Hi everyone! 

 

My name is Mich and I’m a consultant conducting research on FFP and its uses. I’ve actually learned a lot lurking these forums, but still have questions I hope you all could answer.  I am mainly interested in issues regarding the distribution and thawing of FFP.  If you could answer one or two of these questions, I’d be so grateful!  Thanks!!

 

1.       Basic info about what FFP is, what it is used for.

 

2.       Where do hospitals get their FFP from? I understand that many hospitals have blood banks, but is blood also fractionated there, or are private plasma fractionators (such as BioLife, BioMat, etc) also a major source of FFP for hospitals?

 

3.       I’ve seen that FFP is mainly used in trauma centers/surgery units, are there any other departments in hospitals that are active in thawing and using the product?

 

4.       About how many thawing systems are in place in each department that uses them?

 

5.       What are some of the major thawer brands used? I’ve seen people list Helmer, Cytotherm, Boekel, Plasmatherm, Sahara-III, and the ArkBio microwave as some of their favorite thawing systems.  What are some pros/cons for the thawing system you use?

 

6.       What are the sizes of the bags used in the thawers? (Are there standard sizes or do they vary a lot?)

 

7.       Last question! Are there any needs regarding FFP thawing systems? (eg. Quantity a machine can thaw, size, issues regarding frequency of use, or any other issues you have with your current thawing system you wish could be improved on.)

Our three most common uses for FFP are:

1.  To correct prolonged Coag times due to Coumadin overdose.

2.  Massive transfusions

3.  Plasma exchanges

We have a Helmer that thaws up to 8 at one time which is very usefull for the plasma exchanges in particular.  Each FFP goes into a separate plastic bag.  The BB lab does all of the thawing and issuing of FFP for the hospital.  Our backup thawer is a Thermogenesis that will do 4 units at a time.

Hope that answers some questions and helps.

 

 

1.       Basic info about what FFP is, what it is used for.

 

Surely as a consultant you should know what FFP is - I'm sorry if this comes across as rude but this actually quite frightens me a bit that you asking such basic stuff on a forum!

 

2.       Where do hospitals get their FFP from?

 

In the UK they come from the donor centre who separates the whole blood into its relevant components

 

3.       I’ve seen that FFP is mainly used in trauma centers/surgery units, are there any other departments in hospitals that are active in thawing and using the product?

 

Departments themselves don't thaw the products, this is done by the laboratory under strict regulation. Other departments who regularly use FFP are maternity units (during massive haemorrhage cases), liver units and also a lot is used for premature babies to correct their frequent coagulopathies.

 

4.       About how many thawing systems are in place in each department that uses them?

 

This depends on how many beds the hospital has and the level of the trauma centre. We are a 380 bed hospital with specialist maternity and NICU for the area as well as the main A&E and we have two, each capable of thawing 4 units (or 2 each on fast thaw). 

 

5.       What are some of the major thawer brands used? I’ve seen people list Helmer, Cytotherm, Boekel, Plasmatherm, Sahara-III, and the ArkBio microwave as some of their favorite thawing systems.  What are some pros/cons for the thawing system you use?

 

We use the Sahara III - it is a dry system so less messy and also records the temperature of the units and notifies you when it is free from ice. We have used waterbath types that are messy if the bags burst and the microwave ones make human scrambled egg when the bags burst.

 

6.       What are the sizes of the bags used in the thawers? (Are there standard sizes or do they vary a lot?)

 

The FFP packs are usually around 250ml. It varies dependent on the haematocrit of the donor.

 

7.       Last question! Are there any needs regarding FFP thawing systems? (eg. Quantity a machine can thaw, size, issues regarding frequency of use, or any other issues you have with your current thawing system you wish could be improved on.)

 

The Sahara III is perfect for our needs

 

 

1.  To correct prolonged Coag times due to Coumadin overdose.

 

This isn't quite correct - the primary mode for reversal of overdose of an asymptomatic patient is vitamin K. Complete reversal can be achieved in 4 hours (though in practice I have found complete reversal is achievable in less than 2 if sufficient dose is given). For a patient that is currently bleeding, or due to undergo emergency (no planned) surgery, the mode of reversal should be PCC. FFP is notoriously unreliable for reversal (especially for significantly raised INRs) and usually results in incomplete reversal. You also run the risk of TOCO due to the volumes needed, and also delay due to the time taken to transfuse the units safely. PCC is a small volume and dose is adjusted based on INR and weight - for an INR of >8 you are talking of 4+ units of FFP and still running the risk of incomplete reversal - Vitamin K would have worked quicker...

Mitch

Just curious, what is your educational/clinical background and what is the purpose of your current "consultation".  As indicated above, this is all pretty basic knowledge and practice.  

 

Are you going to be marketing for a plasma thawer manufacturer?  (We would be glad to beta test one of those microwave thawers if you would be so kind as to let us keep it after you get your data!)

 

Scott

"You also run the risk of TOCO due to the volumes needed, and also delay due to the time taken to transfuse the units safely. PCC is a small volume and dose is adjusted based on INR and weight - for an INR of >8 you are talking of 4+ units of FFP and still running the risk of incomplete reversal - Vitamin K would have worked quicker..."

Auntie-D: Is TOCO another name for TACO that we use in the US?

Obviously Auntie-D can correct me if I am wrong, but I think that TOCO was a typo for TACO.

I believe TOCO is an anagram for COOT, where TACO is an anagram for INDIGESTION.

 

Scott

Obviously Auntie-D can correct me if I am wrong, but I think that TOCO was a typo for TACO.

 

*Sighs* yes I typo'd - smack my legs and send me to the corner with the naughty hat