Some Practical Questions About Donor Retested FFP

The following question was submitted to the CBBS panelists for consideration:

A Blood Center that supplies a transfusion service with FFP has recently offered FFP-Donor Retested units (FFP-DR). Based on the "potential" for a safer product, the transfusion service has opted to use this product exclusively for patients' FFP needs. Two questions have come up about this policy:

1. Do other transfusion services have opinions for the use of this, besides the increased cost.
2. Since this product is not offered on a consignment basis, the transfusion service is planning to only stock and transfuse group AB FFP-DR.

Putting aside the concept of using only group AB units, the question is whether it is necessary to type patients prior to using this product. It is not required to do so for Cryoprecipitate, or Platelets.

The following ideas have been submitted in response to the posed question. These opinions are paraphrased and are being presented without attribution. They do not represent an official opinion or position of the CBBS.

1. According to one CBBS e-network panelist, FFP-DR is an FDA-approved alternative to FFP and solvent-detergent treated plasma. With respect to safety, it is felt to be the approximate equivalent of SD plasma and should be incrementally safer than FFP. It is difficult, at this point, to have a well-formulated opinion on the use of this product as it is not yet readily available, particularly at levels required by the busiest transfusion services.

AABB standards state that FFP should be ABO compatible with the recipient's red blood cells. As such, no specific pre-transfusion testing is required. This said, however, it is difficult to imagine that most patients receiving FFP won't also require red cells or at least undergo pre-transfusion testing for the potential transfusion of red cells. As such, most patients receiving even AB plasma would probably have a current blood group on hand.

2. A second panelist commented that some hospital services have responded in 3 main ways to the availability of new plasma options:
   1. Continue with regular FFP, primarily due to cost concerns and the great safety of current, regular FFP as now made (including the use of Jumbo 600 mL units).
   2. Switch to FFP-DR. These tend to be smaller hospitals that only carry limited amounts of plasma, primarily for emergency or very urgent use.
   3. Continue with regular FFP (225 mL or jumbo 600 mL units as appropriate and available) for most patients and uses, primarily because most such patients will also be given RBCs and/or platelets too; however, for patients receiving only plasma, e.g., plasma exchange for TTP/HUS patients, switch to FFP-DR. This panelist also felt that one could dispense with typing the patient for ABO, if there was sufficient AB plasma available to meet a patient's needs. However, since there may be a need for other blood components to be transfused (such as RBCs) which would require typing the patient, and since it is unlikely that the supply of AB plasma will be sufficient for all patients who need plasma transfusions, it would seem prudent to type patients for ABO.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator