Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant
Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant
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DOI：
10.1111/j.1365-2141.2004.04972.x
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发表时间：
2004-07-01
影响因子：
6.5
通讯作者：
Williamson, LM
中科院分区：
文献类型：
--
作者：
O'Shaughnessy, DF;Atterbury, C;Williamson, LM
输注新鲜冰冻血浆(FFP)、冷沉淀和冷冻上清血浆的适应症非常有限。当输血时，它们可能会产生不可预测的不良影响。除非使用病原体降低血浆(PRP)，否则传播感染的风险与其他血液成分相似。特别值得关注的是过敏反应和过敏反应，输血相关的急性肺损伤，以及输血抗体引起的溶血，尤其是A和B血型抗原。FFP不适用于无出血的弥漫性血管内凝血，仅推荐作为血栓性血小板减少性紫癜的血浆交换介质(冷冻上清液是一种可能的替代方案)，在没有严重出血的情况下永远不应用于逆转华法林抗凝，并且在肝活检之前的预防措施中只有非常有限的位置。当用于外科或创伤性出血时，FFP和冷沉淀物的剂量应由凝血研究指导，这可能包括近患者测试。FFP不适用于扭转新生儿或重症监护病房患者的维生素K缺乏症。PRP可作为FFP的替代品。在英国，卫生部建议1996年1月1日以后出生的儿童使用来自牛海绵状脑病发病率较低的国家的PRP。预计将于2004年完成对非联合王国来源的单一捐助者方案的有限供应安排。来自美国捐赠者的批量汇集商业制备的PRP(Octaplas)已获得许可，并在英国可用。FFP必须使用一种避免细菌污染风险的技术进行解冻。含有这些血浆产品的塑料袋在冷冻状态下是易碎的，必须小心搬运。
The indications for transfusing fresh-frozen plasma (FFP), cryoprecipitate and cryosupernatant plasma are very limited. When transfused they can have unpredictable adverse effects. The risks of transmitting infection are similar to those of other blood components unless a pathogen-reduced plasma (PRP) is used. Of particular concern are allergic reactions and anaphylaxis, transfusion-related acute lung injury, and haemolysis from transfused antibodies to blood group antigens, especially A and B. FFP is not indicated in disseminated intravascular coagulation without bleeding, is only recommended as a plasma exchange medium for thrombotic thrombocytopenic purpura (for which cryosupernatant is a possible alternative), should never be used to reverse warfarin anticoagulation in the absence of severe bleeding, and has only a very limited place in prophylaxis prior to liver biopsy. When used for surgical or traumatic bleeding, FFP and cryoprecipitate doses should be guided by coagulation studies, which may include near-patient testing. FFP is not indicated to reverse vitamin K deficiency for neonates or patients in intensive care units. PRP may be used as an alternative to FFP. In the UK, PRP from countries with a low bovine spongiform encephalopathy incidence is recommended by the Departments of Health for children born after 1 January 1996. Arrangements for limited supplies of single donor PRP of non-UK origin are expected to be completed in 2004. Batched pooled commercially prepared PRP from donors in the USA (Octaplas) is licensed and available in the UK. FFP must be thawed using a technique that avoids risk of bacterial contamination. Plastic packs containing any of these plasma products are brittle in the frozen state and must be handled with care.