John C. Staley Posted November 5, 2008 Share Posted November 5, 2008 I'm still fighting the battle to bring the use of 5 day plasma to my facility to reduce the waste of a valuable resource and I need some help.First if anyone has a journal reference or two concerning the factor levels in 5 day plasma and or the efficacy of 5 day plasma I would appreciate knowing where I could find them.Also, I have been asked to provide a list of facilities currently utilizing 5 day plasma, especially level I and level II trauma centers.Any help will be greatly appreciated.Thanks John Link to comment Share on other sites More sharing options...
mda Posted November 5, 2008 Share Posted November 5, 2008 I think this was published in the AABB Website. Please check AABB website. We currently use 5 day old Plasma, we are a Trauma I Facility (Shands at University of Florida). We also use Liquid Plasma (26 day-expiration) for our Trauma patients. Note: There are some plasma products that are only good for 24 hours, please check with your blood supplier. Link to comment Share on other sites More sharing options...
shelleyk482 Posted November 5, 2008 Share Posted November 5, 2008 (edited) John,Transfusion, vol 41, April 2001 pg 570There is also a new article coming out in Transfusion that gives the coagulation factor levels in plasma frozen with 24 hour of phlebotomy. I pulled the artice off of the Wiley Interscience site. I don't have the volume number because it was under the "early view" section.Hope this helps Edited November 5, 2008 by shelley482 Link to comment Share on other sites More sharing options...
bmarotto Posted November 5, 2008 Share Posted November 5, 2008 Hi John,Lahey Clinic Burlington, MA is a level II Trauma unit. We also have a very active liver transplant program, performing both cadaveric and live donor transplants. We use plasma for three days post thawing and have reduced our outdate to practically nothing. Our liver team was very supportive of the change. Link to comment Share on other sites More sharing options...
SMW Posted November 6, 2008 Share Posted November 6, 2008 One article you may want to start with is:Downes KA, Wilson E, Yomtovian R. Serial measurement of clotting factors in thawed plasma stored for 5 days. Transfusion 2001 (letter); 41:...and since sometimes a picture is easier to understand, I've taken the info. from this article and created a graph (see attached). As a discussion point (at least for the Factor VIII issue), it's easy to see that group A and B plasma at 5 days essentially has the same Factor VIII levels as group O plasma at day 1....so, and unless they're currently determining the number of units to order based on the patients ABO type, group A and B (and presumably group AB) plasma at 5 days is equivalent to group O plasma at day 1......Also, with the recent advocates for the use of "Massive Transfusion Protocols" and early release of plasma during massive transfusion, most facilities that report instituting these protocols (or having long-standing such policies) report using plasma thawed for greater than 24 hours.... FVIIIABO.pdf Link to comment Share on other sites More sharing options...
Likewine99 Posted November 7, 2008 Share Posted November 7, 2008 John,We are a 450 bed Level II trauma center and went to 5 day plasma about a year ago. It has reduced our waste to almost zero. Our trauma surgeon was all for this and we do have a massive tx protocol. The bld supplier also had input, they were a big help Link to comment Share on other sites More sharing options...
Likewine99 Posted November 7, 2008 Share Posted November 7, 2008 OOPS! Forgot to mention location:SSM DePaul Health CenterSt. Louis MO Link to comment Share on other sites More sharing options...
adiescast Posted November 12, 2008 Share Posted November 12, 2008 At Greenville Hospital System (Greenville, SC), our main hospital is a level 1 trauma center. We started using 5 day thawed plasma when we implemented our massive transfusion protocol this year. Link to comment Share on other sites More sharing options...
dcharland Posted November 20, 2008 Share Posted November 20, 2008 Do you have AB plasma thawed in case of a Massive transfusion Porotocl being activated? Link to comment Share on other sites More sharing options...
adiescast Posted November 21, 2008 Share Posted November 21, 2008 We keep 6 O, 6 A, 6 B, and 3 AB plasmas on hand. The protocol states that we send the 3 ABs with 6 O neg red cells and a pheresis platelet with the first cooler, then we switch to type specific. Most of the time we have had a sample to type before they called the protocol and we have been able to send type specific with the first batch. We have not had much problem with outdating the thawed plasma, but we are using more B and AB plasma than we were before we started the protocol because we keep it thawed and use it for other compatible recipients before it expires. We have a very active cardiac program that uses plasma regularly, which helps to prevent outdating the thawed plasma. Link to comment Share on other sites More sharing options...
dcharland Posted November 21, 2008 Share Posted November 21, 2008 Thanks for the info, we keep 2 A's and 2 O's and I don't think that is enough. It's so helpful to see what other places are doing. Link to comment Share on other sites More sharing options...
PammyDQ Posted January 21, 2009 Share Posted January 21, 2009 We use 5-day plasma. We are not a trauma center, but we have the same medical director as a nearby Level 1 trauma center, and they too use 5-day plasma.Overall our use of FFP has been cut dramatically due to technologists monitoring the indication for the transfusion in combination with education of the medical staff by our esteemed blood bank medical director who is also an expert on coaguopathies. Vitamin-K is being recommended for many cases. Our director wrote ain "inhouse" handbook of transfusion guidelines called "Good Transfusion Practice" (aka The Good Book LOL)for all blood products, and it is distributed to each new batch of residents. Generally FFP is not used at my facility unless it's clearly indicated. Incidentally our facility had one TRALI induced sudden death following a FFP transfusion and the FDA highly scrutinized the indication for the FFP infusion of that patient. Link to comment Share on other sites More sharing options...
PaulSunV Posted February 6, 2009 Share Posted February 6, 2009 Do any of you that are using 5 day plasma have any restrictions on what type of patient can receive the product. I believe that the restriction as it relates to neonates is appropriate but the Medical Director in her infinite wisdom has tentatively agreed to allow the use but only on emergency room patients. For my facility it would hardly make it worth while and the savings probably wouldn’t be there under that restriction. Any input would be greatly appreciated Link to comment Share on other sites More sharing options...
Mabel Adams Posted February 8, 2009 Share Posted February 8, 2009 The data above about O plasma at 1 day having the same coag factor levels as other types at 5 days seems to me a useful argument. Link to comment Share on other sites More sharing options...
dcharland Posted February 9, 2009 Share Posted February 9, 2009 We use 5 day plasma for all patients (except hemophiliacs). Factor VIII and Factor V are reduced but are still at suffient levels to help maintain hemostasis. See "Serial measurement of clotting factors in thawed plasma stored for 5 days" Katharine A. Downes in Transfusion Volume 41, issue 4, pages 570-570. Published online 4/21/2002.We are a level 1 trauma center. Good Luck! Link to comment Share on other sites More sharing options...
bxcall1 Posted February 9, 2009 Share Posted February 9, 2009 SMW, Did the authors give an explanation as to why the Factor VIII levels vary in different blood groups?Enloe Medical Center uses 5 day plasma also. Link to comment Share on other sites More sharing options...
bxcall1 Posted February 9, 2009 Share Posted February 9, 2009 link to abstract on the subject - http://www3.interscience.wiley.com/journal/121398204/abstract Link to comment Share on other sites More sharing options...
Mabel Adams Posted February 10, 2009 Share Posted February 10, 2009 Type O people have long been known to bleed more and they finally found that there was a measurable difference in their coag factor levels. Link to comment Share on other sites More sharing options...
bbbirder Posted February 10, 2009 Share Posted February 10, 2009 Here is another article on 5 day plasma: Coagulation factor levels in plasma frozen within 24 hours of phlebotomy over 5 days of storage at 1 to 6°CTransfusionVolume 48, Issue 12, Date: December 2008, Pages: 2525-2530Mark H. Yazer, Andrea Cortese-Hassett, Darrell J. TriulziAbstract | References | Full Text: HTML, PDF (75K)CONCLUSIONS: The activity of all factors assayed, except for PS, were within their normal range during the 5-day storage period. These results show comparable factor assay levels in TP prepared from fresh-frozen plasma and FP24. Linda Frederick Link to comment Share on other sites More sharing options...
bpkelly Posted February 10, 2009 Share Posted February 10, 2009 I just saw an article describing a study of the two products. I sent the article to one of my outlying pathologists and I don't remember where I saw it. We are a Level 1 trauma center and have been using 5 day plasma for over 10 years without any issues. Sentara Norfolk General Hospital Link to comment Share on other sites More sharing options...
Cheryl Richards Posted February 10, 2009 Share Posted February 10, 2009 University of New Mexico Health Sciences Center, Level 1 trauma service, has been using 5 day plasma for several years and saved a lot of $$ in wasted 24 hour FFP. Just know you can't assign a 5 day outdate to plasma that was procured by an "open" system apheresis - check with your donor service to be sure. Since we get plasma from several different sources, we automatically assign a 24 hour outdate to plasma obtained via apheresis. Link to comment Share on other sites More sharing options...
bacsyhieu Posted February 11, 2009 Share Posted February 11, 2009 (edited) All is nice! Edited February 11, 2009 by bacsyhieu Link to comment Share on other sites More sharing options...
drsbright Posted February 12, 2009 Share Posted February 12, 2009 JOhn: Give me a fax number and I will send you the outcome of a major study on this very topic at Methodist/Claian and Indiana University Hospitals.SMBIndianapolis, Indiana Link to comment Share on other sites More sharing options...
PaulSunV Posted February 12, 2009 Share Posted February 12, 2009 (edited) drsbright,John, has retired but I would like a copy of the study, My fax no. is 801-387-7362, or if you can attach it to an email my email address is Paul.Greiner@imail.orgThanks,Paul Edited February 12, 2009 by PaulSunV Link to comment Share on other sites More sharing options...
drsbright Posted February 13, 2009 Share Posted February 13, 2009 Paul: This was faxed earlier today to the number you gave me. I trust it can be of some benefit to your service.SMBIndianapolis, Indiana Link to comment Share on other sites More sharing options...
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