What is the purpose of administering Fresh Frozen Plasma (FFP)?

Purpose of Fresh Frozen Plasma Administration

Fresh frozen plasma is administered primarily as a source of coagulation factors, with the main indication being major hemorrhage with documented coagulopathy. 1

Primary Indications for FFP

Major Hemorrhage

• FFP should be given for active bleeding with documented coagulopathy when PT >1.5 times normal, INR >2.0, or aPTT >2 times normal. 2, 3
• In major hemorrhage settings, FFP is administered in a balanced ratio with red blood cells (typically 1:1 or 1:1.5) until coagulation test results become available. 1
• The therapeutic dose is 15 ml/kg to achieve a minimum of 30% plasma factor concentration. 2, 3

Specific Clinical Scenarios

• Disseminated intravascular coagulation (DIC) with evidence of bleeding or high bleeding risk (e.g., planned surgery or invasive procedure). 1
• Urgent warfarin reversal in the presence of active bleeding when prothrombin complex concentrate is unavailable (5-8 ml/kg typically sufficient). 1, 2
• Replacement fluid for apheresis in microangiopathies such as thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. 1
• Hereditary angioedema as FFP contains C1-esterase inhibitor. 1

When FFP Should NOT Be Used

Inappropriate Indications

• Prophylactic correction of abnormal coagulation tests prior to low-risk invasive procedures in critically ill patients is not supported by evidence. 1
• Abnormal standard coagulation tests (PT, APTT) are poor predictors of bleeding in hemodynamically stable critically ill patients and do not reflect true hemostatic status in advanced liver disease. 1
• FFP should not be used solely for volume replacement. 1
• Prophylactic FFP in elective cardiac surgery is not recommended. 1
• Correcting laboratory abnormalities without active bleeding or planned invasive procedures is inappropriate. 3

Critical Dosing Considerations

Adequate Dosing

• The standard dose of 10-15 ml/kg is required to achieve therapeutic effect. 3
• Administering inadequate doses (less than 10-15 ml/kg) is a common pitfall that reduces efficacy. 3
• One unit of FFP contains 250-300 ml. 3

Compatibility and Storage

• FFP must be ABO compatible with the recipient; if blood type is unknown, AB plasma is preferred. 2, 3
• Once thawed, FFP can be used for up to 24 hours if stored at 4°C, and must be used within 30 minutes outside refrigeration. 2

Common Clinical Pitfalls to Avoid

• Using FFP as a volume expander instead of crystalloids or colloids is inappropriate and exposes patients to unnecessary transfusion risks. 3
• Failing to obtain coagulation parameters before FFP administration when clinically feasible prevents rational use. 3
• Transfusing FFP for mild coagulation abnormalities in non-bleeding patients lacks evidence and is not indicated. 3
• In liver disease patients, FFP infusions using commonly employed volumes (2-4 units) infrequently correct coagulopathy; higher volumes (6 or more units) may be more effective but are rarely used. 4

Alternative Therapies

• Prothrombin complex concentrates are preferred alternatives for urgent warfarin reversal. 2
• Fibrinogen concentrates are increasingly used as first-line therapy for fibrinogen replacement in many European countries, though clinical superiority over cryoprecipitate is not established. 1
• Cryoprecipitate is indicated when fibrinogen concentration is low (<80-100 mg/dl) with excessive microvascular bleeding. 2
• Recombinant factor VIIa may be considered when traditional options for treating excessive microvascular bleeding are exhausted. 2