Plasma Protein Fraction (Monograph)

Brand name: Plasmanate
Drug class: Blood Derivatives
ATC class: B05AA
VA class: BL500
CAS number: 55963-80-9

Introduction

Protein colloid; sterile solution of selected proteins prepared from pooled human plasma.¹⁰⁴

Uses for Plasma Protein Fraction

Fluid Resuscitation (Shock)

Used for plasma volume expansion in the treatment of certain types of shock, including shock resulting from burns, crushing injuries, abdominal emergencies, or any other cause where there is a predominant loss of plasma fluids and not RBCs.¹⁰⁴

Adequate replacement for human plasma in the treatment of shock and suitable means of providing human proteins for their osmotic effect;¹⁰⁴ however, albumin solutions may be preferable because they contain a greater percentage of albumin and, since they are more purified, are less likely to cause hypotensive reactions.^a (See Hypotension under Cautions.)

Initial therapy in infants and small children for shock resulting from dehydration and infection.¹⁰⁴

Emergency treatment of shock due to hemorrhage.¹⁰⁴ Following the emergency phase of therapy, transfusions of whole blood or RBCs may be indicated, depending on the severity of the blood loss.¹⁰⁴

Plasma Protein Fraction Dosage and Administration

Administration

IV Administration

Administer by IV infusion, preferably at a site at some distance from any site of infection or trauma.¹⁰⁴

Swab the rubber stopper on vial with iodine tincture followed by a sterile antiseptic swab.¹⁰⁴ Insert a 16-gauge needle or dispensing pin perpendicular to the stopper in the area delineated by a raised ring.¹⁰⁴

Does not contain preservatives; discard any partially used vials.¹⁰⁴

Do not mix with protein hydrolysates or solutions containing alcohol.¹⁰⁴

To minimize administration errors, consult the manufacturer’s administration instructions for proper use.¹⁰⁴

Rate of Administration

Adjust rate of infusion according to the clinical response of the patient and changes in BP.¹⁰⁴

For hypovolemic shock in infants and young children: Infusion at a rate of up to 5–10 mL/minute has been suggested.^a

As plasma volume approaches normal, do not exceed 5–8 mL/minute.^a Rapid IV infusion (e.g., >10 mL/minute) may cause vascular overload.^{104 a} (See Infusion Effects under Cautions.)

Dosage

Dosage depends on the patient’s condition and response to therapy.¹⁰⁴

Pediatric Patients

Fluid Resuscitation (Shock)

Hypovolemic Shock

IV

Infants and young children: Initially, 6.6–33 mL/kg (0.33–1.65 g/kg of protein).^a Subsequent dosage is determined by the patient’s condition.^a

Adults

Fluid Resuscitation (Shock)

Hypovolemic Shock

IV

Usual minimum effective dosage: 250–500 mL (12.5–25 g of protein).¹⁰⁴ Subsequent dosage is determined by the patient’s condition.^a

Prescribing Limits

Adults

Fluid Resuscitation (Shock)

Hypovolemic Shock

IV

Do not exceed 5–8 mL/minute.^a

Special Populations

No special population dosage recommendations at this time.¹⁰⁴

Cautions for Plasma Protein Fraction

Contraindications

• Cardiopulmonary bypass procedures.¹⁰⁴ (See Hypotension under Cautions.)

• Severe anemia.¹⁰⁴

• CHF.¹⁰⁴

• Increased blood volume.¹⁰⁴

Warnings/Precautions

Warnings

Risk of Transmissible Agents in Plasma-derived Preparations

Potential vehicle for transmission of human viruses, including hepatitis virus, or other infectious agents.¹⁰⁴

Despite screening for certain viruses (e.g., human immunodeficiency virus [HIV], hepatitis B virus [HBV], hepatitis C virus [HCV]) and a pasteurization procedure to reduce viral infectious potential associated with plasma protein fraction (PPF), a risk for transmission of infectious agents still remains.^a

Transmission of nonenveloped viruses, including hepatitis HAV and parvovirus B19, has been documented following administration of plasma-derived coagulation factors.¹⁰⁵

Report any suspected PPF-associated infections to the manufacturer.¹⁰⁴

Risk of Creutzfeldt-Jakob Disease

May carry a risk of transmitting the causative agent of Creutzfeldt-Jacob disease (CJD) or variant CJD (vCJD).^{100 101 102 103 106 107}

There have been 3 probable cases of vCJD acquired through transfusion of human RBCs,¹¹⁷ although, transmission via human plasma derivatives (including plasma-derived albumin) has not been documented to date.^{106 107 108}

Risk of West Nile Virus

Evidence exists that West Nile Virus (WNV) can be transmitted in transplanted organs (e.g., heart, liver, kidney) and blood products (e.g., whole blood, packed RBCs, fresh frozen plasma).^{110 111 113 114} However, WNV transmission unlikely through commercially available plasma-derived preparations since WNV is an enveloped virus, like HCV, which is known to be inactivated by the heat and solvent/detergent viral inactivation procedures used in the manufacture of these preparations.^{111 112}

For further information on WNV precautions related to blood and blood products, the FDA’s guidance for industry should be consulted ().¹¹¹

General Precautions

Infusion Effects

Rapid infusion may cause vascular overload.^a

Observe all patients (especially those with normal or increased circulatory volumes) for signs of hypervolemia, including dyspnea, fluid in the lungs, pulmonary edema, cardiac failure, or abnormal increases in BP or central venous pressure.^a

Hypotension

Hypotension may occur, especially following rapid IV infusion (i.e., at rates >10 mL/minute) in patients undergoing surgery or in the pre- or postoperative period or during intra-arterial administration in patients on cardiopulmonary bypass.¹⁰⁴ Monitor BP during administration; slow or stop the infusion if sudden hypotension occurs.¹⁰⁴ BP may return to normal spontaneously following slowing or discontinuance of the infusion; vasopressors also may be used to correct hypotension.¹⁰⁴

Sodium Content

Commercially available PPF contains approximately 145 mEq of sodium per liter.¹⁰⁴

Trauma or Surgery Risk

Rapid rise in BP accompanying administration of PPF following injuries or surgery may reveal bleeding points that were not apparent at the lower BP; observe patient carefully to prevent hemorrhage and subsequent shock.^a

Hematologic Effects

Does not contain coagulation factors and, therefore, cannot be used to correct coagulation disorders.¹⁰⁴ Contains trace amounts of blood groups A and B isohemagglutins; however, these are at such low concentrations that use of PPF should have no effect on routine blood typing procedures.¹⁰⁴

Specific Populations

Pregnancy

Category C.¹⁰⁴

Pediatric Use

Manufacturer states that safety and efficacy not established in pediatric patients; however, protein colloid has been found to be very useful in infants and small children for initial treatment of shock resulting from dehydration and infection.¹⁰⁴

Hepatic Impairment

Use with caution in patients with hepatic failure because of added protein, fluid, and sodium load.^a

Renal Impairment

Use with caution in patients with renal failure because of added protein, fluid, and sodium load.^a

Common Adverse Effects

Flushing,¹⁰⁴ urticaria,¹⁰⁴ nausea,¹⁰⁴ headache,¹⁰⁴ back pain.¹⁰⁴

Plasma Protein Fraction Pharmacokinetics

Absorption

Duration

Following IV administration, increased blood volume may last up to 48 hours.¹⁰⁴

Stability

Storage

Parenteral

Solution for Injection

Room temperature (not >30°C).¹⁰⁴ Do not freeze.¹⁰⁴

Do not use solutions that appear turbid.¹⁰⁴

Do not start administration if >4 hours have elapsed since the container was first entered.¹⁰⁴

Do not use solutions that have been frozen, since the container may crack and permit contamination of the contents.¹⁰⁴

Actions

• Pharmacologic properties of PPF are similar to those of its primary constituent, albumin.^a

• Replacement for human plasma in the treatment of shock.¹⁰⁴

• IV administration of PPF results in an increased blood volume.¹⁰⁴

• Causes a shift of fluid from the interstitial spaces into the circulation and a slight increase in the concentration of plasma protein.^a

Advice to Patients

• Potential risk of transmission of infectious agents (e.g., human viruses).¹⁰⁴

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.¹⁰⁴

• Importance of women informing clinicians if they are or plan to become pregnant.¹⁰⁴

• Importance of informing patients of other important precautionary information.¹⁰⁴ (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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