Composition of Fresh Frozen Plasma (FFP)
Fresh frozen plasma (FFP) contains all soluble coagulation factors, including the labile factors V and VIII, as well as both pro- and anticoagulant proteins that help maintain hemostatic balance. 1
Main Components of FFP
FFP is a plasma component that is frozen quickly after collection to preserve the integrity of its constituents. It contains:
- All soluble coagulation factors, including:
- Factor V (labile)
- Factor VIII (labile/antihemophilic factor)
- Von Willebrand factor
- Fibrinogen
- Factor XIII
- Other coagulation factors (II, VII, IX, X, XI)
- Both pro- and anticoagulant proteins
- Fibronectin
- Albumin
- Other plasma proteins
Volume and Preparation
- Each unit of FFP has a volume of approximately 300 ml 1
- FFP is prepared by freezing plasma rapidly after collection
- To maintain optimal factor VIII levels, FFP should be frozen within 6 hours of collection (FFP-I), as factor VIII activity decreases significantly when frozen after longer periods (18-20 hours) 2
- When thawed, FFP can be stored at 4°C for up to 24 hours, with extended storage of up to 5 days for trauma-related major hemorrhage 1
Clinical Considerations
- FFP should be ABO compatible with the recipient
- If blood group is unknown, group AB FFP is preferred as it does not contain anti-A or anti-B antibodies 1
- The recommended therapeutic dose is 15 ml/kg 1
Important Distinctions
FFP vs. Cryoprecipitate
It's important to understand that FFP differs from cryoprecipitate, which is derived from FFP:
- Cryoprecipitate is a concentrate of high-molecular-weight plasma proteins that precipitate when frozen plasma is slowly thawed at 1-6°C 3, 4
- Cryoprecipitate contains concentrated amounts of:
FFP vs. Cryodepleted Plasma
- Cryodepleted plasma (also called cryosupernatant) is the plasma remaining after removal of cryoprecipitate 3, 4
- It contains all other plasma proteins and clotting factors that remain soluble during cold-temperature thawing 3
- Interestingly, cryodepleted plasma has been found to have higher albumin concentration and colloid osmotic pressure compared to FFP 5
Clinical Efficacy Considerations
It's worth noting that FFP transfusion for mild coagulation abnormalities (PT 13.1-17 seconds or INR 1.1-1.85) has limited efficacy in normalizing coagulation values. Research shows it normalizes PT-INR in only 0.8% of patients and achieves halfway normalization in just 15% of patients 6. This highlights the importance of using FFP for appropriate indications rather than mild coagulopathies.