Plasma thawing

[Hippokrates]

Hi there!

In general: How many bags do you need to thaw up at the same time?

[John C. Staley]

We can thaw up to 8 at one time but prefer not to thaw more than 2. Bottom line, if the ED orders 6 we thaw 6. Tried to second guess them once and really got burned. Never again. They order it we thaw it.

[krichards]

We do exactly the same...try to keep it to 2, but will give up to 8 if the situation warrants it.

[Lcsmrz]

Someone in the great wisdom years ago (not me) purchased a two-slot plasma thawer, so that's the maximum we can thaw at one time. We do not relabel for 5-day plasma, and we discard 1-2 plasma a year.

[LaraT23]

We have the capacity to thaw up to 8 but I don't thaw more than two without calling and getting a name and authorization. We do throw out up to 10 units a year that are not used. That is with relabeling for 5 days.

[adiescast]

We recently started a massive transfusion protocol that requires 6 units of plasma to go out at a time. As a result, we changed to 5 day dating and we keep 6 units of each blood type (3 ABs) on the shelf ready to go. We use these pre-thawed units to fill any orders and replace them as we use them. I don't have a good feel for how our wastage is going since we started this because it has only been a month. We try to keep the plasma rotated out so we don't expire too much.

[NedB]

We have an 8-unit thawer, but only fill it up when we must do plasma exchanges or the OR wants both FFP and Cryo. I can not see the need for thawing in anticipation. FFP is for replacement of coagulation factors; there are better blood-volume expanders. We call to verify the order as most of you.

[bmarotto]

We have two 8 unit thawers and one 4-unit thawer. We thaw up to 10 units at a time for liver transplants.

[Melanie]

WE have two eight unit plasma thaw devices as well as the old fashion Forma waterbath that can hold another eight. So, potentially we could thaw 24 at once and have actually done so for plasma exchanges (CPP or FFP). We now have thawed plasma on hand each day of different blood groups for OR cases and other emergencies. Types we have thawed at all times are 6 Goup O's, 6 group A's and 2 Group B's.

[adiescast]

We have an 8-unit thawer, but only fill it up when we must do plasma exchanges or the OR wants both FFP and Cryo. I can not see the need for thawing in anticipation. FFP is for replacement of coagulation factors; there are better blood-volume expanders. We call to verify the order as most of you.

Actually, it is coming out in the area of massive transfusion that it is better to use plasma for the fluid resuscitation than to use the volume expanders. Apparently using the plasma prevents the trauma related coagulopathy that often shows up to plague massive transfusion patients. In this case, the 5 day plasma has enough coagulation factors to be useful.

[irshadaad]

we also have a two limit at a time unless its plsma exchange or COR asks more than that...if not used we label it LQUED PLSMA with 5 day expiry if not used within 24 hrs

[tbostock]

Actually, it is coming out in the area of massive transfusion that it is better to use plasma for the fluid resuscitation than to use the volume expanders. Apparently using the plasma prevents the trauma related coagulopathy that often shows up to plague massive transfusion patients. In this case, the 5 day plasma has enough coagulation factors to be useful.

Yes, most major trauma centers recommend a 1:1 ratio of plasma to red cells to prevent coagulopathy.

[skopti]

We can thaw up to 12 units in the waterbath, but we only thaw 2 units/patient unless we have a plasmapheresis patient, then we thaw the required volume of plasma.

[Malcolm Needs ☆]

In the UK, the Guidelines say that, as a start (if the patient actually needs FFP in the first place) they should be given 12-15mL/kg body weight. This is about the ONLY blood component that the doctors regularly under-prescribe!

I've got an idea, but don't quote me on this, the this figure of 12-15mL/kg body weight is set to go up.

It won't make any difference; they will still order 2 units of FFP for both Tom Thumb and Goliath!!!!!!!

:rolleyes:

[RR1]

When you quote the number of bags being thawed, it would be useful to know what volumes are in each of your bags. In the UK we stored both 300ml and 150ml FFP bags (and 50ml bags for paeds).

[eric1980]

My lab potentially can thaw 4+8 units of FFP at a time. We will not thaw more than 2 units for ward orders, but for ORs and Emergency, anything goes.

Off-topic:

Yes, most major trauma centers recommend a 1:1 ratio of plasma to red cells to prevent coagulopathy.

What do you guys say if I suggest to the doctor who are ordering 3 units of FFP and 3 units of packed cells, to take 3 or 4 units of whole blood instead?

I am a "whole blood for bleeders until they stop bleeding" advocate.

[SMW]

I have been a long time advocate of Whole Blood in exactly those scenarios. Massively bleeding patient requiring oxygen carrying capacity (red blood cells) and coagulation factors (from plasma). It's generally faster (no thaw time, one product to dispense and transfuse), cheaper (one product instead of two) and limits donor exposure. And for a massively bleeding patient the coag. factors even in stored Whole Blood are sufficient--certainly for a patient with liver disease since those factors in low level in the patient are stable factors in the product (II, VII, IX, X). That being said though, many US hospitals do not maintain an inventory of Whole Blood and/or their blood center does not even maintain or provide Whole Blood as a general inventory item. Also, since Whole Blood needs to be type-specific, if a patient type has not been determined for a trauma situation, it's back to the "universal" components. [The US does not generally test/label group O Whole Blood units for A/B hemolysins.]

When "component therapy" came into vogue and in response to surgeon comments that "my patient is bleeding whole blood, I want whole blood", some blood banks began using the (unproven) "rationale" to the surgeons that a unit of red cells and a unit of fresh frozen plasma was better than a unit of whole blood--and in my opinion swinging the pendulum too far. I don't want to say how many years ago we began using plasma that had been thawed greater than 24 hours but to read some of the recent literature one would think this is a novel application. Oh well, so much for history lessons..........