Fresh Frozen Plasma (FFP) Collection, Preparation and Uses

Fresh Frozen Plasma (FFP) Collection, Preparation and Uses Samuel Good Fresh Frozen Plasma Introduction Fresh Frozen Plasma (FFP) is the name for the liquid portion of human blood, which has been frozen and preserved. It is taken by blood donation and is stored until needed for blood transfusion. FFP has been available since 1941 (Hoffman, et al, 1990), it was used initially as a volume expander (Erber, et al, 2006), but is now used for the â€Å"management and prevention of bleeding in coagulopathic patients† (Ho, et al, 2005). The term FFP is confusing as the plasma cannot be frozen as well as fresh at the same time. What the term implies is that the plasma was frozen rapidly after it was taken and therefore can be considered fresh. The plasma, from a transfusion aspect, contains essential components such as fibrinogen, albumin, globulin and coagulation factors. These allow for specific individual components to be transferred to a recipient who is in need. The most efficient and effective way to make optimum use of blood which has been donated, is to separate it into its individual components. This process allows for a â€Å"wider availability of blood products† (Spence, et al, 2006) and also reduces the risk patients are exposed to â€Å"transfusion-related risks† (Erber, et al, 2006). The use of FFP and its individual products has increased tenfold since its first introduction (Hoffman, et al, 1990). One reason for this may be the declining availability of whole blood because of the trend to use component therapy (Spence, et al, 2006). Collection and Storage When a donor gives a unit of whole blood, the blood is then separated into several components parts. These include; packed red blood cells (pRBC), platelets and FFP. If required the FFP can be further divided into cryoprecipitate and something called cryo-poor plasma. Cryo-poor plasma is rarely used as a therapeutic response (Lauzier, et al, 2007). As mentioned previously, plasma is the non-cellular, liquid part of the blood. It is made up of; water, electrolytes and proteins. The proteins include the clotting factors and intrinsic coagulants (Murray, et al, 1995). The plasma is separated from the blood after donation and then frozen. For the plasma to be considered ‘fresh’ it must be frozen â€Å"within eight hours of collection† (Murray, et al, 1995) and stored at a temperature of minus 18 degrees centigrade or lower. If this fails to happen, the product is known just as ‘frozen plasma’, which like cryo-poor plasma, is rarely used for therapeutic means. However, to maintain coagulation factors to optimum levels the plasma should be stored at minus 30 degrees centigrade (Lauzier, et al, 2007). FFP can be prepared by separation from whole blood or via plasmapheresis. Plasmapheresis is the name given to a â€Å"broad range of procedures† where â€Å"extracorporeal separation of blood components† (Erber, et al, 2006) results in a plasma which is filtered. Preparation To summarise, FFP is collected in citrate-containing anticoagulant solution, frozen within 8 hours and stored at minus 30 degrees centigrade for up to a year. Although every protection is taken to ensure sterility, it is quite possible for the donor to have an asymptomatic bacteraemia at the time of donation (Stanworth, et al, 2004). The bacteria will have its proliferation down-regulated by the plasma being frozen. However, FFP can still sometimes transmit infectious diseases. Therefore, screening and pathogen inactivation may be performed to reduce the risk. FFP contains no RBC’s and also no WBC’s. As there are no WBC’s the plasma is referred to be as being leucodepleted. This is an indication as to why FFP can transmit said diseases. As mentioned pathogen inactivation can be performed and this is done by using either Methylene blue or a solvent/detergent process. The Methylene Blue Technique Methylene blue is a dye that has been shown to be very effective in the inactivation of pathogens. It binds to nucleic acids and, on illumination with white light, singlet oxygen is formed. This then destroys viral DNA and RNA, therefore viral replication cannot take place. Solvent/Detergent Technique This technique is used for the preparation of factors viii and ix as well as immunoglobulins. First, a solvent is added to the plasma which removes the lipid viral envelope. After this is complete, a detergent is added which inactivates the viral contents. The solvent and detergent are then removed by a physical separation technique, in which they are dissolved in oil. Column chromatography can then be used to isolate factors viii and ix. Once any treatment that is required is complete, the FFP is ready for use. It is an accepted practice that FFP is thawed before use (Ho, et al, 2005). The required units of FFP are placed in a water bath set at 30 – 37 degrees centigrade for approximately 20 – 30 minutes. Von Heyman, et al investigated the effects of 2 different thawing machines and running warm water of 43 degrees centigrade, on the activity of clotting factors, inhibitors and activation markers in FFP. They discovered no significant differences in the activity of coagulation markers over a 6 hour period post thawing. However, a major conclusion found was that, if FFP is immediately transfused after thawing, the product remained rich in clotting factors. Also, if the plasma is left, the activity of said clotting factors decline gradually and therefore FFP should only be maintained at room temperature for up to 4 hours. If thawed FFP is not used within 24 hours it becomes a separate product known as ‘thawed plasma’ (Murray, et al, 1995). Most clotting factors are stable in thawed plasma, however some labile factors, such as v and viii are not. Their degradation actually accelerates whilst the plasma is in a liquid state (Lauzier, et al, 2007). The only main advantage of having thawed plasma readily available, is that it can be transfused rapidly if a severely injured patient requires it. FFP Blood Type Specific It is widely accepted that O negative is the universal donor for pRBC’s, however for FFP this isn’t the case. A and B antigens of the blood are located on the red cells themselves. Type O individuals are devoid of these proteins on their red blood cells. Plasma does not contain RBC’s, but it contains antibodies to the corresponding absent protein. An example of this is: Type A individual has Anti-B antibodies in their blood. Type O plasma has both Anti-A and Anti-B antibodies and is incompatible with about 55 percent of the population. An individual with type AB blood has neither Anti-A nor Anti-B antibodies. This makes the AB plasma ideal for universal use when the blood type of the patient is unknown. The Rh status is irrelevant because any plasma with Anti-D is destroyed at the manufacturing stage. Recipient blood Acceptable blood groups of donor plasma O O,A,B,AB A A,AB B B,AB AB AB The major problem with blood type AB is that the percentage of the population which has it is only 4 percent. Therefore it is better to use FFP which is blood type compatible, which will be determined at the blood bank. Usage There are very few actual specific needs for the use of FFP (Spence, et al, 2006). Usually FFP is used to treat â€Å"deficiencies of coagulation proteins where specific factor concentrates are unavailable† (Hoffman, et al, 1990). Coagulation deficiencies can occur in a variety of different clinical situations. These include massive blood loss, surgery, and infection or acquired multiple coagulation factor deficiencies. Examples of FFP usage: Replacement of isolated factor deficiencies Reversal of Warfarin effects Massive blood transfusion Antithrombin III deficiency Treatment of immunodeficiency Treatment of thrombotic thrombocytopenic purpura Treatment of Disseminated intravascular coagulation Replacement of isolated factor deficiency FFP can be used to heat deficiencies of factors II, V, VII, IX, X and XI. It is only chosen as a treatment when no specific component therapy is available. Certain factors require a different haemostatic level, for example; severe factor X deficiency only requires a factor level of about 10 percent. Therefore FFP has a range of success when treating factor deficiencies. Reversal of Warfarin effect If a patient is being treated with Warfarin, they have been shown to be deficient in â€Å"functional vitamin K dependent coagulation factors II, VII, IX and X† (Spence, et al, 2006). Usually vitamin K will be administered, however anticoagulated patients will be actively bleeding, and therefore FFP can be used. Massive blood transfusion The use of FFP as a treatment on massive blood transfusion has increased over the decades. Massive bleeding is defined as â€Å"the loss of one blood volume within 24 hours† or as â€Å"50 percent blood loss within 3 hours† or a â€Å"bleeding rate of 150 ml/minute† (Lauzier, et al, 2007). It is indicated for use in patients who have documented blood clotting abnormalities after large blood loss and who are in need of urgent treatment. This is due to the fact that in most emergency situations it is unacceptable to wait hours for lab results to be returned. Antithrombin III deficiency FFP is sometimes used as a source of Antithrombin III in people who are deficient of this inhibitor. Especially if the patients are undergoing surgery or who use Heparin to treat thrombosis. Treatment of Immunodeficiency FFP has been used in children and adults with a humoral immunodeficiency as a source of immunoglobulin. It is also sometimes used for infants when parental nutrition is lacking, and they are suffering with severe protein losing enteropathy (Erber, et al, 2006). Treatment of thrombotic thrombocytopenic purpura The treatment recommended for this condition is a daily plasma exchange (Murray, et al, 1995). Prompt intervention is indicated if development of neurological abnormalities start to appear. This plasma exchange usually continues for at least 2 days after remission (Ho, et al, 2005). Treatment of Disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a syndrome where the control of the coagulation system becomes disturbed and out of control. This is usually due to pro-coagulants being dispersed into circulation (Stanworth, et al, 2004). Most of the time this happens secondary to a disease or disorder, such as cancer. In the presence of DIC, fibrinogen, platelets and coagulation factors V and VIII become rapidly depleted. FFP is given as treatment to prevent further problems or progression. Treatment usually involves a patient being infused with a single line of FFP and then coagulation tests performed to assess the clinical benefit (Stanworth, et al, 2004). There are also some conditional uses where FFP can be used but is not the first choice treatment, such as liver disease and Paediatric use. If patients have an abnormal coagulation profile and are suffering from liver disease, they can be treated with FFP. There is varying success and treatment must be monitored by regular transfusion coagulation tests. Clotting times of infants have been shown to be longer than that of adults (Murray, et al, 1995), and even longer in premature babies (OShaughnessy, et al, 2004). Vitamin K deficiency is the most common cause of neonatal bleeding (Murray, et al, 1995). FFP can be used to counter the effects if required. In the case of babies suffering from haemorrhagic disease of the newborn, FFP can be used as treatment. But only if the â€Å"chance of bleeding is greater than the risk of harmful reactions† to the treatment with FFP (Lauzier, et al, 2007). Risks As with any transfusion there is a risk of infection, the main risks identified include: Disease transmission Excessive intravascular volume Anaphylactoid reactions Alloimmunisation Transfusion related acute lung injury The risks associated with viral infectivity of FFP are similar to that of whole blood and RBC’s. As mentioned earlier this risk can be countered by photochemically treating the plasma. Allergic reactions that occur in response to FFP transfusion vary in severity from â€Å"hives to fatal non-cardiac pulmonary oedema† (Stanworth, et al, 2004). Transfusion relate acute lung injury (TRALI) is defined as a â€Å"new episode of acute lung injury within 6 hours of complicated therapy† (OShaughnessy, et al, 2004). It manifests as severe respiratory problems, including hypoxia and other symptoms linked to pulmonary oedema. Symptoms will usually subside 2 days after ceasing FFP treatment (Stanworth, et al, 2004). Alloimmunisation can occur if Anti-Rh antibodies are formed after treatment with FFP. To counter this, plasma containing Anti-D antibodies should not be given to an RhD-positive recipient. There has also been reported incidences of post-transfusion Hepatitis, and depends on a number factors, including donor selection. Also with any intravenously transfused fluid, there is a chance of hypervolemia which could lead to cardiac failure, therefore administration of FFP should not be given in excessive doses. Below is a suggested dosage breakdown: Volume of 1 Unit Plasma: 200-250 mL 1 mL plasma contains 1 u coagulation factors 1 Unit contains 220 u coagulation factors Factor recovery with transfusion = 40% 1 Unit provides ~80 u coagulation factors 70 kg X .05 = plasma volume of 35 dL (3.5 L) 80 u = 2.3 u/dL = 2.3% (of normal 100 u/dL) 35 dL In a 70 kg Patient: 1 Unit Plasma increases most factors ~2.5% 4 Units Plasma increase most factors ~10% Figures taken from (http://reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499) Conclusion In conclusion, FFP can be used as an effective treatment for a number of different clinical issues. It also does not come without risk and therefore FFP should be collected, stored, prepared and used in an efficient and safe manner. Below I have summarised the administration of FFP. FFP (Fresh Frozen Plasma) Volume: 240-300ml (mean 273ml) Storage: designated temperature controlled freezer. Core temperature -30 o C Shelf life: 24 months (frozen) Must be ABO compatible, but Rh is not necessary to be considered for transfusion and no anti D prophylaxis is required if Rh-D negative patients receive Rh-D positive FFP. Prior to the transfusion FFP must be thawed under controlled conditions using specifically designed equipment. Thawing usually takes approximately 15-30 minutes Once thawed, FFP must not be re-frozen and should be transfused as quickly as possible. Post-thaw storage results in a decline in the quality of coagulation factors. If stored at 4 degrees centigrade post thawing (in a designated temperature controlled refrigerator), the transfusion must be completed within 24 hours of thawing. Pooled solvent-detergent treated plasma is also commercially available Dose: typically 10-15ml/kg. This dose may need to be exceeded in massive haemorrhage depending on the clinical situation and its monitoring (BCSH 2004) Typical infusion rate 10-20ml/kg/hr (approximately 30 minutes per unit) Rapid infusion may be appropriate when given to replace coagulation factors during major haemorrhage. There is anecdotal evidence that acute reactions may be more common with faster administration rates. (http://reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499) REFERENCES Erber WN, Perry DJ: Plasma and plasma products in the treatment of massive hemorrhage. Best Pract Res Clin Haematol 2006, 19:97-112 Hewson JR, Neame PB, Kumar N, Ayrton A, Gregor P, Davis C, Shragge BW. Coagulopathy related to dilution and hypotension during massive transfusion. Crit Care Med. 1985;13(5):387-391. Ho AM, Karmakar MK, Dion PW. Are we giving enough coagulation factors during major trauma resuscitation? Am J Surg. 2005;190(3):479-484. Hoffman M, Jenner P. Variability in fibrinogen and Von Willebrand factor content of cryoprecipitate.  Brief Sci Rep. 1990;93(5):694-697. Lauzier F, Cook D, Griffith L, Upton J, Crowther M: Fresh frozen plasma transfusion in critically ill patients. Crit Care Med 2007, 35:1655-1659. Leslie SD, Toy PT. Laboratory hemostatic abnormalities in massively transfused patients given red blood cells and crystalloid. Am J Clin Pathol. 1991;96(6):770-773. Murray DJ, Olson J, Strauss R, Tinker JH. Coagulation changes during packed red cell replacement of major blood loss. Anesthesiology. 1988;69(6):839-845 Murray DJ, Pennell BJ, Weinstein SL, Olson JD.Packed red cells in acute blood loss: dilutional coagulopathy as a cause of surgical bleeding. Anesth Analg. 1995;80(2):336-342. OShaughnessy DF, Atterbury C, Bolton Maggs P, Murphy M, Thomas D, Yates S, Williamson LM, British Committee for Standards in Haematology, Blood Transfusion Task Force: Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol 2004, 126:11-28. Spence RK: Clinical use of plasma and plasma fractions. Best Pract Res Clin Haematol 2006, 19:83-96. Stanworth SJ, Brunskill SJ, Hyde CJ, McClelland DB, Murphy MF: Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol 2004, 126:139-152 Tieu BH, Holcomb JB, Schreiber MA. Coagulopathy:its pathophysiology and treatment in the injured patient. World J Surg. 2007;31(5):1055-1065 http://en.wikipedia.org/wiki/Fresh_frozen_plasma http://www.psbc.org/therapy/ffp.htm http://reference.medscape.com/drug/ffp-octaplas-fresh-frozen-plasma-999499 http://ccforum.com/content/14/1/202

Nutrition †Fast food Essay

Many people eat fast foods because they are cheap, tasty, and convenient. But do people know what fast foods are made from? Is it healthy to eat fast foods everyday? Do fast food companies really fool their customers? In the essay â€Å"The Big Fat Case Against Big Macs,† Ellen Goodman doubts that the best lawyers can prove that fast food companies, like McDonald’s and Burger King, are the causes that make many people become overweight and have health problems, but they can prove that fast food companies fooled their consumers, especially young kids. For example, McDonald’s uses toys as attractions to make kids buy its meals. She also states that fast food companies put slogans to make kids think that eating their â€Å"Big Kids Meal† will make them grow up faster. She also doubts that fast foods have nothing to do with the health problems because why would McDonald’s in France take out an ad telling parents that kids should not eat more than one hamburger in a week. She believes that many people become overweight and have health problems not just because of the fast food companies. Instead of blaming fast food companies, people should blame their sedentary lifestyles. Many people think that fast food companies fooled their customers, young kids, by selling their meals that come with toys. Selling food with toys does not mean fooling people. Well, is there any law that forbids people from selling food with toys? That is how people do business; they just want to get more profits from selling food with toys. Fast food companies don’t force people to buy their products, it’s our own choice. If the toys are the reasons why kids keep buying the meals, why don’t just parents take their kids to toys stores and buy a toy there? We can’t say that fast food companies fooled kids. Well, maybe in some cases they do fool kids, like in the part where they put slogans on their meals that say: â€Å"Do you want to be a Big Kid ? † Kids don’t have any idea about fast foods. The first thing that comes to their minds is that they have to eat this foods to get big ,and kids will just keep eating this foods, while parents keep telling their kids to be strong and big. Fast foods are made from some ingredients that are not healthy. Believe it or not, eating a lot of fast foods is not good for our bodies. In fact many people believe that fast foods are usually high in fat, calories, and cholesterol, which can lead to health problems like high blood pressure, and heart disease. For example, a friend of mine likes to eat fast foods such as McDonald’s. He eats McDonald’s three times a week, and now he has a high blood pressure. He needs to check his blood pressure once a week, so that he can maintain it. Fast foods are not healthy, so try not to eat fast food as much as you can or you will regret it. Ellen Goodman believes that there is no different between eating fast foods and eating slow foods. In this case, slow foods mean foods that are good, clean, and fair. She is right about that. People will get fat from eating both, fast foods and slow foods, and she also thinks that many people become overweight not just because of the fast food companies. Once again, she is right about that. Many people usually blame fast food companies when they become overweight. But the truth is fast food companies don’t make people fat, we are the one who makes ourselves fat. Let’s take an example, how many people do you think will sit down and watch a television after they eat? Probably almost all of them right? Well, instead of sitting down and watch a television, they could walk at park to burn their calories. The point is people won’t get fat if they do a lot of exercises. There are a lot of bad rumors about fast foods, like fast foods are not healthy and can make people fat, and fast food companies fooled their customers. Maybe some of the rumors are true and some of them are false. For examples, it is true that fast foods are not healthy for our bodies and it is false that fast food companies fooled their customers. As the conclusion, there are both good sides and bad sides about fast foods.

The Unexplained Puzzle Into Enders Game Essay Topics

The Unexplained Puzzle Into Ender's Game Essay Topics So the entire war is because we can't speak to one another. Cost-free Enders Game essay samples can be found FreeEssayHelp with no payment or registration. From the very start of the novel, Ender's extraordinary empathic abilities are absolutely conspicuous. Speaking about something you understand well makes it a lot easier and enjoyable! The book proceeds to inspect the question of good and evil. Since you can see, several of the topics listed are new and deal with the present issues happening in the World today. Take notes concerning all prospective topics you're able to consider. Start researching, and get started writing! Only as long as you have a look at your life from a neutral perspective are you going to be in a position to tell what's really happening and what's a fragment of your imagination. There are a couple of easy guidelines to follow to be able to be in a position to compose a fantastic persuasive essay. To get started writing your assignment you would want to run into an interesting and promising topic. You ought to be proficient in the topic, have an overall idea about the chosen issue and can get the best arguments to demonstrate your thesis. Understanding Ender's Game Essay Topics If it's a college essay, it is critical to consider what aspects of it is going to be evaluated. Possessing no thought of the persuasive essay topics, you just do not understand what to write about. It will be simpler that you compose a superior persuasive essay if it's a subject in which you have knowledge. Well, it's not that easy to pick the finest persuasive essay topics from a pool of great sug gestions. All things considered, you can observe that writing a persuasive essay isn't a brain surgery. Always bear in mind an ideal persuasive essay ought to be persuasive. Good persuasive essay topics need to be persuasive. There are several good persuasive essay topics to pick from. Just comply with the guidelines stated above, and you will be well on your way to writing an excellent persuasive essay. The more information you are able to gather about the subject, the better prepared you'll be for writing your essay. You should utilize APA reference tools to aid in writing your essay the right way or seek the services of an expert essay writer that could write the essay employing the APA reference tools. Doing this, you'll certainly find your ideal essay title easily and faster. What Everybody Dislikes About Ender's Game Essay Topics and Why There are a lot of intriguing topics that could be become a persuasive essay if you take the opportunity to consider about doing it. There are just a few things that define whether an essay you're working on is going to be a good one. After you settle on the subject and pick the position on which you will base your essay, the remainder of the job can then begin. Still, figuring out the very best topic for your essay i sn't your only concern for a student. It's important to understand that essay topics are just basic ideas that leave you pondering a notion that might be a huge deal to another person. Argumentative essay topics are so important since they are debatableand it's critical to at all times be critically considering the world around us. Selecting a persuasive essay topic may take lots of time without ending up with the terrific solution. In an issue of speaking, picking out persuasive essay topics is similar to telling yourself what you wish to convey to the rest of earth. The simplest approach to pick out a persuasive essay topic is to go over a present issue. Persuasive essay topics don't always must be of a critical nature, you can write about things which are relevant in your life. Selecting an excellent topic for your essay is among the most essential and frequently tricky parts for many students. Deciding on the most suitable topic for a persuasive speech can be not such an easy issue to do as it might seem. Then comes the revelation he was not playing a game whatsoever, but instead commanding the faraway troops who were fighting the Formics in actual time. In light of the above it's significant that it might be worth mentioning that the present world is easily the most dangerous place because it is full of hatred, jealousy, slothful, vindictiveness and competition of ill money which never support the qualities of a healthful society. Discussing something which you are familiar isn't only more fun but also a good deal simpler. The day's ba ttle is remarkably big and complex.

Kants Moral Theory and Utilitarism Comparison Essay

Kant’s moral theory and utilitarianism are two very different moral theories. Kant’s moral theory works off of the categorical imperative. Utilitarianism works off of the greatest happiness principle. Morality and right action are very different within these two theories, and the idea of slavery is a good example of the differences. Utilitarianism can allow slavery, whereas Kant’s moral theory cannot allow slavery. Kant’s moral theory uses the categorical imperative as its basis. The categorical imperative states â€Å"act only according to that maxim whereby you can at the same time will that it should become a universal law†. (Kant, pg. 30) A maxim is a reason a person commits and act. (Kant, pg. 30) Kant does not believe a person†¦show more content†¦Utilitarianism is a moral theory using the greatest happiness principle as its’ basis. The greatest happiness principle is mathematical and uses the number of individuals ex periencing happiness or pain. If an act promotes more happiness than pain for individuals involved, then the act is moral. (Mill, pgs. 1 and 7) Utilitarianism is a situational moral theory. There are actions that can be moral in some situations, but immoral in other situations. This can be confusing, because there is not always a moral act set in stone. Despite the confusion this is also a good thing, because the theory is extremely flexible. This can be a problem, because there are actions that can be performed under utilitarianism that are questionable at best in many other theories. There are two exerts, one form Immanuel Kant’s Grounding for the Metaphysics of Morals and one from John Stuart Mill’s Utilitarianism, that help with the understanding of Kant’s moral theory and utilitarianism. The first is an example of how the categorical imperative is applied. â€Å" A man reduced to despair by a series of misfortunes feels sick of life but is still so far in possession of his reason that he can ask himself whether taking his own life would not be contrary to his duty to himself. Now he asks whether the maxim of his action could become a universal law of nature. But his maxim is this: from self-love I make as my principle to shorten my life when its