What is the dosage of Fresh Frozen Plasma (FFP)?

From the Guidelines

The standard dosage of fresh frozen plasma (FFP) is 10-15 mL/kg body weight, typically administered as a single dose. For an average adult, this translates to approximately 2-4 units of FFP 1. The infusion rate should generally be 2-4 mL per minute, though this can be increased in emergency situations. FFP should be ABO-compatible with the recipient, and Rh compatibility is preferred but not essential. Before administration, FFP must be thawed at 30-37°C, which takes about 20-30 minutes, and should be used within 24 hours of thawing. FFP is indicated for bleeding associated with multiple coagulation factor deficiencies, such as in liver disease, disseminated intravascular coagulation, or massive transfusion, as well as for urgent reversal of warfarin therapy when prothrombin complex concentrates are unavailable. FFP works by replacing multiple coagulation factors simultaneously, helping to restore hemostasis in patients with coagulopathy. However, it should not be used as a volume expander or for nutritional support, and carries risks including transfusion reactions, transfusion-associated circulatory overload, and disease transmission.

Some key points to consider when administering FFP include:

• The dosage of 10-15 mL/kg is based on the patient's body weight, and the infusion rate should be adjusted accordingly 1.
• FFP is most effective when used to prevent coagulopathy, rather than treating established coagulopathy 1.
• The use of FFP should be guided by laboratory results, including prothrombin time (PT) and activated partial thromboplastin time (aPTT) 1.
• FFP is not a substitute for other treatments, such as vitamin K or prothrombin complex concentrates, and should be used in conjunction with these treatments when necessary 1.

It's worth noting that the evidence suggests that prothrombin complex concentrates (PCC) may be preferred over FFP for urgent reversal of warfarin therapy, due to the faster onset of action and lower risk of adverse effects 1. However, FFP may still be used in situations where PCC is not available or is contraindicated. Overall, the decision to use FFP should be based on the individual patient's needs and circumstances, and should be guided by the most recent and highest-quality evidence available.

From the Research

Dosage of Fresh Frozen Plasma

• The optimal dosage of fresh frozen plasma (FFP) is not clearly established, but several studies have investigated its use in different clinical scenarios 2, 3, 4, 5, 6.
• A study published in 2014 compared the effectiveness of high-dose fibrinogen and clinically recommended doses of FFP in reversing dilutional coagulopathy in an in vitro model of severe hemodilution, and found that both treatments were equally effective in improving viscoelastic coagulation assays, but FFP improved conventional coagulation assays and coagulation factors 3.
• Another study published in 2016 compared the use of FFP, four-factor prothrombin complex concentrates, and recombinant factor VIIa in critically ill patients with coagulopathy from liver disease, and found that prothrombin complex concentrates and recombinant factor VIIa were more effective in reducing international normalized ratio (INR) and facilitating procedures than FFP 4.
• A 2020 in vitro study compared the haemostatic profile of different ratios of packed red blood cells, platelet concentrates, and FFP with coagulation factor concentrates, and found that the use of coagulation factor concentrates allowed for delivery of a higher haematocrit and fibrinogen content compared with FFP 5.
• A retrospective cohort study published in 2011 compared the impact of FFP and coagulation factor concentrates on morbidity and mortality in trauma-associated haemorrhage and massive transfusion, and found that the use of coagulation factor concentrates was associated with reduced morbidity and transfusion requirements compared with FFP 6.

Clinical Recommendations

• The dosage of FFP may vary depending on the clinical scenario and the patient's individual needs, but a common dose is 10-20 mL/kg 3, 4.
• The use of coagulation factor concentrates, such as fibrinogen and prothrombin complex concentrates, may be a viable alternative to FFP in certain clinical scenarios, and may offer advantages in terms of reduced morbidity and transfusion requirements 4, 5, 6.
• Further studies are needed to establish the optimal dosage and clinical indications for FFP and coagulation factor concentrates in different clinical scenarios 2, 3, 4, 5, 6.