What is the recommended dose of Fresh Frozen Plasma (FFP) for a patient?

Fresh Frozen Plasma (FFP) Dosing Recommendations

The recommended therapeutic dose of Fresh Frozen Plasma (FFP) is 15 ml/kg of body weight. 1

Dosing Guidelines for FFP

Standard Dosing

• 15 ml/kg is the standard therapeutic dose recommended by clinical guidelines 1
• This typically equates to 10-15 ml/kg to achieve minimum 30% plasma factor concentration 2
• For an average adult, this translates to approximately 3-4 units of FFP

Considerations for Massive Bleeding

• In massive transfusion protocols for trauma patients, a high-ratio transfusion strategy is recommended:
  • At least one unit of plasma per two units of packed red blood cells (1:2 FFP:RBC ratio) 1
  • In some cases of reduced RBC availability, a plasma-first approach using an inverse ratio of 2 FFP to 1 RBC can be adopted 1

Administration Considerations

• FFP should be ABO compatible with the patient
• If blood group is unknown, group AB FFP is preferred (contains no anti-A or anti-B) 1
• Once thawed, FFP can be used for up to 24 hours if stored at 4°C 1
• When removed from refrigeration, it must be used within 30 minutes 1
• Average volume per bag is approximately 300 ml 1

Appropriate Indications for FFP Use

FFP should only be used in specific clinical scenarios:

• Replacement of coagulation factors during major hemorrhage (trauma, obstetrics) 1
• Acute disseminated intravascular coagulation (DIC) with bleeding 1
• Actively bleeding patients with INR > 1.5 1
• Immediate reversal of warfarin-induced hemorrhage when PCC is unavailable 1
• Thrombotic thrombocytopenic purpura (usually with plasmapheresis) 1
• Replacement of coagulation factors when specific factors are unavailable 1

Common Pitfalls to Avoid

• FFP should not be used for:

  • Routine circulatory volume replacement 1
  • Management of mild-moderate coagulation abnormalities in non-bleeding patients 1
  • Routine use in patients with cirrhosis/liver disease unless significant coagulopathy is identified 1
  • Isolated low fibrinogen levels (cryoprecipitate is preferred) 2
  • Correction of INR < 1.5 in non-bleeding patients 1

• FFP transfusion for mild abnormalities of coagulation values (PT 13.1-17 seconds or INR 1.1-1.85) fails to normalize PT in 99% of patients 3

By following these evidence-based guidelines for FFP administration, clinicians can optimize patient outcomes while avoiding unnecessary transfusions and their associated risks.