What are the indications for Fresh Frozen Plasma (FFP) in patients with dengue fever?

Indications for Fresh Frozen Plasma (FFP) in Dengue Fever

Fresh frozen plasma (FFP) should only be used in dengue fever patients with active bleeding and abnormal coagulation parameters (PT >1.5 times normal or INR >2.0), or in preparation for invasive procedures when coagulopathy is present. 1

Primary Indications for FFP in Dengue Fever

• FFP transfusion is indicated for correction of excessive microvascular bleeding (coagulopathy) in the presence of prolonged PT (>1.5 times normal) or INR >2.0, or aPTT >2 times normal 1
• FFP should be considered when there is active bleeding with coagulation abnormalities 1
• FFP may be used for correction of excessive microvascular bleeding secondary to coagulation factor deficiency in patients who have received massive transfusions (>70 ml/kg) and when coagulation tests cannot be obtained quickly 1

FFP Administration Guidelines

• FFP should be given in doses of 10-15 ml/kg to achieve a minimum of 30% plasma factor concentration 1, 2
• The typical volume of one unit of FFP is 250-300 ml 2
• FFP should be ABO compatible with the recipient 1, 2
• Coagulation tests (PT/INR and aPTT) should be obtained before FFP administration whenever possible 1

When FFP Should NOT Be Used in Dengue Fever

• FFP should not be used to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures 1
• FFP is not indicated solely for augmentation of plasma volume or albumin concentration 1
• FFP should not be used prophylactically based only on platelet count without consideration of clinical bleeding status 3, 4

Evidence for FFP in Dengue

• One prospective randomized controlled study showed that infusion of 600 ml FFP in dengue patients with thrombocytopenia (<40,000/mm³) contributed to a significant increase in platelet count in the first 12 hours, but this effect was not sustained at 24 and 48 hours 5
• Inappropriate use of FFP has been documented in 21.5-36.62% of dengue cases, highlighting the need for strict adherence to evidence-based transfusion guidelines 3, 6

Clinical Decision Algorithm for FFP Use in Dengue

1. Assess for active bleeding

   • If no active bleeding → FFP not indicated regardless of laboratory values 1
   • If active bleeding → proceed to step 2

2. Check coagulation parameters (PT/INR, aPTT)

   • If PT >1.5 times normal, INR >2.0, or aPTT >2 times normal → FFP indicated 1
   • If coagulation parameters normal → FFP not indicated, consider other blood components 1

3. Consider planned invasive procedures

   • If invasive procedure planned and coagulopathy present → FFP indicated 1
   • If no procedure planned → base decision solely on bleeding status and coagulation parameters 1

Common Pitfalls in FFP Use for Dengue

• Transfusing FFP based solely on low platelet count without bleeding or coagulopathy 3, 4
• Using FFP as volume expander instead of crystalloids or colloids 1, 2
• Failing to check coagulation parameters before FFP administration 1
• Administering inadequate doses of FFP (less than 10-15 ml/kg) 1, 2
• Transfusing FFP to correct mild coagulation abnormalities in non-bleeding patients 1

The management of dengue requires judicious use of blood components including FFP, with clear indications based on clinical bleeding status and laboratory parameters rather than prophylactic administration based solely on platelet counts or other laboratory values 3, 7.