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Quicker Time to Transfusion?

Clinician's Brief (Capsule)

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Transfusion of fresh frozen plasma (FFP) is used to treat various coagulopathies. FFP is usually stored at -20°C; at this temperature, FFP maintains the activities of its clotting factors for up to 1 year. However, because FFP is frozen, it must be thawed before it is transfused, and the time delay could negatively impact the recipient.

The purpose of this prospective study was to determine how long it takes to thaw FFP and how plasma refrigeration affects the activity of coagulation factors (V, VII, VIII, IX, X, and fibrinogen), clotting times (prothrombin time [PT] and activated partial thromboplastin time [aPTT]), and FFP sterility. Mean thawing time was 34.7 ± 1.38 minutes. Refrigeration for 2 weeks significantly decreased clotting factor activity as well as prolongation in PT and aPTT times, but all times remained within reference intervals. Sterility was not found to be affected. Refrigerated plasma, which does not have the thawing time delay associated with FFP, could be clinically effective in treating coagulopathies. Critical coagulopathic patients could receive plasma sooner, possibly improving their prognosis.

Commentary

Anyone who has had a dying-in-front-of-your-eyes anticoagulant rodenticide toxicity case will find this article useful. The study authors at Tufts determined that plasma can be refrigerated for 2 weeks and still contain viable coagulation factors. In contrast to FFP, frozen plasma and stored plasma would not be expected to contain adequate concentrations of labile factors V and VIII. Although this is not an issue when transfusing cases with anticoagulant rodenticide intoxication, it is an issue when transfusing bleeding type A hemophiliacs or when transfusing cases with massive hemorrhage. Coagulation factors V and VIII in refrigerated plasma had acceptable activity after 14 days, which means refrigerated plasma may benefit patients with those deficiencies. What we do not know is how long it takes to warm the refrigerated plasma to the same degree as the frozen plasma and if these results would hold for FFP that is warmed and stored in the refrigerator.—Elke Rudloff, DVM, DACVECC

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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