Question 3

Compare and contrast fresh frozen plasma and prothrombin complex concentrate.

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College Answer

Very few answers included details on prothrombin complex concentrate which meant it was difficult to score well. Useful headings included preparation and administration, dose, indications and adverse effects. Not many candidates knew the dose of FFP, and few were able to describe the preparation/production of the product. Few candidates knew the factors available from either product. Commonly missed was the need for ABO typing for FFP and that Prothrombin complex concentrate did not require this

Discussion

  Fresh frozen plasma Prothrombinex
Description The liquid portion of the blood, separated and frozen within 8 hours of collection Lyophilised human clotting factor concentrate
Presentation 250-300ml bags, clearly labelled with the donor blood type. Glass vial with powdered concentrate inside, for reconstitution with sterile water. Each vial usually contains 500 units.
Preparation Separation (by centrifuge) from whole blood, either after donation or by apheresis. It must be prepared and frozen within 6-18 hours. Prepared by adsorption of coagulation factors from plasma onto an ion exchange medium followed by selective elution
Contents

Essentially all clotting factors except fibrinogen

  • Factor VII of the extrinsic pathway (so it will correct the PT)
  • Factors XI and IX of the intrinsic pathway (so, it decreases your aPTT)
  • Factors X and II (Prothrombin) of the common pathway 
  • 200 IU of Factor VIII per adult dose
  • 500 units of Factor IX  
  • 500 units of Factor II (prothrombin)
  • 500 units of Factor X 
Storage

can be stored frozen for up to 12 months at -25ºC. 

Refrigerated, stored for 6 months
Indications

Coagulopathy

Plasma exchange

ACE-I angioedema

C1 esterase inhibitor deficiency

Suxamethonium apnoea

Warfarin reversal

Correction of coagulopathy from deficiency of specific factors

Dose 10–15 mL/kg per dose For the reversal of warfarin is 15–50 IU/kg
Precautions Large volume: may cause circulatory overload Small volume: not a resuscitation fluid
Group, crossmatch Needs to be ABO grouped, but does not require crossmatch Does not need to be ABO grouped or crossmatched
Adverse effects
  • Circulatory overload
  • Lung injury (TRALI)
  • Allergic reaction (from urticaria to anaphylaxis)
  • Acute or delayed haemolytic transfusion reaction
  • Non-haemolytic febrile transfusion reaction
  • Risk of bacterial or viral infection
  • Allergic or anaphylactic reaction
  • Thrombosis  in predisposed individuals 

References

Benjamin, Richard John, and Lisa Swinton McLaughlin. "Plasma components: properties, differences, and uses." Transfusion 52 (2012): 9S-19S.

Khawar, Hina, et al. "Fresh frozen plasma (FFP)." StatPearls [Internet] (2020).

Anderson, Brian J., Steven R. Keeley, and Neil D. Johnson. "Prothrombinex‐induced thrombosis and its management with regional plasminogen activator in hepatic failure." Medical journal of Australia 153.6 (1990): 352-356.