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Infusing Fresh Plasma

Forming a blood clot to stop bleeding after surgery, dental work or injury is difficult for those with bleeding disorders. These conditions, which include hemophilia and von Willebrand Disease, are characterized by a lack of clotting factors (proteins in the blood that promote clotting). People with bleeding disorders risk damage to muscles, joints and internal organs if bleeding is left uncontrolled.

Plasma Infusion

In people with bleeding disorders, the amount of clotting factors in the blood can be low, or the factors can be missing entirely. Thus, an important treatment for those with bleeding disorders is the replacement of clotting factors. This is called a plasma infusion. The procedure is done through intravenous (in the vein) injection and can be delivered in a variety of forms as well as at home or in the hospital:

Concentrated Frozen Plasma: Concentrated frozen plasma, or cryoprecipitate, comes from a donor and contains all the important clotting factors. Because it is concentrated, only a small amount of the product is required during a treatment. However, concentrated frozen plasma is more expensive than fresh frozen plasma. It also needs to be kept frozen and may be a challenge to keep at home.
Factor Concentrates: Factor concentrates are both the most concentrated and the most expensive of the plasma infusion options. These concentrates contain only the clotting factor needed to treat a specific bleeding disorder, such as hemophilia A or B. Factor concentrates bring a higher level of convenience because they can be stored and used in the home, and smaller amounts are needed for a single treatment. The clotting factors in these products can either come from donors or be produced in a lab.
Fresh Frozen Plasma (FFP): Fresh frozen plasma is a natural product that comes from donated blood. It contains all of the different types of clotting factors, so it is useful in the treatment of many bleeding disorders. This is also the least expensive of all the plasma options. Because it is not concentrated, large volumes of FFP may be necessary to control bleeding. Since it needs to be kept frozen, FFP may be difficult to keep in the home.

The Plasma Infusion Process

Plasma infusions can be done in hospitals or in a person's own home and can be performed by medical professionals or patients themselves. Many hemophiliacs who need frequent infusion learn to self-infuse.

The infusion is given through an IV needle, which may pinch for a moment, but is not terribly painful. The patient reclines during the process and can relax by reading, watching T.V. or listening to music.

If a doctor or nurse is doing the infusion, the patient's temperature, respiration, blood pressure and pulse will be monitored. Depending on the condition and the type of infusion, the procedure may be completed in as little as 30 minutes or may take several hours.

During an infusion, a medical professional will watch the patient closely for:

change in skin temperature
leakage or oozing from the IV
pallor (loss of skin color)
redness at the IV site
swelling of the injection site
tenderness.

A patient will also be watched for any minor reactions to the plasma, such as:

dizziness
fever and chills
flushing, rash or redness on chest
mottling (spots or blotches)
nausea
tachycardia (rapid heartbeat).

Also, there is a very slight chance that a patient might experience a major reaction to a blood product such as difficulty breathing or chest pain. If this happens, infusion will be discontinued and the patient will be treated for the reaction before further infusions.

When an infusion is completed, any bleeding a patient is having should stop within a few hours. Exact times vary with each person. If a patient is bleeding heavily, it may take a bit longer for it to stop. Once the bleeding stops, patients can be assured that they are preventing damage to joints, muscles and organs.

Plasma Infusion Risks

Plasma infusion is a very effective way to replace clotting factors in the blood. However, there are a few risks that should be considered: Occasionally, patients have mild or severe reactions to blood products. Also, with any donated blood product there is some risk of contracting a virus, such as hepatitis or HIV. However, donated blood is carefully screened and the risk of contracting a virus is very small.

Sometimes individuals with hemophilia A actually develop antibodies that are inhibitors to clotting factors. This happens more frequently in children than in adults and causes the plasma infusions to become ineffective.

Resources

Bontempo, Franklin A., M.D. (1992). Fresh Frozen Plasma. Retrieved September 22, 2007, from the Transfusion Medicine Update Web site: http://www.itxm.org/archive/tmu8-92.htm.

Fackler, Amy, MA (2005). Clotting factor replacement for hemophilia. Retrieved September 22, 2007, from the PeaceHealth Web site: http://www.peacehealth.org/

kbase/topic/detail/other/hw190139/detail.htm.

UCL Institute of Child Health and Great Ormond Street Hospital for Children (n.d.). Fresh frozen plasma, blood product transfusion clinical guideline; Fresh frozen plasma infusion. Retrieved September 22, 2007, from Great Ormond Street Hospital for Children NHS Trust (Gosh) and UCL Institute of Child Health (ICH) joint Web site: http://www.ich.ucl.ac.uk/

clinical_information/clinical_guidelines/cpg_guideline_00085.