Is there fibrinogen in Fresh Frozen Plasma (FFP)?

Fibrinogen Content in Fresh Frozen Plasma (FFP)

Yes, FFP contains fibrinogen at a concentration of approximately 2.5-3.0 g/L (or even less: 0.9-2.0 g/L after thawing), making it a source of fibrinogen, though at relatively low concentrations compared to cryoprecipitate or fibrinogen concentrates. 1

Fibrinogen Content in Different Blood Products

Fresh Frozen Plasma (FFP)

• Contains all soluble coagulation factors, including fibrinogen
• Fibrinogen concentration: 2.5-3.0 g/L (or 0.9-2.0 g/L after thawing) 1
• Approximately 2 g of fibrinogen in four units of FFP 2
• Due to this relatively low concentration, FFP is considered unsuitable for significant fibrinogen replenishment in severe hypofibrinogenemia 1

Alternative Sources of Fibrinogen

1. Cryoprecipitate

   • Higher concentration of fibrinogen: 15-17 g/L 1
   • Contains other factors: von Willebrand factor, factor VIII, and factor XIII
   • Dosing: Generally, two units of cryoprecipitate per 10 kg of body weight raise plasma fibrinogen by 1 g/L 1

2. Fibrinogen Concentrate

   • Highest concentration: 20 g/L when reconstituted according to manufacturer guidelines 1
   • Virus-inactivated derivative of pooled plasma
   • Provides more predictable amounts of fibrinogen than cryoprecipitate 1

Clinical Implications

When to Use FFP as a Source of Fibrinogen

FFP is administered as a source of coagulation factors, including fibrinogen, primarily in:

• Major hemorrhage, often in a balanced ratio with red blood cells (1:1 or 1:1.5) 1
• Disseminated intravascular coagulation (DIC) with active bleeding 1
• Reversal of warfarin anticoagulation when prothrombin complex concentrate is unavailable 1
• Replacement fluid for apheresis in microangiopathies 1

When Alternative Sources Are Preferred

For significant hypofibrinogenemia requiring targeted fibrinogen replacement:

• Cryoprecipitate or fibrinogen concentrate is recommended when fibrinogen levels are low (<1.5 g/L) with clinically significant bleeding 1
• In obstetric hemorrhage, fibrinogen levels should be maintained above 2 g/L 1

Important Considerations

Stability of Fibrinogen in FFP

• Fibrinogen in FFP remains stable even after repeated freezing and thawing cycles 3
• Studies show that vitamin K-dependent factors and fibrinogen levels remain adequate for transfusion in twice-thawed-and-refrozen FFP 3

Clinical Outcomes

• In trauma patients with coagulopathy, fibrinogen concentrate has shown better outcomes than FFP regarding mortality, sepsis, need for ICU admission, and duration of hospitalization 4
• In pediatric cardiac surgery, FFP in the pump prime can limit dilutional hypofibrinogenemia 5

Common Pitfalls

1. Inappropriate Use of FFP

   • FFP should not be used solely for volume replacement 1
   • Not recommended for prophylactic correction of abnormal coagulation tests prior to low-risk procedures in critically ill patients 1
   • Not recommended for prophylactic use in elective cardiac surgery 1

2. Dosing Considerations

   • The recommended therapeutic dose of FFP is 15 ml/kg 2
   • Administration should be guided by clinical response in actively bleeding patients

3. Blood Group Compatibility

   • Donor and recipient blood groups should be the same for FFP transfusion
   • If patient's blood group is unknown, ABO non-identical plasma with "low titre" anti-A or anti-B activity is acceptable 1
   • Group O components should only be given to group O recipients 1

In summary, while FFP does contain fibrinogen, its relatively low concentration makes it less suitable than cryoprecipitate or fibrinogen concentrate for significant fibrinogen replacement in cases of severe hypofibrinogenemia.