Adverse Effects of Fresh Frozen Plasma Transfusion: TRALI, TACO and Allergic Reactions

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Author: Sally V. Rudmann, PhD, MLS(ASCP)SBB
Reviewers: Christine Christopher, MT(ASCP)SBB and Rory Huschka, M.Ed., MT(ASCP)

Recent data have drawn attention to the significant risks associated with the transfusion of Fresh Frozen Plasma (FFP). Despite a number of efforts to provide restrictive guidelines for FFP transfusion, the number of units transfused has actually risen over the past two decades and many of these plasma transfusions may be inappropriate. It is important for health care professionals who are involved in the transfusion process to be aware of these guidelines and be able to recognize when serious reactions are occurring.

This course highlights the appropriate and inappropriate uses of FFP and then discusses the adverse reactions that may occur with FFP transfusion, including transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and allergic/anaphylactic transfusion reactions (ATRs).

Continuing Education Credits


  • Describe Fresh Frozen Plasma (FFP) including the composition, volume, storage requirements, shelf life, indications, contraindications, and dosage.
  • Discuss the current concerns regarding FFP utilization.
  • List the current published indications for the use of FFP.
  • Discuss the results of the AABB consensus conference on evidence-based practice for FFP administration.
  • Define TRALI, TACO, and allergic reactions and for each describe the mechanism of action, symptoms and signs, prevention, and treatment.
  • Discuss recent TRALI mitigation strategies including AABB Standard
  • Discuss procedures for transfusion reaction investigations including overall goals and current standards of practice.

Course Outline

  • Fresh Frozen Plasma
      • Introduction
      • Definitions of Terms Used in this Course
      • Fresh Frozen Plasma (FFP): Component Characteristics, Storage, and Thawing Requirements
      • Table 1: Selection of ABO Compatible FFP
      • Guidelines for the Use of FFP
      • Guidelines for the Use of FFP, continued
  • Adverse Reactions Commonly Associated with Plasma Transfusion: TRALI
      • Plasma Transfusion Risks
      • Transfusion-Related Acute Lung Injury (TRALI)
      • TRALI Characteristics and Mechanisms
      • AABB Recommendations Regarding Plasma Donors
      • AABB Recommendations Regarding Plasma Donors: HLA Testing and Targeted HLA Typing
      • TRALI: Other Cellular Component Associations
      • The most commonly reported cause of severe/fatal TRALI is:
  • Adverse Reactions Commonly Associated with Plasma Transfusion: TACO
      • Transfusion-Associated Circulatory Overload (TACO)
      • Summary of Clinical Features that Differentiate TACO from TRALI
      • An 86-year-old male patient presented with shortness of breath and systolic hypertension 2 hours after receiving 6 units of FFP. The patient responded...
  • Adverse Reactions Commonly Associated with Plasma Transfusions: ATR
      • Allergic/Anaphylactic Transfusion Reaction (ATR)
      • Antibodies Associated with Anaphylaxis
      • ATR Mechanism and Prevention
      • Which of the following components would be suitable for a recipient with a high-titer class-specific anti-IgA antibody?
  • Investigation of Suspected Transfusion-Related Adverse Reactions
      • Transfusion Reaction Investigation Goals
      • Recognizing and Responding to a Transfusion-Associated Adverse Event
      • Recognizing and Responding to a Transfusion-Associated Adverse Event, continued
  • References
      • References

Additional Information

Level of instruction: Intermediate

Intended Audience: Medical laboratory scientists, medical technologists, and technicians. This course is also appropriate for medical laboratory science students and pathology residents.
Author information: Sally V. Rudmann, PhD, MLS(ASCP)SBB received her MS in Microbiology & Immunology from Wright State University and her PhD in Education from Ohio State University. She is currently the Accreditation Program Director and Graduate Program Coordinator of the Medical Technology Program at the Ohio State University Medical Center as well as a Professor Emeritus of Medical Technology for the Ohio State University, School of Allied Medical Professionals. She is the author of numerous journal articles, publications, and books about blood banking and transfusion medicine.
Reviewer information: Christine Christopher, MT(ASCP)SBB has over 25 years of experience as a Medical Technologist. She holds a Bachelors degree in Medical Technology from Northern Illinois University and Certification as a Specialist in Blood Bank. She has been employed by Central Dupage Hospital in Winfield, IL as a Medical Technologist and by the College of American Pathologists as an Inspection Specialist in the Laboratory Accreditation Program and as a Technical Assessor for the CAP 15189 ISO program.
Reviewer Information: Rory Huschka, M. Ed., MT(ASCP), has over 20 years of combined experience as a Medical Technologist, Technical Supervisor, Professor, and Manager. He is the former Director of Clinical Laboratory Science and Medical Laboratory Technician Programs at Brookline College. He is currently a Program Director at MediaLab, Inc. Rory holds a BS degree in Medical Technology from North Dakota State University and a Masters in Educational Leadership. 

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