Compare and contrast fresh frozen plasma and prothrombin complex concentrate
The safe and appropriate use of these products in ICU is a key area of critical care practice so a fair bit of detail was required for a pass. Most candidates had a decent understanding of the main constituents of the two products, although few mentioned that FFP may still contain some cells, or that prothrombin concentrates contain heparin. To gain full marks for this section the components and concentration/amounts would need to be accurately described. Production of
the two products was generally well understood and articulated. A more comprehensive and specific list of indications than rather than "bleeding" or "coagulopathy" was expected. While using elements of the standard "compare/contrast" pharmacology structure was helpful, rigidly adhering to it, for instance, noting FFP's "poor oral bioavailability" - did not garner marks. It is important to note that heparin is not reversed by FFP and FFP may in fact increase heparin's effect. FFP does not cause dilutional coagulopathy, it is the treatment for dilutional coagulopathy. Most candidates recognised the need for ABO matching with FFP but not prothrombin concentrates, however few noted that Rhesus matching is not required. The larger fluid load of FFP in comparison to prothrombin concentrates was well recognised a major drawback of FFP use.
The bioavailability of FFP would indeed be poor. However it does contain about 80-100g/L of protein, and very little fat or sugar, making it an excellent choice for somebody on a strict diet. Oh well, at least this 52% pass rate is beter than Question 3 from the first paper of 2019, when 90% of the candidates failed.
| 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
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| 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 |
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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).