Canine Freeze Dried Plasma (cFDP) can be used in lieu of FFP for any of the above-mentioned indications cited for FFP. In addition, since cFDP can be reconstituted quickly (does not require a thawing process), it is possible to start a transfusion more rapidly as compared to FFP. When available, strongly consider cFDP as a resuscitation product at the point of injury, en route to Role 2 or 3 care and/or until canine WB becomes available. cFDP replaces effective circulating volume without diluting coagulation factors or substantially reducing oncotic pressure. In this way, cFDP’s most beneficial role on the battlefield is to serve as bridge to resuscitation with canine WB. Evidence supports that cFDP is biologically equivalent to FFP in terms of coagulation factor activity, biochemical profile and clot forming ability (Edwards – unpublished data).

## HANDLING/ STORAGE

- cFDP is available as a white to yellow powdered product within a transfusion bag that is enclosed in a Mylar outer wrap. To minimize any transfer of moisture from the environment into the product, do not open the Mylar wrap until the product is ready for use.
- Store cFDP at room temperature or refrigerated at 2 to 6oC (35.6 to 39.2°F).

## RECONSTITUTION

Follow the manufacturer’s directions in the reconstitution of cFDP. In general, sterile water for injection (amount specified by the manufacturer) is aseptically added through either an inserted port or the designated port provided on the bag of cFDP. Gently manually mix the bag until the product completely dissolves (approximately 5 minutes). Once reconstituted, either transfuse within 4 hours of reconstitution or refrigerate for up to 28 days.

## DOSAGE

- MWDs in need of a plasma transfusion should typically receive one 240 to 250 mL bag (unit) of cFDP; reassess after the first unit to determine if the MWD requires subsequent transfusions.
- The speed of administration depends on the indication and clinical condition of the MWD.
  - For MWDs that do not have ongoing hemorrhage or other substantial fluid losses, administration of FDP over 2 to 4 hours is typically appropriate.
  - In emergent situations, bolus FDP as indicated for MWDs that are rapidly losing blood. Boluses of 1-3 units may be necessary to stabilize a severely injured MWD. To accomplish this, a unit of FDP may be placed in a commercial pressure infuser sleeve or can be accomplished by using the 3 way stopcock and 60 mL syringe set up described in the WB administration section above.

## ADMINISTRATION

- If the bag of FDP has an inline filter, attach extension sets to the inline filter port and prime the line with FDP to remove the air. If no inline filter is present, spike the bag of FDP with either a:
  - Blood administration set (that contains a blood filter), OR
  - Regular fluid administration set that has a separate blood filter (such as a Hemo-Nate® filter) placed in the transfusion line.

Note: Although an in-line filter is recommended to reduce clots or other impurities from the transfused product, the lack of a blood filter does not preclude the administration of FDP if the transfusion is clinically necessary.

- Connect the primed transfusion line to a 20-gauge or larger peripheral or central IV catheter or an IO catheter.
- Begin transfusion at 1 to 2 mL/kg/h over the first 15 minutes and monitor for signs of transfusion reaction (see below). If no significant reaction observed, increased the rate of transfusion to 2 to 4 mL/kg/h for an additional 15 minutes. If no transfusion reactions observed over the first 30 minutes, increase the transfusion rate to ensure delivery of the FDP unit is complete within 2 to 4 hours.

## TRANSFUSION MONITORING AND REASSESSMENT

- Transfusion monitoring and assessment in the administration of FDP is the same as for FFP detailed above.