Plasma Transfusion: The Other Side

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Risks of plasma transfusion transmitted infections are similar to that of whole blood and red blood cells.

Dr. R.S Dahiya, Ex-Professor, PGIMS Rohtak

There is a debate on the use of plasma transfusion for treatment of COVID-19 cases. Though encouraging results are being claimed, certain questions still demand more clear vision and explanation. We are discussing here about general aspects of Plasma transfusion and it’s problems.

~Risks of plasma transfusion transmitted infections are similar to that of whole blood and red blood cells.
~Fresh frozen plasma is a blood product made from the liquid portion of whole blood.
~It is used to treat conditions in which there are low blood clotting factors or low levels of other blood proteins.

**The risks commonly associated with plasma transfusion include — Transfusion related acute lung injury (TRALI), 
—Transfusion associated circulatory overload (TACO), and —Allergic transfusion reactions (ATR)
—Also the more rare complications include infectious disease transmission, leukocyte-associated risks, anaphylactoid reactions,
 A unit of Fresh Frozen Plasma(FFP) is usually administered over 30 minutes. 170 – 200 micron filter is required (standard blood administration set). Once thawed, cryoprecipitate must not be re-frozen and should be used immediately. If delay is unavoidable, the component should be stored at ambient temperature and used within 4 hours.

Side Effects of Donating Plasma
Dehydration.
Dizziness.
Fatigue.
Bruising and discomfort.
Infection.
Citrate reaction.
Arterial puncture.

HF: Is a plasma transfusion the same as a blood transfusion?
Dr. Dahiya: A person may receive a plasma transfusion if they have experienced severe burns, infections, or liver failure.
Whole blood transfusion: A person may receive a whole blood transfusion if they have experienced a severe traumatic hemorrhage and require red blood cells, white blood cells, and platelets.

HF: Why would you need a plasma transfusion?
Dr. Dahiya: You may need a plasma transfusion to replace missing or low levels of blood proteins due to: a medical condition such as liver disease. heart surgery. severe blood loss(COVID-19 cases on trial bases)

HF: What is the difference between cryo and FFP?

Dr. Dahiya: Fresh Frozen Plasma is made from plasma which is separated from donor blood and frozen to minus 35° Centigrade to preserve it.
Cryo is made from FFP which is frozen and repeatedly thawed in a laboratory to produce a source of concentrated clotting factors including Factor VIII, von Willebrand factor and fibrinogen.

HF: What plasma can be given to O positive group patients?

Dr. Dahiya: Patients should only receive FFP which does not contain antibodies which could attack their own red cells. Group O people have both Anti-A and Anti-B so group O FFP can ONLY be given to group O patients. If group O FFP were given to a group A patient, the Anti-A will attack the patient’s group A red cells.

HF: Is cross matching required for FFP?

Dr. Dahiya: The universal FFP donor, conversely, is AB because it will contain neither anti-A nor anti-B antibodies. Whole blood donors and recipients must be exact ABO matches because whole blood contains both RBCs and serum.

HF: How many FFP does it take to correct International Normalised Ratio (INR)?

Dr. Dahiya: Based on the information available, both time to administration (limited by thawing time) and dose of FFP play a role in rapid reversal of elevated INR levels. From the studies presented above, 3-4 units of FFP are needed to decrease an INR.

HF: Does blood type matter for plasma transfusion?

Dr. Dahiya: Plasma transfusions are matched to avoid A and B antibodies in the transfused plasma that will attack the recipient’s red blood cells. People with type AB blood are universal plasma donors. Their plasma does not contain A or B antibodies and can be transfused safely to all blood types.

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