Best blood product to be given in a patient of multiple clotting factor deficiency with active bleeding:
Correct Answer: Fresh frozen plasma
Description: Ans. c. Fresh frozen plasma (Ref: Harrison 19/e p138 e-3 18/e p953. Sabiston 19/e p588)Best blood product to be given in a patient of multiple clotting factor deficiency with active bleeding is fresh frozen plasma."FFP contains stable coagulation factors and plasma proteins: fibrinogen, antithrombin, albumin, as well as proteins C and S. Indications for FFP include correction of coagulopathies, including the rapid reversal of warfarin: supplying deficient plasma proteins: and treatment of thrombotic thrombocytopenic purpura. "--Harrison 19/e p138 e-3Fresh-frozen Plasma (FFP)FFP is produced from the separation of plasma from donated bloodQ.Stored at -18degC and has a shelf life of 1 yearQ.Each unit contains 400 mg of fibrinogen and 1 unit activity of each of the clotting factorsQ,Most labile clotting factors (V & VIII) may be diminishedQ proportional to shelf life.FFP contains stable coagulation factors & plasma proteins: fibrinogen, antithrombin, albumin, proteins C & SQ.Indications for FFP* Correction of coagulopathies:* Rapid reversal of warfarinQ* Supplying deficient plasma proteinsQ* Treatment of thrombotic thrombocytopenic purpuraQPatients who are IgA-deficient and require plasma support should receive FFP from IgA-deficient donors to prevent anaphylaxis.FFP should not be routinely used to expand blood volumeQ.FFP: An acellular component & does not transmit intracellular infections, e.g., CMV.Characteristics of Selected Blood ComponentsComponentVolume (mL)ContentClinical ResponseWhole Blood450 +- 45* No elements removed* Contains RBCs. WBCs, plasma & platelets (WBCs & platelets may be non-functionalQ)* Not for routine use* Used for acute massive bleeding, open heart surgery & neonatal total exchangePacked RBCs180-200* RBCs with variable leukocyte content & small amount of plasma* Increase Hb 1 gm/dL & hematocrit 3%cPlatelets50-70* 5.5 x 1010/RD unit* Increase platelet count 5000-10,000/uL0FFP200-250* Plasma proteins: Coagulation factors, proteins C & S, antithrombin0* Increases coagulation factors about 2%Cryoprecipitate10-15* Cold-insoluble plasma proteins, fibrinogen, factor VIII, vWFdeg* Topical fibrin glue, also 80 IU factor VIIIQCryoprecipitateCryoprecipitate is a source of fibrinogenQ, factor VIIIQ and von Willebrand factor (vWF)Q.It is ideal for supplying fibrinogen to the volume-sensitive patient.Stored at < -18degC1 unit of cryoprecipitate contains 80-145 units of Factor VIII & 250 mg of fibrinogenQ.Cryoprecipitate is pooled from many donors, so there are maximum chances of disease transmission among all blood productsQ.Cryoprecipitate may also supply vWF to patients with dysfunctional (type II) or absent (type III) von Willebrand disease.
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