What are the indications for Fresh Frozen Plasma (FFP) infusion?

Indications for Fresh Frozen Plasma (FFP) Infusion

Fresh frozen plasma should only be administered for specific clinical indications where coagulation factor replacement is necessary, particularly in actively bleeding patients or those at high risk of bleeding with coagulopathy. 1

Primary Indications for FFP

Major Hemorrhage Scenarios

• Replacement of coagulation factors during major hemorrhage, particularly in:
  • Trauma
  • Obstetric hemorrhage
  • When actively bleeding with INR >1.5 or equivalent point-of-care test result 1
  • As part of balanced transfusion protocols (typically 1:1 or 1:1.5 ratio with red blood cells) until coagulation test results are available 1

Coagulopathies

• Acute disseminated intravascular coagulation (DIC) with active bleeding 1, 2
  • Not based on laboratory results alone
  • Reserved for patients with clinical bleeding or at high risk of bleeding (e.g., pre-operative)
  • Target dose: 15 ml/kg 1

Anticoagulant Reversal

• Immediate reversal of warfarin-induced hemorrhage when prothrombin complex concentrate (PCC) is not available 1
  • Note: PCC is the first-choice treatment when available

Specialized Clinical Scenarios

• Thrombotic thrombocytopenic purpura (TTP) with plasmapheresis 1, 3
  • Preferably using pathogen-inactivated FFP
• Replacement of coagulation factors when specific factor concentrates are unavailable 1, 3

Administration Considerations

Blood Group Compatibility

• FFP should be the same blood group as the patient
• If blood group is unknown, group AB FFP is preferred (contains no anti-A or anti-B)
• For group O FFP given to non-group O children, high-titer negative units should be used 1

Dosing

• Recommended therapeutic dose: 15 ml/kg 1
• Single unit volume is approximately 300 ml
• Transfusion should be guided by clinical response in actively bleeding patients

Inappropriate Uses of FFP

FFP should NOT be used for:

• Routine volume replacement 1, 3
• Prophylactic correction of mild-moderate coagulation abnormalities in non-bleeding critically ill patients 1
• Routine use in patients with cirrhosis/liver disease unless significant coagulopathy with bleeding is present 1
  • Isolated abnormalities of PT or APTT do not reflect "balanced hemostasis" in these patients
• Formula-based replacement without clinical indication 3
• Nutritional support 3
• Treatment of immunodeficiency states 3

Special Considerations

Liver Disease

• FFP should not be used routinely in patients with liver disease based solely on abnormal coagulation tests 1
• Only indicated when there is active bleeding or before invasive procedures with significant coagulopathy 4
• May be preferable to factor concentrates in liver disease patients with bleeding 4
• Caution: volume overload may be problematic in some liver disease patients 4

Practical Aspects

• FFP can be thawed using dry oven (10 min), microwave (2-3 min), or water bath (20 min)
• Once thawed, FFP can be stored at 4°C for up to 24 hours (extended to 5 days for trauma-related major hemorrhage)
• Once removed from refrigeration, must be used within 30 minutes
• Never refreeze thawed FFP 1

By following these evidence-based indications for FFP administration, clinicians can optimize patient outcomes while avoiding unnecessary transfusions that carry risks without clinical benefit.