT PLASMA COMPONENTS
Fresh frozen plasma
Frozen plasma
Thawed plasma
Cryoprecipitate-reduced
Cryoprecipitate
Coagulation factors – Factor VIII, IX, XIII and VIIa
Albumin
10
11. FRESH FROZEN PLASMA
Plasma separated from whole blood.
Frozen within 6-8 hours of collection.
Rapid freezing of plasma preserves the
labile coagulation factors at maximum levels.
Stored at ≤ –20°C for up to one year
Or at ≤ –65°C for up to 7 years
11
12. PREPARATION OF FFP
Whole blood - double/triple – CPD/CPDA or special bag system with
additive solution – SAGM
Balance the bags and placed in centrifuge.
Centrifugation – 5000 rpm for 5 min at 4°C (Heavy spin).
Separate plasma into satellite bag using plasma extractor.
12
13. Label with unit number and blood group before separation.
Cut the tubing between two seals
Place the plasma at -20°C or lower within 6 hours of collection.
FFP from a standard donation of whole blood (450ml) usually measures
175-250 ml.
It contains 70-80 units/dl of Factor VIII, Factor IX, vWF and other plasma
clottting factors.
13
17. BEFORE ISSUE…
Before transfusion, it is thawed over 20 to 30 mins at 30 to 37°C.
A water bath is used for thawing.
The entry ports need to be protected from contamination during this
process.
Transfused immediately or stored at 4°C (1–6°C) for 24 hours – “FFP
thawed”
After 24 hours, the words “fresh frozen” should be removed and
labelled as “Thawed plasma”.
17
18. INDICATIONS
Multiple coagulation factor deficiencies – liver disease, DIC,
coagulopathies.
Reversal of coumarin drug effect.
Use in antithrombin deficiency.
Immunodeficiency syndromes.
Raised PT and INR
18
19. DOSE AND ADMINISTRATION
Accepted dose of FFP transfusion is 12-15ml/kg.
However dose depends on the underlying clinical disease.
Post transfusion assessment of patient’s coagulation parameters like
PT, aPTT or specific factor asssay is important for monitoring.
19
20. FROZEN PLASMA
Separated from whole blood within 8 - 24 hours of collection.
The level of the labile clotting factors, factors VIII and V is lower in FP,
than in FFP.
Adequate – treatment of mild to moderate coagulation factor
deficiencies.
20
21. SOLVENT/DETERGENT-TREATED
PLASMA The thawed plasma is treated with solvent tri-n-butyl phosphate (1%)
and detergent Triton X-100 (1%)
Removed after treatment and the sterile-filtered plasma is refrozen.
ADVANTAGES: Significantly inactivates the lipid enveloped viruses
(e.g. HCV, HBV, HIV).
But not the non lipid enveloped viruses - hepatitis A and parvovirus.
21
22. CRYOPRECIPITATE
Precipitate of fresh frozen plasma (FFP) when it is
thawed at 4°C (1°C - 6°C) and then centrifuged,
collected, and refrozen.
It is rich in fibrinogen, factor VIII (80–100 u), vWF,
fibronectin, and factor XIII.
It revolutionized the treatment of hemophilia and
von Willebrand disease.
22
25. It contains 80-100 units of F VIII, 100-250 mg of fibrinogen, 50-60mg
of fibronectin and 40-70% of vWF and 20 – 30% F XIII.
Although this product contains small amounts of isohaemagglutinins,
it is not necessary to perform compatibility testing prior to
administration.
Neonates should receive only ABO-compatible cryoprecipitate.
25
26. Each unit – 10 to 15ml.
SHELF LIFE: Frozen:1 yr
Thawed: 6 hr
STORAGE: 18°C or lesser
BEFORE ISSUE:
Thawed over 20 to 30 mins at 30 to 37°C in water bath.
26
27. INDICATIONS
Hemophilia A
von – Willebrands disease
Congenital fibrinogen deficiency
Factor XIII deficiency
Acquired Factor VIII deficiency – eg: DIC, massive transfusion
Used as local/topical hemostatic agent.
27
28. USAGE
Dosage - relatively subjective
Monitored by serial measurements of plasma fibrinogen.
One unit will increase the fibrinogen by 5 to 10 mg/dl in an average
sized adult.
Cryoprecipitate has been used with a source of thrombin as a
topical haemostatic agent as well
28
29. CRYOPRECIPITATE-DEPLETED FRESH-FROZEN
PLASMA
(CRYOSUPERNATANT)
The remaining thawed plasma of FFP that is left after Cryoprecipitate is
separated is called cryoprecipitate reduced (cryo-poor) plasma or
cryosupernatant.
All the factors like fibrinogen, factor VIII, von Willebrand’s factor (vWF),
factor XIII and fibronectin, are reduced in the cryo-poor plasma.
It is deficient in the pathogenic ultra-large multimers of vWF but contains
vWF-cleaving metalloprotease.
29
30. STORAGE: –18°C or colder.
SHELF LIFE: one year from the whole blood collection date.
INDICATIONS: treatment of refractory thrombotic thrombocytopenic
purpura
30
31. FACTOR VIII CONCENTRATES
Prepared from large volumes of pooled
plasma or in the form of recombinant FVIII
using DNA technology.
When prepared from pooled plasma,
techniques used to inactivate or eliminate
viral contamination include pasteurization,
solvent/detergent treatment, and
monoclonal purification.
31
32. Factor content per unit volume is 10 – 40 times greater than plasma.
Stored at 4°C in a home refrigerator.
INDICATIONS:
Hemophilia A
Hemophilia B
Persons deficient in factor VIII.
02/11/2016
32
33. FACTOR IX CONCENTRATES
Prepared from pooled plasma.
Available in three forms:
Prothrombin complex concentrates
Factor IX concentrates
Recombinant Factor IX.
02/11/2016
33
34. INDICATIONS:
Treatment of Factor IX deficiency or Hemophilia B
Treatment of Factor XI Deficiency (Hemophilia C)
Also contains Factor II, VII and X in concentrated form.
Vials contains 500 units of Factor X.
34
35. FACTOR XIII CONCENTRATES
There are currently two plasma-derived virus inactivated factor XIII
concentrates.
Fibrogammin P
Factor XIII concentrate
Single-use vial contains 1000 – 1600 IU of lyophilised concentrate
STORAGE: AT 2 - 8°C
SHELF LIFE: 36 months
35
36. ALBUMIN
Albumin is the quantitatively dominant plasma protein.
MW - 66kDa, water-soluble protein.
Synthesized in the liver at a rate of about 15 g/day.
Half-life of around 25 days.
36
37. PREPARATION
Commercially available albumin preparations are obtained from
plasma fractionation, according to Cohn and Oncley or Kistler and
Nitschmann.
Albumin is obtained as fractionV in Cohn process.
These are subsequently pasteurized for virus inactivation.
These solutions contain either 3.5–5% or 20–25% albumin at a purity
of 95–98%.
37
38. Preservative: None
Protein composition: ≥96% of the total protein in the final
product must consist of albumin.
38
39. PLASMA FRACTIONATION PROCESS
The Cohn process: Based on the differential precipitation
of plasma proteins by manipulation of ethanol concentration
and ph of a low-ionic-strength solution maintained at a
subzero temperature.
02/11/2016
39
41. DOSE
According to the American Hospital Formulary Service(AHFS) Drug
Information guide, a typical initial adult dose of albumin is 25 g.
Can be repeated in 15 to 30 minutes depending on the patient’s
response.
Up to 250 g of albumin may be infused in a 48-hour period.
The infusion rate should be based on the patient’s condition.
41
42. ADMINISTRATION
Albumin should be inspected for turbidity prior to administration.
Administration must begin within 4 hours of entry into the container.
Because blood group isohemagglutinins are removed from albumin
products, albumin is given without regard to ABO type
42
44. FIBRIN GLUE AND SEALANTS
This results from a mixture of fibrinogen source (FFP, PRP,
heterologous or autologous cryoprecipitate) with bovine thrombin.
The hemostasis is achieved with action of thrombin on fibrinogen.
This is widely used during surgery to stop bleeding immediately.
44