From the Guidelines
Fresh frozen plasma (FFP) is primarily used to treat major haemorrhage, disseminated intravascular coagulation (DIC) with evidence of bleeding, reversal of warfarin anticoagulation in the presence of active bleeding, and other conditions such as thrombotic thrombocytopenic purpura (TTP) and hereditary angioedema. The main indications for FFP are based on its ability to replace coagulation factors, and its use should be guided by clinical assessment and laboratory coagulation tests when possible 1.
Some of the key conditions that FFP treats include:
- Major haemorrhage, often administered in a balanced ratio with red blood cells (RBCs)
- 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
- Thrombotic thrombocytopenic purpura (TTP) and haemolytic uremic syndrome (HUS)
- Hereditary angioedema, as FFP contains C1-esterase inhibitor
It's worth noting that FFP should not be used for volume expansion alone or as a nutritional supplement, and its use should be guided by clinical assessment and laboratory coagulation tests when possible 1. The typical dose of FFP is not explicitly stated in the most recent guidelines, but it is generally administered in a dose of 10-15 mL/kg body weight, with each unit containing approximately 200-250 mL. FFP works by immediately providing functional clotting factors to restore hemostasis, and it should be ABO-compatible with the recipient and requires thawing before administration, which takes about 30 minutes.
In terms of the evidence, the most recent guidelines from the Association of Anaesthetists 1 provide the best guidance on the use of FFP, and they recommend its use in the conditions outlined above. The guidelines also emphasize the importance of clinical assessment and laboratory coagulation tests in guiding the use of FFP. Overall, FFP is a valuable treatment option for a range of coagulation disorders, and its use should be guided by the most recent evidence and clinical guidelines.
From the FDA Drug Label
If minor bleeding progresses to major bleeding, give 5 to 25 mg (rarely up to 50 mg) parenteral vitamin K1. In emergency situations of severe hemorrhage, clotting factors can be returned to normal by administering 200 to 500 mL of fresh whole blood or fresh frozen plasma, or by giving commercial Factor IX complex
- Fresh Frozen Plasma (FFP) is used to treat conditions such as:
- Severe hemorrhage
- Major bleeding
- Emergency situations of severe hemorrhage secondary to warfarin sodium overdosage 2
From the Research
Conditions Treated by FFP
The following conditions are treated with Fresh Frozen Plasma (FFP):
- Replacement of single factor deficiencies 3, 4
- Immediate reversal of warfarin effect 3, 4
- Vitamin K deficiency associated with active bleeding 3
- Acute disseminated intravascular coagulation (DIC) 3, 5, 4, 6
- Thrombotic thrombocytopenic purpura (TTP) 3, 4
- Inherited deficiencies of inhibitors of coagulation 3
Conditional Uses of FFP
FFP is conditionally used in the following situations, if there is bleeding and evidence of disturbed coagulation:
- Massive transfusion 3, 5, 4
- Liver disease 3, 5, 4
- Cardiopulmonary bypass surgery 3, 5, 4
- Special pediatric indications 4
No Justification for FFP Use
There is no justification for the use of FFP in the following conditions: