Fresh Frozen Facts, Part IV: Plasma’s Pharmaceutical Cousins

We’ve spent the last three posts talking about plasma as a transfusion product — thawed, typed, delivered in a blood bag, and used (too often) without a clear plan. But plasma isn’t just a transfusion product. It’s also the raw material for a whole class of plasma-derived pharmaceuticals — therapies that are purified, concentrated, and engineered for targeted clinical use.

These aren’t “just” blood products. They’re manufactured biologics, held to rigorous standards, and often used with precision in hematology, neurology, rheumatology, immunology, and beyond.

Let’s look at some of the most important players — and how they work.

Albumin: The Volume Expander That Isn’t Just Volume

• Derived from pooled human plasma and purified to 5% or 25% concentrations.

• Maintains oncotic pressure, draws fluid into the intravascular space.

• Used in volume-sensitive resuscitation (e.g., cirrhosis with tense ascites, nephrotic syndrome, plasmapheresis), but not for general volume expansion.

• Doesn’t correct coagulopathy or replace clotting factors.

• Also used as a replacement fluid in some apheresis protocols.

  
  

Pearl: If you’re reaching for FFP "for volume," ask yourself: is albumin the right choice instead?

IVIG: Immune Modulator with Broad Utility

• Intravenous immunoglobulin (IVIG) is made from pooled plasma from thousands of donors.

• Contains primarily IgG, with small amounts of other immunoglobulin classes.

• Used to neutralize autoantibodies, modulate immune response, or replenish IgG in patients with antibody deficiencies.

  
  

Common indications:

• ITP, autoimmune hemolytic anemia

• Guillain-Barré syndrome, myasthenia gravis, CIDP

• Primary immunodeficiencies

• Kawasaki disease

  
  

Risks: Headache, thromboembolic events, aseptic meningitis, renal dysfunction (especially with sucrose-containing products).

Pearl: IVIG is expensive, powerful, and slow to infuse — use with intention, not desperation.

Rh Immune Globulin (RhIg/RhoGAM): Small Dose, Big Impact

• Concentrated anti-D antibodies made from Rh-negative donors sensitized to D antigen.

• Administered to Rh-negative patients exposed to Rh-positive RBCs — most commonly pregnant patients or following transfusion errors.

  
  

Primary use:

• Preventing alloimmunization in Rh-negative pregnant individuals carrying Rh-positive fetuses.

• Also used in ITP as an alternative to IVIG (particularly in children), though less commonly now.

  
  

Mechanism in ITP: Coats D-positive RBCs, redirecting macrophage clearance and sparing platelets.

Pearl: One of the oldest, most elegant forms of targeted immune modulation — and a triumph of transfusion medicine.

Other Plasma-Derived Therapies

Anti-Tetanus, Anti-Rabies, and Other Hyperimmune Globulins

• Pooled antibodies from vaccinated donors.

• Used for post-exposure prophylaxis or treatment of rare infections.

• Includes hepatitis B immune globulin (HBIG), cytomegalovirus immune globulin (CMV-IG), and more.

  
  

Antithrombin Concentrate

• Used in hereditary antithrombin deficiency, especially during pregnancy or surgery.

• Also considered in select ECMO or cardiac surgery patients with heparin resistance.

  
  

C1 Esterase Inhibitor

• For hereditary angioedema (HAE), where C1-INH deficiency leads to bradykinin-mediated swelling.

• Plasma-derived and recombinant versions exist.

  
  

Factor Concentrates

• Covered in Part III, but worth reiterating: purified concentrates for hemophilia A/B, factor XIII deficiency, von Willebrand disease, and more.

• Far more effective than FFP when a specific deficiency is known.

  
  

Patient-Centered Considerations

Plasma-derived therapies aren’t just pharmacologic tools — they’re also part of the complex, personal decision-making that happens between patients and providers.

For example, some Jehovah’s Witnesses — who decline transfusion of whole blood, red cells, platelets, or plasma — may accept plasma-derived fractions such as albumin, IVIG, or clotting factor concentrates. Whether these are acceptable is a deeply individual decision, often informed by religious interpretation and personal conviction. Respecting these boundaries, and knowing what options exist beyond standard transfusion, is essential to providing care that aligns with a patient’s values.

It’s also worth remembering the complicated history of clotting factor concentrates. In the 1980s and ’90s, many recipients — particularly people with hemophilia — were devastated by transfusion-transmitted infections like HIV and hepatitis C, sometimes acquired through pooled plasma products. For decades afterward, even their sexual partners were deferred from blood donation, based on perceived risk.

Today, thanks to modern donor screening, pathogen reduction, and manufacturing safeguards, those policies have changed. While individuals with hemophilia are still generally deferred from donating blood due to the risk of bleeding from venipuncture, their sexual partners are no longer automatically excluded under current FDA guidelines.

It’s a reminder that the story of plasma — like all of transfusion medicine — is one of evolving science, ethics, and trust.

Final Thought: Precision Is the Point

Fresh frozen plasma is broad and blunt — it works when you don’t know exactly what’s wrong, or when you need many things at once. But these plasma-derived pharmaceuticals? They’re sharp tools. Precision instruments. Each one represents decades of innovation aimed at solving specific physiologic problems.

So before you grab FFP “just in case,” consider:

• Is there a better-targeted option?

• Could the patient benefit more from albumin, or a specific concentrate?

• Are you using plasma because it’s easy — or because it’s best?

  
  

Transfusion medicine doesn’t end with a blood bag. Sometimes the most powerful plasma products don’t look like blood at all.