C. Precautions

1. Storage of product for >8 hours is associated with a

rapid decrease in WBC function, making this a less

than useful product.

2. Fever, alloimmunization, TRALI, and CMV infection

have all been reported complications.

Fresh Frozen Plasma, Frozen Thawed

Plasma, and Cryoprecipitate

A. Indications (2,38)

1. FFP, Frozen Thawed Plasma

Clinically significant bleeding or for correction of

hemostatic defects prior to invasive procedures in the

presence of

a. Complex factor deficiency unresponsive to vitamin K

b. Isolated congenital factor deficiency for which virusinactivated-plasma-derived or recombinant factor

concentrates are unavailable

c. Support during the management of disseminated

intravascular coagulation

2. Cryoprecipitate

a. Congenital or acquired dys- or hypofibrinogenemia*

b. Congenital FXIII deficiency in the absence of FXIII

concentrate*

c. Bleeding associated with von Willebrand disease,

hemophilia A when virally inactivated plasmaderived or recombinant factor products are unavailable.

B. Contraindications

1. None absolute

2. Exert caution when possibility of volume overload

exists.

3. Use with caution in the setting of NEC and/or

T-activation as it may aggravate hemolysis (39).

4. Not indicated for hypovolemic shock in the absence of

bleeding, nutritional support, treatment of immunodeficiency, or prevention of intraventricular hemorrhage.

C. Equipment and Technique

See Platelet Transfusion.

1. Cross-matching is not required because type-specific or

AB-negative product is usually issued.

2. Dose of FFP is 10 to 20 mL/kg; multiple transfusions

may be required until the underlying condition

resolves.

3. Once thawed, FFP should be transfused within 6 hours

for labile factor replacement.

4. In cases for which repeated FFP transfusions are

required, a thawed unit from a single donor may be

divided into smaller aliquots and used within 24 hours

if stored between 1°C and 6°C.

5. A dose of 1 U/5 kg of cryoprecipitate will increase the

total fibrinogen by approximately 100 mg/dL in the

absence of ongoing consumption.

6. 1 U of cryoprecipitate equals approximately 12 to

20 mL.

Directed Donor Transfusions

A. Potential Problems

Directed donations provide no known benefit in terms of

increased safety and may pose unique immunologic and

serologic risks to the neonate (30,40).

*In the presence of active bleeding or planned invasive procedures.