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Blood products - fresh frozen plasma FFP (Newborn Services)

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Key points

  • Fresh frozen plasma (FFP) is processed from a single donor blood donation either prepared from a whole blood unit or from a plasmapheresis donor.
  • It is prepared within 8 hours of collection. This method ensures the preservation of labile coagulation factors.
  • The plasma is stored at -30°C and thawed under controlled conditions at the Bloodbank.
  • Neonatal packs take 15-20 minutes to thaw in the Bloodbank.
  • Informed consent required.
  • Parent signs Agreement to Treatment form (CR0111).

Indications

  • Disseminated Intravascular Coagulation (DIC) complicated by bleeding
  • Massive Transfusion Protocol
  • FFP should be considered with an INR >2 depending on the underlying cause and clinical condition of the infant
  • Vitamin K deficiency with bleeding
  • Liver disease in the presence of bleeding and abnormal coagulation or as a prophylaxis

Prescribing of Fresh Frozen Plasma

  • Prescribed on the blood transfusion/IV fluid chart (CR5541).
  • Usual dosage 10 - 15 ml/kg infused over 60 minutes. A more rapid infusion may be used if indicated - see Massive Transfusion Protocol.
  • In massive transfusion FFP units are given in a ratio to red cells of 1:1
  • In infants with ongoing blood loss and consumption of coagulation factors, close monitoring of levels of coagulation factors should be used to guide additional doses of FFP.

Ordering

On NZBS requisition form (111F01802).

Storage and administration

  • Shelf life once thawed is 4 hours, when stored in blood fridge.
  • FFP pack will have a yellow expiratory sticker, stating 'date' and 'time' of expiry.
  • When pack arrives in Newborn Services it must be used within 2 hours.
  • Draw into syringe through a new 170u blood group filter. As FFP are leucodepleted at source by NZBS, bedside leucodepletion is not necessary.
  • Once plasma is partially transfused it should never be returned to the fridge for reuse at a later time because of the risk of contamination.
  • For neonatal transfusions ABO compatible or AB Plasma (compatible to all blood groups) is used.

As with all blood products, infants must be monitored for signs of a transfusion reaction - for more information see  Blood products - red cell transfusion.

Complications

  1. Infections with HBV, HIV, bacterial contamination etc. as for red cell transfusion.
  2. Volume overload.
  3. Allergic reactions.
  4. Antibody mediated reactions, e.g. if group A plasma (containing Anti-B) is given to a group B baby, haemolysis may occur. Leucocyte antibodies may be present in donor blood and could cause reactions.
  5. May contribute to rise in blood viscosity.

Reference

  1. www.nzbloodservice.co.nz

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Document Control

  • Date last published: 01 August 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years