Indications for Fresh Frozen Plasma (FFP) Use
Fresh Frozen Plasma should only be used in specific clinical scenarios with documented coagulopathy, particularly during active bleeding when the INR is >1.5 or when immediate reversal of anticoagulation is needed. 1, 2
Primary Indications
- Replacement of coagulation factors during major hemorrhage, particularly in trauma and obstetrics 1, 3
- Acute disseminated intravascular coagulation (DIC) with active bleeding 1
- Patients who are actively bleeding with INR >1.5 or prothrombin time (PT)/activated partial thromboplastin time (aPTT) >1.5 times normal 1, 2
- Immediate reversal of warfarin-induced hemorrhage when prothrombin complex concentrate (PCC) is not available (PCC is preferred first-line treatment) 1, 2
- Thrombotic thrombocytopenic purpura with plasmapheresis, preferably using pathogen-inactivated FFP 1
- Replacement of specific coagulation factors when concentrates are unavailable 1
Dosing and Administration
- The recommended therapeutic dose is 15 ml/kg body weight 1, 3
- FFP should be the same blood group as the patient; if unknown, group AB FFP is preferred 1
- Once thawed, FFP can be used for up to 24 hours if stored at 4°C 1
- After removal from refrigeration, FFP must be used within 30 minutes 1
- For major hemorrhage in trauma, thawed FFP can be stored at 4°C for up to 5 days 1
Massive Hemorrhage Management
- A fibrinogen <1 g/L or PT/aPTT >1.5 times normal represents established hemostatic failure 1
- Early infusion of FFP (15 ml/kg) should be used prophylactically when massive hemorrhage is anticipated 1
- Established coagulopathy may require more than 15 ml/kg of FFP to correct 1
- For severe trauma, a 1:1:1 ratio of red cells:FFP:platelets may be considered 1
Situations Where FFP Is NOT Recommended
- Management of mild-moderate coagulation abnormalities in non-bleeding critically ill patients before invasive procedures 1, 4
- Routine use in patients with cirrhosis/liver disease unless significant coagulopathy with bleeding is identified 1, 5
- Routine circulatory volume replacement 1
- Nutritional support or protein-losing states 6, 7
- Treatment of immunodeficiency states 6, 7
- Hypovolemia 6, 7
Important Clinical Considerations
- Studies show FFP transfusion for mild abnormalities (PT 13.1-17 seconds or INR 1.1-1.85) normalizes PT in only 0.8% of patients 4
- In chronic liver disease, standard FFP doses (2-4 units) correct coagulopathy in only 10-12.5% of patients 5
- For hypofibrinogenemia, cryoprecipitate may be more effective than FFP, as four units of FFP contain approximately 2g fibrinogen compared to 4g in two pools of cryoprecipitate 1
- To reduce transfusion-related acute lung injury (TRALI) risk, many centers use male-only plasma for component therapy 1