Fresh Frozen Plasma Administration Rate
Fresh frozen plasma should be infused as rapidly as clinically tolerated in acute bleeding situations, with the primary goal being rapid correction of coagulopathy rather than adhering to a specific infusion rate. 1, 2
Practical Administration Guidelines
Thawing and Preparation Time
- FFP can be thawed using three methods with varying times: 1
- Dry oven: 10 minutes
- Microwave: 2-3 minutes
- Water bath: 20 minutes
- Once thawed, FFP must be used within 30 minutes if removed from refrigeration 1
- Thawed FFP stored at 4°C can be used for up to 24 hours 1
Infusion Rate Considerations
In emergency situations requiring rapid reversal (trauma, major hemorrhage, warfarin-associated intracerebral hemorrhage), FFP should be administered as quickly as possible. 3
- Time to treatment is the most critical determinant of successful anticoagulation reversal 3
- Every 30-minute delay in FFP administration decreases the odds of INR reversal within 24 hours by 20% 3
- Patients who achieved successful INR reversal had a median time from diagnosis to first FFP dose of 90 minutes versus 210 minutes in those who failed reversal 3
Volume and Dosing Context
The infusion rate must account for the therapeutic dose required: 1, 2
- Standard therapeutic dose: 15 ml/kg body weight 1
- For a 70 kg patient, this equals approximately 1,050 ml (3-4 units of 250-300 ml each) 1, 2
- For warfarin reversal specifically: 5-8 ml/kg is usually sufficient 2
Critical Pitfalls to Avoid
Do not delay FFP administration for arbitrary infusion rate protocols in actively bleeding patients. 3
- The blood bank should be alerted immediately to facilitate timely preparation 1
- FFP should be administered in conjunction with packed RBCs (8-10 units) in massive hemorrhage to avoid further clotting factor loss 1
- Minimizing delays in FFP administration is the most prudent first step in emergency management 3
Safety Monitoring During Rapid Infusion
While rapid administration is often necessary, monitor for: 2
- Circulatory overload (TACO) - particularly relevant given the large volumes required
- Transfusion-related acute lung injury (TRALI) 1, 2
- Citrate toxicity with massive transfusion (hypocalcemia/hypomagnesemia) 1
In non-emergency situations or stable patients, standard blood product infusion rates (completing transfusion within 4 hours of issue) may be appropriate, but this should never delay treatment in acute coagulopathic bleeding.