13-41: Transfusion of Plasma Components

Fresh frozen plasma (FFP) is available in units of approximately 200 mL. FFP contains normal levels of all coagulation factors (about 1 unit/mL of each factor). FFP is used to correct coagulation factor deficiencies (such as in liver disease) and to treat thrombotic thrombocytopenic purpura or other thrombotic microangiopathies. FFP is also used to correct or prevent coagulopathy in trauma patients receiving massive transfusion of packed RBC (PRBC). An FFP:PRBC ratio of 1:2 or more is associated with improved survival in trauma patients receiving massive transfusions, regardless of the presence of a coagulopathy.

Cryoprecipitate is made from fresh plasma by cooling the plasma to 4°C and collecting the precipitate. One unit of cryoprecipitate has a volume of approximately 15–20 mL and contains approximately 250 mg of fibrinogen and between 80 and 100 units of factor VIII and von Willebrand factor. Cryoprecipitate is most commonly used to supplement fibrinogen in cases of acquired hypofibrinogenemia (eg, acute DIC) or in rare instances of congenital hypofibrinogenemia. One unit of cryoprecipitate will raise the fibrinogen level by about 8 mg/dL (0.24 mcmol/L). Cryoprecipitate is sometimes used to temporarily correct the acquired qualitative platelet dysfunction associated with kidney disease.