The Usage Of Plasma and Albumin

In the United States, the use of fresh frozen plasma (FFP) has increased dramatically over the past 10 years, at least tenfold, and in some estimates as much as 150 times. The reason for this is not entirely clear. It has paralleled the widespread adoption of blood component therapy and the consequently decreased availability of whole blood, although its increased use is not necessarily for that reason alone. During the period of increasing blood component usage, surgeons and other physicians have become aware of the properties of FFP, a component embodying all the normal plasma proteins as well as all clotting factors except platelets. Thus its use in trauma, massive transfusions, bleeding disorders, shock, and other clinical conditions entailing known or suspected plasma abnormalities, may seem needed in order to restore a normal physiologic status in both the therapeutic and prophylactic senses. In addition, it is readily prepared in almost any blood bank and is usually less expensive than most other protein-containing solutions, such as albumin. The other component or derivative of blood to be considered today is albumin. Like FFP, the use of albumin in the U.S. has increased strikingly in the past few years, probably to about the same degree as the use of FFP, although accurate data are lacking. In Japan, the increased usage has been enormous: Professor Abe in 1984 published figures showing a rise of approximately 33 times between 1977 and 1982. It appears from his paper that a great deal of the albumin usage in Japan is for vague purposes of general support in debilitating diseases and malnutrition. At least half the usage in the U.S.A. is in surgical conditions. Most reviews of albumin usage acknowledge that much of it is wasted, or used in clinical circumstances where its use is not established on a firm scientific basis. Clinicians in the developed countries are using these two blood components in rapidly increasing numbers, without following strict clinical indications. In the interests of economy and of the appropriate clinical application of the worlds limited blood produce resources, it is very important to examine the correct scientific basis for the use of these two products, as far as it can be ascertained from existing data. Today, for each of these two blood products, we shall look at the clinical situations in which their use is justified by available data, and those in which it is not, and also the reactions and other adverse effects th