Fresh Frozen Facts: Addendum — The Plasma Family Tree

When I first wrote my Fresh Frozen Facts series, I focused on the workhorses. But plasma isn’t a single product: it’s a whole family, with cousins and spin-offs that have slightly different strengths, weaknesses, and roles.

Today, let’s walk through the “plasma family tree” and see how FFP compares to PF24, thawed plasma, liquid plasma, cryopoor plasma, and solvent/detergent–treated plasma like Octaplas.

🧊 FFP (Fresh Frozen Plasma)

• Frozen within 8 hours of collection.

• Retains nearly all labile factors (especially V and VIII).

• Shelf life: 1 year at ≤ –18°C.

• Indications: the broad-spectrum plasma support we all know.

• ❌ Con: Requires freezer storage and thawing (30+ minutes), not “immediately available” in an emergency.

  
  

⏱️ PF24 (Plasma Frozen within 24 Hours)

• Frozen within 24 hours instead of 8.

• Reduced factor VIII, otherwise very similar to FFP.

• Shelf life: 1 year at ≤ –18°C.

• Often interchangeable with FFP in clinical practice.

• ❌ Con: That reduction in factor VIII may matter in certain bleeding disorders, though usually it is clinically insignificant.

  
  

❄️ Thawed Plasma

• FFP or PF24 that has been thawed and then stored at 1–6°C.

• Shelf life: up to 5 days after thawing.

• Factor V and VIII decline gradually, but most other factors remain stable.

• Role: stocked in some hospitals for faster turnaround in emergencies when FFP/PF24 would take too long to thaw.

• ❌ Con: Slightly reduced factor activity compared to freshly thawed FFP/PF24; short post-thaw shelf life.

  
  

💧 Liquid Plasma

• Collected and stored as plasma, never frozen.

• Stored at 1–6°C, shelf life up to 26–40 days (depending on regulatory body).

• Factor V and VIII decline during storage.

• Role: often stocked in trauma centers as “always ready” plasma for massive transfusion protocols (MTPs).

• ❌ Con: Lower levels of labile clotting factors make it less suitable for patients who need high VIII activity.

  
  

🩸 Cryopoor Plasma (CPP, Cryosupernatant)

• Plasma remaining after cryoprecipitate removal.

• Depleted in fibrinogen, factor VIII, and large vWF multimers.

• ADAMTS13 levels are normal, which is why CPP has been used as replacement fluid in TTP during therapeutic plasma exchange (TPE).

• Rarely used in the U.S. today, but still a recognized product.

• ❌ Con: Limited hemostatic utility outside TTP; largely obsolete for most other indications.

  
  

🧪 S/D Plasma (Solvent/Detergent–Treated Plasma)

• Plasma pooled from many donors, treated with solvent/detergent to inactivate lipid-enveloped viruses (HIV, HBV, HCV, etc.).

• Advantages: pathogen reduction, standardized factor levels, lower TRALI risk.

• Limitations: does not inactivate non-enveloped viruses (HAV, parvovirus B19).

• Globally available under several names, but in the U.S. we use Octaplas.

• ❌ Con: Pooling introduces theoretical risk of donor-derived rare pathogens slipping through; supply and cost can also be limiting.

  
  

🌍 Octaplas (S/D Plasma, Octapharma)

• FDA-approved form of S/D plasma.

• Beyond solvent/detergent, Octaplas is passed through a PrP resin column to reduce abnormal prion proteins — a unique step not shared by all S/D plasmas worldwide.

• The clinical utility of this prion clearance step is unknown, but it is part of the FDA approval package.

• Indications: same as FFP, but often chosen for patients with multiple transfusion reactions or when pathogen-reduced products are preferred.

• Advantages: lower allergic reaction rates, consistency across units, potential added prion safety.

• ❌ Con: Expensive, availability may be limited compared to standard FFP/PF24, and not all institutions stock it.

  
  

🧾 Plasma Comparison Table

Product	Prep/Storage	Factor Content	Special Uses	Pathogen/Prion Reduction	Cons
FFP	Freeze ≤8h, –18°C, 1 yr	Full (incl. labile factors)	General plasma support	Standard donor testing only	Requires freezer/thaw time; not immediately available
PF24	Freeze ≤24h, –18°C, 1 yr	Slight ↓ VIII	Interchangeable with FFP	Standard donor testing only	Slightly lower VIII levels
Thawed Plasma	Thawed FFP/PF24, 1–6°C, 5 d	↓ V, VIII over time	Faster turnaround in emergencies	Standard donor testing only	Reduced factor activity; short post-thaw life
Liquid Plasma	Never frozen, 1–6°C, 26–40 d	↓ V, VIII over time	“Always ready” for MTPs	Standard donor testing only	Declining clotting factor activity
Cryopoor Plasma	Post-cryoprecipitate	Low fibrinogen, VIII, vWF multimers; normal ADAMTS13	TTP (replacement during TPE)	Standard donor testing only	Obsolete for most other uses
S/D Plasma	Pooled, solvent/detergent treated	Standardized	Broad use, ↓ TRALI risk	Inactivates lipid-enveloped viruses only	Doesn’t target non-enveloped viruses; cost
Octaplas	Pooled, solvent/detergent + PrP column	Standardized	Broad use, ↓ reactions	Viral inactivation + PrP resin (prion clearance; clinical utility unknown)	Higher cost; limited availability

🌟 Takeaway

Plasma is not one-size-fits-all. FFP and PF24 dominate day-to-day use, but thawed plasma, liquid plasma, cryopoor plasma, and S/D products like Octaplas each have unique features and limitations.

Knowing the differences — from “always ready” trauma plasma to prion-cleared Octaplas — helps match the right plasma to the right patient.