Canonical Question
Blood – Pharmacology
Master answer
| Fresh Frozen Plasma (FFP) | Prothrombin Complex Concentrate (Prothrombinex) | |
| Intro | Human plasma containing all coagulation factors including the labile plasma coagulation Factors VIII and V | Human plasma derivative containing concentrates of factors II, IX and X (500IU PCC has 500IU of II, IX, X each in a vial) The 3 factor prothrombin complex concentrate available in Australia (4 factor PCC in some European countries) |
| Preparation | Prepared either via: Separation from whole blood Apheresis: Removal of a large volume (typically 800ml) of plasma from a single patient, with return of red cells to the donor. Once collected, it is frozen and rethawed in a water bath prior to use | developed through the process of ion-exchange chromatography from the cryoprecipitate supernatant of large plasma pools and after removal of antithrombin and factor XI |
| Indications | reversal of warfarin anticoagulation (in setting of bleeding or need for invasive procedure) Bleeding and multiple coagulation defects (e.g. DIC with significant PT/PTT elevation) Correction of coagulation defects for which no specific factor is available Transfusion of more than one blood volume with evidence of active bleeding + coagulopathy accepted treatment for patients with thrombotic thrombocytopenic purpura often in conjunction with plasma exchange. Where PCCs are not available | Bleeding and warfarinized Bleeding from factor deficiency (either congenital or due to liver disease, and haemophilia) Prophylaxis |
| Contraindications | Allergy to class/drug ABO incompatibility when you can correct coagulopathy effectively with specific therapy in plasma exchange procedures except for treatment in thrombotic thrombocytopenic purpura treatment of immunodeficiency states | Allergy to class/drug DIC known HIT (Heparin induced thrombocytopenia) patients with haemophilia B if a specific factor IX concentrate is available |
| PC | Dose: 10-15ml/kg will increase factors by ~20-30% Transfuse at least 15 mL/kg at a time (4 units in 70-kg adult) INR >1.5 and needs invasive procedure INR >1.5 and actively bleeding (e.g. massive transfusion protocol, post-bypass surgery) INR of FFP is ~1.6; therefore transfusing for INR <1.7 is not advised | Dose: – 25-50 IU\kg (1 IU\kg of Factor IX raises the Factor IX by 1%) – Dose adjusted based on INR |
| PD – MoA | restores factors II, VII, IX and X in the anticoagulated patient | provision of factors II, IX and X |
| Side Effects | Serious Hemolytic transfusion reactions Febrile non-hemolytic reactions Transfusion-associated circulatory overload (TACO) Transfusion-related acute lung injury (TRALI) Transfusion-associated graft-versus-host disease Anaphylaxis Sepsis Common Headache, paraesthesia Nausea, Pruritus, urticaria | Serious Thromboembolic Events Common Allergy, anaphylaxis phlebitis vomiting, fever rash, urticaria SOB pain thrombocytopenia |
| PK | IV Distributed and metabolized in the same way as endogenous coagulation factors | IV Distributed and metabolized in the same way as endogenous coagulation factors |
| Advantages | cheap | small volume readily available reliable reversal avoids complications of FFP – immune reaction, TRALI, fever, infection risk familiarity cheap |
| Disadvantages | ABO compatibilty a must (but crossmatch before transfusing not) Needs to be thawed – time delay Immune reaction, TRALI, fever, infection risk significant fluid load in patients that are elderly and frail, or have heart failure. | More expensive than FFP May cause thromboembolic complications |
Exam appearances
| Exam | Exact wording | Relationship | Success |
|---|---|---|---|
| 2019A Q03 | Compare and contrast fresh frozen plasma and prothrombin complex concentrate. | historical_member | — |
| 2022B Q02 | Compare and contrast fresh frozen plasma and prothrombin complex concentrate. | historical_member | — |