FFP Does Not Raise Platelet Count
Fresh Frozen Plasma (FFP) does not increase platelet count and should never be used for this purpose. FFP contains coagulation factors, not platelets, and has no mechanism to raise platelet numbers 1.
Understanding the Fundamental Difference
FFP is a plasma product that contains:
- Soluble coagulation factors (Factors II, V, VII, VIII, IX, X, XI, XII, XIII) 1, 2
- Fibrinogen (approximately 2g per 4 units) 2
- Von Willebrand factor 1
- Anticoagulant proteins (protein C, protein S, antithrombin) 3
FFP contains zero platelets and therefore cannot increase platelet count 1.
What Actually Raises Platelet Count
Platelet concentrates are the only blood product that raises platelet count. Each single unit of platelet concentrate contains approximately 7.5 × 10¹⁰ platelets and should increase the platelet count by 5-10 × 10⁹/L in a 70-kg recipient 1.
Recommended Platelet Transfusion Strategy:
- Initial dose: 4-8 platelet concentrates or one apheresis pack 1
- Target threshold: Maintain platelet count >50 × 10⁹/L in bleeding patients 1
- Higher threshold: Consider maintaining >100 × 10⁹/L in patients with multiple trauma, severe bleeding, or traumatic brain injury 1
Common Clinical Pitfall
A dangerous misconception exists that FFP can somehow improve platelet function or count. While FFP corrects coagulopathy by replacing clotting factors when PT >1.5 times normal or INR >2.0 1, 4, it has no effect on thrombocytopenia. One small study in dengue patients showed a transient platelet increase at 12 hours after FFP, but this was not sustained and likely represented spontaneous recovery rather than a true FFP effect 5.
Appropriate FFP Indications (Not Including Platelets)
FFP is indicated for:
- Coagulopathy with bleeding (PT >1.5 times normal, INR >2.0, or aPTT >2 times normal) 1, 4, 2
- Major hemorrhage requiring coagulation factor replacement 1, 2
- Urgent warfarin reversal when prothrombin complex concentrate unavailable 1, 4
- Acute disseminated intravascular coagulation with bleeding 1
Standard FFP dose: 10-15 ml/kg (typically 2-4 units for a 70-kg adult) 1, 4, 2