Recommended Dose of Fresh Frozen Plasma (FFP)
The recommended dose of FFP is 10-15 ml/kg body weight, which achieves a minimum of 30% plasma factor concentration necessary for hemostatic effect. 1, 2
Standard Dosing Guidelines
For correction of coagulopathy with bleeding:
- Administer 10-15 ml/kg FFP as the initial dose 1, 2
- This typically translates to 2-4 units (500-1000 ml) for an average 70 kg adult 1
- Each unit of FFP contains approximately 250-300 ml 2, 3
For urgent warfarin reversal:
- Lower doses of 5-8 ml/kg FFP are usually sufficient 1
- This represents approximately 1-2 units for most adults 1
Dose-Response Relationship
Higher doses are more effective at correcting coagulopathy:
- A median dose of 17 ml/kg successfully corrected INR in 36% of patients, compared to 10 ml/kg which failed to correct INR 4
- Studies from Iran using 560 ml (approximately 8 ml/kg for 70 kg patient) showed better response than South Africa using 280 ml (approximately 4 ml/kg), with fewer patients requiring second treatments 1
Clinical Context for Dosing
FFP is indicated when:
- PT > 1.5 times normal or INR > 2.0, or aPTT > 2 times normal with microvascular bleeding 1
- Massive transfusion (>1 blood volume or ~70 ml/kg) with ongoing bleeding when coagulation tests unavailable 1
- Specific coagulation factor deficiencies without available concentrates 1
Critical Dosing Considerations
Avoid underdosing:
- Doses below 10 ml/kg are unlikely to achieve the 30% factor concentration threshold needed for hemostasis 1, 2
- Prophylactic FFP in non-bleeding patients with coagulopathy does not prevent bleeding and increases transfusion-related complications 4, 5
Monitor for dose adequacy:
- Recheck coagulation parameters after transfusion to determine need for additional doses 1
- Further doses depend on coagulation monitoring and amount of other blood products administered 1
Special Population: Hereditary Angioedema
For acute HAE attacks when specific therapies unavailable:
- Doses of 10-15 ml/kg have shown effectiveness 1
- One case report used 20 ml/kg with complete resolution 1
- Response is slower than specific therapies (median 4 hours vs. minutes) 1
Important Safety Warnings
FFP carries significant risks:
- Transfusion-related acute lung injury (TRALI) occurred more frequently in transfused patients (18% vs. 4%) 4
- Circulatory overload, ABO incompatibility, and infectious disease transmission are documented risks 1, 2
- Increased red cell transfusion requirements in patients receiving prophylactic FFP 5
FFP is NOT indicated for:
- Volume expansion or albumin replacement 1
- Prophylaxis in non-bleeding patients with mild coagulopathy 4, 5
- Correction of coagulopathy in cirrhotic patients without bleeding (may increase portal pressure) 2
Administration Logistics
Once thawed: