Protocols - Hemorio

1 - TRANSFUSION OF FROZEN FRESH PLASMA
Due to the possibilities of diseases transmission risks and the existence of hemoderivatives, are currently
restricted to the therapeutic indications of frozen fresh plasma in its natural state. When you can not
dispose of an industrialized derivative or other therapeutic resource.
The indications of PFC are determined at Resolution RDC no. 10, as of January 23, 2004. They are:
For the correction of congenital and acquired deficiencies, isolated or combined of clotting factor(s).
In the cases of factor XIII deficiency, or fibrinogen or in the von Willebrand disease non responsive to
DDAVP, the frozen fresh plasma may be used if there is no an availability of cryoprecipitate.
Coagulopathies of severe consumption with active bleeding and great decrease in the serum
concentration of multiple factors.
This clinical situation demands a transfusion of PFC whenever there is an hemorrhage and laboratorial
evidences of factors failures – extension of Prothrombin Time (TP) or the Partial Activated Thromboplastin
Time (TTPa) of at least 1.5 times.
Massive Transfusion (more than 1 volemia in less than 24 hours) provided that there is some persistence
of hemorrhage and/or microvascular bleeding, associated to the significant change of hemostasia
(extension of, at least, 1.5 times the TP, the TTPa or INR).
Treatment of Hemorrhages in hepatopath with deficits of multiple factors and changes of coagulogram. It
is usually considered as a significant change of the coagulogram a TP, or TTPa above 1.5 times the
normal value. The usage of an associate prothrombinic complex may increase the efficacy of plasma at
the correction of the coagulopathy.
Liver transplant pre-operative, especially during the anepathic phase of the surgery.
Purpura Fulminans of the New Born by Deficit of C Protein and/or S Protein. At the deficiencies of C
protein and S protein the usage of PFC is indicated, reminding the thrombosis risk.
Thrombosis by Deficit of Anti-Thrombin III: The product of choice is the concentrate of Anti-Thrombin III.
However, this product is rarely available to use at the Brazilian hospitals.
Correction of hemorrhages by usage of coumarin anticoagulants or fast reversion of the coumarin effects.
The product of choice in this situation is the prothrombin complex. As the availability of this kind of
concentrate is not sufficiently broad yet at the Brazilian hospitals, the usage of PFC is an acceptable
alternative.
Hemorrhage by Deficit of dependent Vitamin K Factors in the new born.
Replacement of Factors during the therapeutic plasmapheresis.
Subjects with relapsed angioneurotic edema (Qüincke edema) caused by a deficit of the inhibitor of C1esterase.
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