Fresh Frozen Plasma (FFP) Dosing and Usage for Coagulation Factor Replacement
The recommended therapeutic dose of Fresh Frozen Plasma (FFP) for coagulation factor replacement is 15 ml/kg. 1
Composition and Characteristics of FFP
FFP contains all soluble coagulation system factors, including the labile factors V and VIII. Key properties include:
- Average volume per bag: 300 ml
- Contains approximately 2 g fibrinogen in four units (compared to 4 g in two pools of cryoprecipitate)
- Must be ABO compatible with the patient
- If blood group is unknown, group AB FFP is preferred (contains no anti-A or anti-B)
- For patients born in 1996 or later, FFP should be sourced from outside the UK and undergo viral inactivation
Indications for FFP Use
FFP is indicated in the following clinical scenarios:
- Replacement of coagulation factors during major hemorrhage (trauma, obstetrics)
- Acute disseminated intravascular coagulation (DIC) with bleeding
- Actively bleeding patients with INR > 1.5
- Immediate warfarin reversal when prothrombin complex concentrate (PCC) is unavailable
- Thrombotic thrombocytopenic purpura (with plasmapheresis)
- Replacement of coagulation factors when specific concentrates are unavailable 1
Dosing Considerations in Specific Clinical Scenarios
Prevention of Coagulopathy in Massive Hemorrhage
- Standard dose: 15 ml/kg for uncomplicated cases 1
- For anticipated blood loss of one blood volume, early FFP should be given to prevent dilutional coagulopathy 1
Treatment of Established Haemostatic Failure
- For patients with widespread microvascular oozing or inadequate hemostasis (fibrinogen < 1 g/L or PT/aPTT > 1.5 times normal)
- Higher doses of at least 30 ml/kg may be required 1
Important Clinical Considerations
Blood Group Compatibility
- FFP should be the same blood group as the patient
- If blood group is unknown, use group AB FFP
- For group O FFP given to non-group O children, use high-titer negative 1
Storage and Administration
- Can be thawed using dry oven (10 min), microwave (2-3 min), or water bath (20 min)
- Once thawed, can be stored at 4°C for up to 24 hours (extended to 5 days for trauma-related major hemorrhage)
- Once out of refrigeration, must be used within 30 minutes
- Never refreeze thawed FFP 1
Common Pitfalls and Limitations
Inappropriate use in non-bleeding patients: FFP is frequently misused in non-bleeding patients with mild coagulation abnormalities. Studies show that FFP transfusion for mild abnormalities fails to normalize PT in 99% of patients 2.
Inadequate dosing in severe coagulopathy: Standard 15 ml/kg dosing may be inadequate in consumptive coagulopathy, where larger volumes (≥30 ml/kg) are often needed 1.
Use as volume replacement: FFP should not be used for routine circulatory volume replacement 1.
Use in mild coagulopathy before procedures: There is limited evidence supporting FFP use in non-bleeding patients with mild-moderate coagulation abnormalities before invasive procedures 1, 3.
Diminishing returns with increasing volume: Studies show a nonlinear relationship between FFP volume and INR correction, with the greatest effect seen with initial supplementation 4.
Alternative Considerations
When FFP is not available or appropriate, consider:
- Cryoprecipitate (for hypofibrinogenemia)
- Prothrombin complex concentrate (PCC) - preferred for warfarin reversal
- Factor concentrates for specific factor deficiencies
By following these evidence-based guidelines for FFP administration, clinicians can optimize patient outcomes while minimizing unnecessary exposure to blood products and their associated risks.