Addendum to the British Committee for Standards in Haematology (BCSH): Guidelines for the use of fresh‐frozen plasma, cryoprecipitate and cryosupernatant, 2004 (Br. J Haematol 2004,126,11‐28)

The guideline on the use of fresh-frozen plasma (FFP), cryoprecipitate and cryosupernatant (British Committee for Standards in Haematology, Blood Transfusion Task Force, 2004) is currently under review. While the guideline is being reviewed, the BCSH Transfusion Task Force group would like to issue the following communication and recommendations: The recently published BCSH guideline “A practical guideline for the haematological management of major haemorrhage” (Hunt et al, 2015), recommends that transfusion laboratories seeing major haemorrhage cases due to trauma should consider having pre-thawed plasma on standby to allow FFP to be immediately available for the management of major bleeding. Some centres are already doing this; however this practice is leading to practical difficulties, including FFP wastage due to the current shelf-life of pre-thawed FFP being only 24 h. For the purposes of this addendum solvent detergent-treated FFP (Octaplas) is not considered as this is a licensed medicinal product and therefore its shelf-life following thawing is governed by the manufacturer (Octapharma, Lachen, Switzerland). Once thawed, standard FFP may be stored at 4 ± 2°C in an approved temperature-controlled blood storage refrigerator before administration to the patient as long as the infusion is completed within 24 h of thawing, or within 120 h of thawing only for patients who develop unexpected major bleeding (e.g. trauma) and for whom delay in providing FFP is detrimental. Pre-thawed FFP that is out of a controlled temperature environment (4 ± 2°C) can be accepted back into temperature controlled storage if this occurs on one occasion only of less than 30 min. Transfusion of FFP should be completed within 4 h of issue out of a controlled temperature environment. (At present there is a lack of evidence relating to how long thawed plasma can safely remain out of controlled temperature storage. The recommendation in this guideline is based on current practice in other countries and expert opinion, extrapolated from evidence on red cell storage with the aim of minimizing FFP wastage while also ensuring safety of the component for recipients. The recommendation may change in the future as a result of research carried out on FFP storage and bacterial growth.) Apart from clinical scenarios of unexpected major haemorrhage, transfusion laboratories should use FFP that has been thawed for a maximum of 24 h prior to clinical use due to the fact that clotting factor activity (particularly factors V, VII and VIII) drops over time during storage at 4 ± 2°C.