Addendum to the British Committee for Standards in Haematology (BCSH): guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant, 2004 (Br. J Haematol 2004,126,11-28) - response to Neisser-Svae and Heger

We thank Neisser-Svae and Heger for their interest in the addendum publication (Green et al, 2017), and for sharing their data of thawed solvent detergent-treated fresh frozen plasma (SDFFP) for up to 5 days (Neisser-Svae et al, 2016). We agree with the authors that the reduction in factor VIII (FVIII) for 5 days following thawing is not significantly different between SDFFP and fresh frozen plasma (FFP). However, FVIII is only one of a number of factors present in FFP that must be considered in terms of its likely efficacy, and given that most recipients of FFP may have normal FVIII levels (FVIII being an acute phase protein), one could argue that it may not be the most important clotting factor. When considering the biochemical differences of different plasmas, one should take into account not only the level of FVIII, but also other clotting/anticoagulant factors. Given that there are clear differences between SD FFP and FFP for other factors, such as Protein S and α2-antiplasmin (Benjamin & McLaughlin, 2012; Heger et al, 2016; Neisser-Svae et al, 2016), one cannot automatically conclude that FFP and SDFFP have the same biochemical profile. Whether these differences result in any clinically significant difference between the two components is less clear, partly because we currently do not know what levels of coagulation factors are important for the efficacy of FFP. Further studies are needed to address this.