Blood Products
Author: Jenny Kinsella
22/08/2018
Know your FFP from your platelets? Here's a basic guide to the products we commonly use in ED resus, what we use them for, what they look like, and most importantly how to store them to prevent wastage.
Packed Red cells (PRC)
PRCs
Role: Carries O2 throughout the circulatory system from the lungs to the rest of the body and brings back CO2 waste.
Stored: In a fridge and must be used within 30 mins of removal from fridge.
Appearance: Dark red blood unit.
Platelets (Pool of platelets)
Platelets
Role: Reacts to bleeding from a blood vessel injury by ‘clumping’ together initiating a blood clot. Platelets travel through the bloodstream unactivated until there is a breach in a blood vessel where is becomes activated releasing molecules that cause the platelets to become sticky and adhere to each other. Activation within the platelets cause Fibrinogen to convert to Fibrin, which is a protein that arranges itself to form the sticky, fibrous mesh trapping platelets, RBC and WBC.
Stored: Ready for use when delivered from blood bank.
Appearance: Usually dark yellow but may vary.
Cryoprecipitate (Cryo)
Role: Prepared from FFP. Frozen then thawed for use. It is a more concentrated product derived from FFP. It contains specific proteins for clotting mainly Fibrinogen, Factor VIII, actor XIII, Von Williebrands. Concentrated form of FFP.
N.B. Fibrinogen is produced by the liver. It is converted to Fibrin once activated by injury/bleeding. It creates a cross-linked mesh binding the initial platelet plug.
Stored: Once thawed at blood bank and brought to department, product is ready for use. DO NOT REFRIGERATE.
Appearance: Straw/ yellow coloured blood unit
Fresh Frozen Plasma (FFP)
FFP
Role: Contains all coagulation factors. Indicated for patients with a coagulopathy who are bleeding or at risk of bleeding. May be indicated to replace plasma coagulation factors during massive trauma, surgery, liver disease or Disseminated Intravascular Coagulopathy (DIC). Used when there are low clotting factors and low level blood proteins.
Stored: Ready for use once delivered from blood bank. DO NOT REFRIGERATE.
Appearance : straw/ yellow coloured.
Medication Therapy
Beriplex
Role: Prothrombin Complex Concentration (PCC) made up of clotting factors.
Indications: The treatment of Haemophilia B and Warfarin reversal.
In life threatening haemorrhage (intracranial, GI) give IV Vitamin K + Beriplex.
In less severe haemorrhage (epistaxis, haematuria) give IV Vitamin K.
Asymptomatic with INR> 8, or INR 5-8 with bleeding risk (i.e. recent surgery) give Vitamin K.
Asymptomatic INR 5-8 stop Warfarin and monitor same.
Tranexamic Acid
Role: Used to prevent and treat blood loss. Antifibrinolytic, reversibly binds to receptors on plasminogen, degrading fibrin and preserving the framework of fibrin matrix structure.
Indications: Trauma, PV bleeding, ante/post partum haemorrhage.
Dose: 1G IV over 10 mins, followed by 1G infusion over 8 hours.