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Page 1

A Compilation from Recent
Peer-Reviewed Literature

Second Edition

Practice
Guidelines
for Blood
Transfusion

Page 2

First Edition, May 2002

Authors:
Ritchard Cable, M.D., Connecticut Region
Brian Carlson, M.D., Tennessee Valley Region
Linda Chambers, M.D., Biomedical Headquarters
Jerry Kolins, M.D., Southern California Region
Scott Murphy, M.D., Penn-Jersey Region
Lowell Tilzer, M.D., Central Plains Region
Ralph Vassallo, M.D., Penn-Jersey/NE Pennsylvania Regions
John Weiss, M.D., Badger-Hawkeye Region
Mary Ellen Wissel, M.D., Central Ohio Region

Second Edition, April 2007

Revised by:
Yvette Miller, M.D. (Chair), Arizona Region
Gary Bachowski, M.D., Ph.D., North Central Region
Richard Benjamin, M.D., Ph.D., Biomedical Headquarters
Diane K. Eklund, M.D., Northern California Region
A.J. Hibbard, M.D., Badger-Hawkeye Region
Thomas Lightfoot, M.D., New York-Penn Region
Claire Meena-Leist, M.D., Indiana-Ohio Region
NurJehan Quraishy, M.D., Western Lake Erie Region
Suneeti Sapatnekar, M.D., Ph.D., Northern Ohio Region
Jerry Squires, M.D., Ph.D., Biomedical Headquarters
Annie Strupp, M.D., Lewis and Clark Region
Ralph Vassallo, M.D., Penn-Jersey Region
John Weiss, M.D., Ph.D., Badger-Hawkeye Region

Graphic Designer: George Ramirez

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Selection and Preparation:

Plasma for transfusion must be ABO-compatible with
the recipient’s red cells, for example, group A Plasma
is suitable for group A and group O patients. Group AB
Plasma is suitable for all blood types. Frozen Plasma
must be thawed, usually in a water bath, and infused
immediately or stored at 1-6oC for up to 24 hours.
FFP and FP24 may be relabeled as Thawed Plasma
and used as a source of stable coagulation factors for
up to 5 days, unless it was collected by apheresis in
an open collection system. Plasma, cryoprecipitate
reduced is indicated in the treatment of Thrombotic
Thrombocytopenic Purpura (TTP).

Ref. 19, 35, 37

Dosing:

The dose of plasma is determined by the patient
size and clinical condition. When used to correct
multiple coagulation factor deficiencies, plasma
transfusion should be guided by coagulation
testing. A prothrombin time (PT) greater than 1.5
times the mid-range of normal, an activated partial
thromboplastin time (APTT) greater than 1.5 times
the top of the normal range, or factor assay less than
25%, can be used as thresholds at which therapeutic
or prophylactic replacement may be indicated in an
appropriate clinical setting. When such testing is not
readily available, clinical evidence of bleeding may be
used to direct transfusion decisions. Plasma should
be administered in doses calculated to achieve a
minimum of 30% of plasma factor concentration. This
is usually achieved with the administration of 10-20
mL/kg, though more may be required depending
upon the clinical situation.

When used to correct isolated coagulation factor
deficiencies for which no concentrated preparation is
available (e.g., factor V, or XI), dosing will depend on
the half-life of the specific factor, the pretransfusion

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level of the factor, the desired post transfusion level
and the duration of raised levels required.

Ref. 7, 18, 38

TTP initially requires exchange of 1 � 1.5 plasma
volume daily and may need to be increased to twice-
daily single plasma volume exchanges in refractory
patients. The volume and/or frequency of exchange
may be tapered as disease activity declines.

Response:

Frozen Plasma used to correct coagulation
abnormalities should stop bleeding and bring
the APTT and PT within the hemostatic range, but
transfusion will not always correct these values, or the
correction may be transient.

Frozen Plasma used to treat TTP should result in an
increasing platelet count associated with a decrease in
serum lactate dehydrogenase.

Indications and Contra-indications:

Frozen Plasma is indicated for use in patients with the
following conditions:
1. Active bleeding due to de�ciency of multiple

coagulation factors, or risk of bleeding due to
de�ciency of multiple coagulation factors.

2. Severe bleeding due to warfarin therapy, or urgent
reversal of warfarin e�ect

3. Massive transfusion with coagulopathic bleeding.
4. Bleeding or prophylaxis of bleeding for a known

single coagulation factor de�ciency for which no
concentrate is available.

5. Thrombotic thrombocytopenic purpura.
6. Rare speci�c plasma protein de�ciencies, such as C1-

inhibitor.

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9/2007 - HIS 20371

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