Fresh frozen plasma risks

National Institutes of Health Consensus Conference. Fresh frozen plasma indications and risks. Transfus Med Rev 1987 l(3) 201-4. 

In the United States, infants nsnaUy receive 1 mg of phytonadione intramnscnlarly at birth for prophylaxis. Most infants bnUd np vitamin Ki and K2 stores in the fiver dnring the first month of life. The speed of repletion depends on the amonnt of milk or formnla received. Oral snpplementation resnlts in late vitamin K-dependent bleeding if not given for a prolonged course. Controversy has arisen over whether the high plasma vitamin K levels achieved with intramnscnlar injection may lead to an increased incidence of childhood cancer. This risk has not been snbstantiated and the benefits of widespread use outweigh the minimal risk. Fresh frozen plasma is nsed to treat hemorrhages. 

B. Parenteral injection is an alternate route of administration, but is not likely to result in more rapid reversal of anticoagulant effects, and is associated with potentially serious side effects. If hemorrhage is present, use fresh frozen plasma for rapid replacement of coagulation factors. Subcutaneous administration is preferred over IM injection, although both can cause hematomas. The maximum volume is 5 mL or 50 mg per dose per injection site. The adult dose is 10-25 mg, and that tor children is 1-5 mg this may be repeated in 6-8 hours. Switch to oral therapy as soon as possible. Intravenous administration is rarely used because of the risk of anaphylactoid reaction. The usual dose is 10-25 mg (0.6 mg/kg in children under 12 years), depending on the severity of anticoagulation, diluted in preservative-free dextrose or sodium chloride solution. Give slowly at a rate not to exceed 1 mg/min or 5% of the total dose per minute, whichever is slower. 

Infection risk On 10 April 2009, during a routine record review in connection with a subsequent blood drive, a blood bank supervisor learned of a breach in the deferral protocol for blood products collected from trainees [52 ]. Further investigation showed that the blood that had been obtained during the previous drive had been from trainees who had been immunized with yellow fever vaccine 4 days before the drive. All of those blood products had already been processed and incorporated into the inventory at the hospital s blood bank. The blood bank supervisor reviewed the blood bank s records and identified 87 units of whole blood and three units of platelet that had been obtained from the recently immunized trainees. Blood products that had been released for transfusion were tracked forward to identify the patients who had received the implicated blood products. Unused blood products were identified and destroyed. Five patients had received six blood products (three units of platelets, two units of fresh frozen plasmas, and one unit of packed erythrocytes) from six of the trainees, who had no previous history of immunization or travel consistent with... 

Fluid balance Because of the low concentration of coagulation proteins in fresh frozen plasma, large volumes may be needed when it is used to reverse excess oral anticoagulation treatment, with a risk of fiuid overload [41, 42 ]. 

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