Plasma is obtained by separating the liquid portion of blood from the
cells. One unit of plasma is the plasma taken from a unit of whole
blood. Plasma is frozen quickly after donation, usually within 8-24
hours of collection, to preserve the clotting factors. Frozen plasma
can be stored up to one year, and thawed shortly before use. Frozen
plasma contains all coagulation factors in close to normal
concentrations. Thawed plasma may be transfused up to 5 days after
thawing and contains slightly decreased levels of Factor V (66+/-9%)
and decreased Factor VIII levels (41+/-8%)
Plasma is free of red blood cells, leukocytes and platelets, and in
general must be ABO compatible with the recipient's red blood cells. Rh
factor need not be considered. Since there are no viable leukocytes,
plasma does not carry a risk of transmission of cytomegalovirus (CMV)
or graft versus host disease (GVHD)
Plasma transfusion is indicated in patients with documented
coagulation factor deficiencies and active bleeding, or who are about to
undergo an invasive procedure. Deficiencies may be congenital or
acquired secondary to liver disease, disseminated intravascular
coagulation (DIC), or hemodilution after massive transfusion
with red blood cells and crystalloid / colloid solutions. Additionally,
plasma transfusion is indicated in the treatment of thrombotic
thrombocytopenic purpura (TTP), usually in conjunction with plasma exchange.
Plasma should not be used for coagulation factor deficiencies for
which a safer product is available, i.e. factor VIII and IX
concentrates for hemophilia A and B respectively. As well, plasma
should not be used for reversal of warfarin (Coumadin)
anticoagulation. This can safely be achieved by giving Vitamin K or
holding warfarin two to three days prior to a planned procedure. Rapid
reversal of warfarin anticoagulation for life threatening bleeding may
be achieved with Kcentra®, a 4 factor prothrombin complex concentrate (PCC).
Plasma should not be used for volume expansion unless the patient also has a significant coagulopathy and is bleeding.
The volume of one unit of plasma is 200-250 mL. The initial
recommended dose for adults is 10 mL/kg, and is 10-15 mL/kg for
Example: 70 kg patient x 10mL/kg = 700 mL (round up to nearest 200mL) = 800 mL = 4 units of plasma.
When in doubt, Hematology or Blood Bank consultation is advised concerning the dose of plasma.