Plasma is the clear, straw-colored liquid portion of blood that remains after red blood cells, white blood cells, and platelets are removed. This liquid component makes up about 55% of total blood volume and is primarily composed of water, carrying important proteins, sugars, fats, and salts throughout the body. Fresh Frozen Plasma (FFP) is a blood product derived from donated blood that is rapidly frozen to preserve delicate biological components, specifically the proteins responsible for blood clotting. FFP is administered intravenously to replace these essential factors when patients are deficient, helping manage severe bleeding and certain blood disorders.
The Components and Processing of FFP
Fresh Frozen Plasma is a complex solution containing a full range of coagulation factors, natural anticoagulants, and plasma proteins like albumin and immunoglobulins. FFP is distinguished by its inclusion of labile clotting factors, such as Factor V and Factor VIII. These factors degrade quickly at warmer temperatures, necessitating rapid processing to maintain their function.
The “fresh frozen” designation refers to the strict timeline required for its preparation from a whole blood donation. Plasma must be separated from the blood cells and then frozen solid at a temperature of -18°C or colder, typically within eight hours of collection. This rapid freezing process ensures the maximum preservation of the coagulation proteins and their ability to promote clotting when needed in a patient.
For long-term storage, the frozen plasma is kept in specialized freezers at temperatures often below -30°C, which can extend its shelf life for up to one year. When a patient requires the product, the frozen unit is thawed and warmed, often in a water bath between 30°C and 37°C, a process that usually takes about 20 to 30 minutes. Once thawed, FFP must be administered relatively quickly, as the activity of the labile clotting factors begins to gradually decline, making it less effective over time.
Key Medical Uses for Fresh Frozen Plasma
The primary use of FFP is to correct deficiencies in multiple coagulation factors, especially in patients who are actively bleeding or are about to undergo an invasive procedure. This is often necessary in cases of severe liver disease, which impairs the organ’s ability to synthesize a wide array of clotting proteins. FFP provides a balanced replacement of all coagulation factors, helping to restore the patient’s ability to form clots and stop hemorrhage.
In trauma and massive hemorrhage protocols, FFP is administered alongside red blood cells and platelets to replenish the clotting factors rapidly consumed or diluted by severe blood loss and fluid resuscitation. Giving FFP in a ratio that approaches that found in whole blood is associated with improved survival in severely injured patients with significant bleeding. The product’s mechanism of action is straightforward: it directly supplies the missing or deficient proteins needed to activate the body’s entire clotting cascade.
FFP is also used to quickly reverse the effects of certain oral anticoagulants, most commonly warfarin, in patients who are experiencing serious bleeding or require emergency surgery. Warfarin acts by blocking the production of Vitamin K-dependent clotting factors (Factors II, VII, IX, and X), and FFP immediately replenishes these factors, circumventing the drug’s effect. The typical dosage for an adult is often between 10 to 20 milliliters per kilogram of body weight to achieve a therapeutic increase in coagulation factor levels.
The Transfusion Process and Potential Side Effects
Before FFP can be administered, the thawed product must be cross-checked for compatibility with the recipient’s blood type, specifically the ABO blood group. Although FFP does not contain red blood cells, it does contain antibodies against the opposite ABO antigens, which can cause a reaction if mismatched. Once compatibility is confirmed, the plasma is infused intravenously through a catheter, a process that generally takes less than one hour per unit.
Despite strict safety protocols, the transfusion of FFP carries several potential adverse effects that require careful monitoring during and after the procedure. One serious, although uncommon, complication is Transfusion-Related Acute Lung Injury (TRALI), which can cause sudden onset of respiratory distress within six hours of the transfusion. TRALI is believed to involve a reaction between donor antibodies and the recipient’s white blood cells, leading to fluid accumulation in the lungs.
Another risk is Transfusion-Associated Circulatory Overload (TACO), which occurs when the volume of the transfused plasma exceeds the patient’s cardiovascular system capacity. This leads to symptoms of fluid buildup, particularly in the lungs. Patients with pre-existing heart or kidney conditions are at higher risk for TACO, especially when receiving large or rapid infusions. Less severe, but more common, reactions include allergic responses, which can range from mild hives and itching to more severe anaphylactic reactions.