Frozen Plasma (FP) and Solvent/Detergent (S/D) Plasma

Frozen plasma (FP) is obtained by freezing collected plasma within a timeframe that ensures preserved function of labile coagulation factors. One unit of FP is ~280 mL. FP contains all stable coagulation system factors, albumin, and globulins. It may be stored at ≤−18 degrees Celsius for up to 12 months. Thawed plasma should not be refrozen.

Solvent/detergent (S/D) plasma is pooled human plasma that is pathogen inactivated through filtration and S/D treatment. Octaplasma has been available in Canada since 2011 for selected patients.

Benefits of this product, compared with FP, include:

1) Improved standardization of clotting factor levels.

2) Reduced frequency of adverse transfusion reactions.

3) Reduced infectious risks.

Octaplasma comes in standardized 200-mL bags. Its use is not recommended for patients with IgA deficiency with documented antibodies against IgA (Octaplasma contains IgA) and hypersensitivity to plasma or to any ingredient in the formulation. Octaplasma is also not recommended for use in patients with severe deficiency of protein S (reduced protein S levels compared with FP) and to correct hyperfibrinolysis caused by a deficiency of the plasmin inhibitor (reduced alpha2-antiplasmin level compared with FP). Indications for plasma transfusion and method of administration are the same as for FP.

IndicationsTop

FP or S/D plasma transfusion is indicated in case of:

1) International normalized ratio (INR) >1.7 and ≥1 of:

a) Significant bleeding.

b) Prior to an invasive procedure with a risk of bleeding (plasma is generally not required prior to minor procedures, eg, paracentesis, thoracentesis, central line insertion).

2) Prophylactic or therapeutic coagulation factor replacement in patients with single factor deficiency if specific coagulation factor concentrates with inactivated infectious factors are not available.

3) Thrombotic thrombocytopenic purpura (TTP).

4) Massive transfusion.

Different INR targets may be appropriate in patients with liver disease.

Plasma should not be used for the reversal of warfarin or direct anticoagulants. Plasma also should not be used for blood volume replacement in patients with no coagulation factor deficiency, in patients with coagulation factor deficiencies when an appropriate coagulation factor concentrate is available, or for fibrinogen replacement therapy.

ProcedureTop

In stable adult patients transfuse slowly (50 mL/h) for the first 15 minutes. Plasma should be dosed at 10 to 15 mL/kg (~4 units in an average-sized adult). The recommended infusion time is 30 to 120 minutes per unit, with a maximum time of 4 hours. If clinically indicated, prothrombin time (PT)/INR and activated partial thromboplastin time (aPTT) may be checked after transfusion to assess response.