Fresh frozen plasma therapy in acute pancreatitis.

Despite improvements in general supportative measures, the mortality from acute pancreatitis in the United Kingdom, still approaches 10%. Although many specific therapies have been proposed, none has consistently been shown to improve outcome in controlled clinical trials. Intravenous fresh frozen plasma has been advocated as a therapy for acute pancreatitis. It may supplement declining natural antiprotease capacity, particularly alpha2 macroglobulin which appears to have a central role in the elimination of disseminated pancreatic enzymes in man. Initially, the effect of fresh frozen plasma therapy on survival in an experimental model of acute pancreatitis was studied. A rat model of acute pancreatitis was established including the facility for continuous intravenous infusion of fluid. Intravenous therapy including fresh frozen plasma significantly improved survival at 72 hours in the model when compared with crystalloid (p 0.001) and colloid (p 0.01) controls. Subsequently a controlled clinical trial was performed involving five hospitals over a twenty three month period. Two hundred and two patients admitted with acute pancreatitis were randomised to receive either low volume fresh frozen plasma therapy (two units daily for three days) or colloid control. The major serum antiproteases were measured during the course of the disease. There were no significant differences between the two groups of patients in terms of clinical outcome. Serum alpha2 macroglobulin levels were reduced in both groups on day one and continued to fall significantly Iron; day one to day three in the colloid control group (p 0.005) whilst remaining substantially unaltered in patients receiving fresh frozen plasma (p = 0.6527). The ability of relatively low volumes of fresh frozen plasma to supplement declining alpha2, macroglobulin levels in the early stages of acute pancreatitis has therapeutic implications. The administration of larger volumes of fresh frozen plasma or alpha2 macroglobulin concentrates may improve clinical outcome.