From the Guidelines
Fresh frozen plasma (FFP) is a blood product containing all clotting factors and proteins found in human plasma, including factors I, II, V, VII, VIII, IX, X, XI, XIII, as well as proteins C and S, antithrombin III, and other plasma proteins, and its use should be guided by the most recent and highest quality evidence, such as the 2025 Association of Anaesthetists guidelines 1. The main indications for FFP use include major haemorrhage, disseminated intravascular coagulation (DIC) with evidence of bleeding or at high risk of bleeding, reversal of warfarin anticoagulation in the presence of active bleeding if prothrombin complex is not available, replacement fluid for apheresis in microangiopathies, and hereditary angioedema, as stated in the 2025 guidelines 1. Some key points to consider when using FFP include:
- FFP should not be used solely for volume replacement or as a routine circulatory volume replacement, as stated in the 2025 guidelines 1 and the 2016 AAGBI guidelines 1.
- The prophylactic use of FFP to correct abnormal coagulation tests prior to low-risk invasive procedures in patients who are critically ill is not recommended, as stated in the 2025 guidelines 1 and the 2022 EASL clinical practice guidelines 1.
- FFP must be ABO-compatible with the recipient, requires thawing before administration, and should be administered within 24 hours once thawed, as stated in the 2025 guidelines 1.
- The typical dose is 10-15 mL/kg body weight, with effectiveness monitored through coagulation tests like PT/INR and aPTT, as stated in the 2025 guidelines 1. It's also important to note that FFP transfusion carries potentially life-threatening risks, including transfusion-related acute lung injury, transfusion-associated circulatory overload, allergic/anaphylactic reactions, and transmission of infections, as stated in the 2022 EASL clinical practice guidelines 1.
From the Research
Contents of Fresh Frozen Plasma (FFP)
The contents of FFP include various coagulation factors, such as:
- Factor VIII (FVIII) 2, 3, 4
- Factor II (FII) 3
- Factor V (FV) 3
- Factor VII (FVII) 3
- Factor IX (FIX) 3
- Factor X (FX) 3
- Protein C (PC) 3, 4
- Protein S (PS) 3
- Von Willebrand factor antigen and ristocetin cofactor 3
- Fibrinogen 3, 4
- Antithrombin activities 3
Factors Affecting Coagulation Factor Activity in FFP
Several factors can affect the activity of coagulation factors in FFP, including:
- Time between donation and freezing 2
- Freezing time 2
- Ice front velocity 2
- Storage conditions, such as temperature and duration 3, 4
- Pre-analytical and assay conditions, such as citrate anticoagulant concentrations and inflammation 4
Comparison of Coagulation Factor Activity in FFP and Other Plasma Products
Studies have compared the coagulation factor activity in FFP with other plasma products, such as 24-hour plasma (FP24) and thawed plasma (TP) 3. The results show that: