What is the recommended dose of Fresh Frozen Plasma (FFP) for a patient?

Fresh Frozen Plasma Dosing Recommendation

The recommended dose of Fresh Frozen Plasma (FFP) is 10-15 ml/kg body weight, which typically translates to 2-4 units (500-1000 ml) for an average 70 kg adult. 1, 2, 3

Standard Dosing Protocol

• Initial dose: 10-15 ml/kg is the evidence-based starting point for correcting coagulopathy with active bleeding 1, 2, 3
• For a 70 kg patient, this equals approximately 700-1050 ml (3-4 units of 250-300 ml each) 2
• Each unit of FFP contains approximately 250-300 ml volume 2

Critical Dosing Considerations

Doses below 10 ml/kg are ineffective and should be avoided. 2 Research demonstrates that:

• Doses <10 ml/kg fail to achieve the 30% factor concentration threshold needed for hemostasis 2, 3
• Studies show median doses of 8 ml/kg are more effective than 4 ml/kg, but still suboptimal 2
• Transfusing only 1-2 units is inadequate to correct established coagulopathy 3

Context-Specific Dosing

Massive Hemorrhage/Trauma

• Use 1:1:1 ratio (RBCs:FFP:platelets) in severe trauma with massive hemorrhage 3
• Minimum ratio of 1:2 plasma:RBC should be maintained 3
• Administer empirically when coagulation tests are unavailable and massive transfusion is declared 3

Warfarin Reversal

• Lower doses of 5-8 ml/kg (approximately 1-2 units) are usually sufficient for urgent warfarin reversal 2
• However, prothrombin complex concentrate (PCC) is preferred over FFP when available 1, 2

When FFP is Indicated

FFP should only be administered when: 1, 2, 3

• Major hemorrhage with coagulopathy (PT >1.5 times normal or INR >2.0, or aPTT >2 times normal) with active bleeding
• Massive transfusion (>1 blood volume or ~70 ml/kg) with ongoing bleeding
• Disseminated intravascular coagulation (DIC) with evidence of bleeding or high bleeding risk
• Warfarin reversal with active bleeding when PCC unavailable
• Therapeutic plasma exchange as replacement fluid in thrombotic thrombocytopenic purpura

Critical Contraindications

Do NOT use FFP for: 1, 2, 3

• Prophylactic correction of mild-moderate coagulation abnormalities (INR ≤1.5) in non-bleeding patients before procedures 1, 4, 5
• Volume replacement or albumin augmentation 1, 2
• Isolated thrombocytopenia without coagulopathy 3
• Cirrhotic patients without active bleeding (may increase portal pressure) 2

Research shows that transfusing FFP for INR ≤1.5 normalizes PT in only 0.8% of patients and provides no hemostatic benefit while exposing patients to transfusion risks 4, 5

Administration Guidelines

• Infuse as rapidly as clinically tolerated in acute bleeding situations 2
• Thawing methods: dry oven (10 min), microwave (2-3 min), or water bath (20 min) 2
• Once thawed, use within 30 minutes if removed from refrigeration, or within 24 hours if stored at 4°C 2
• Recheck coagulation parameters after transfusion to determine need for additional doses 2

Important Safety Warnings

FFP carries significant risks: 2, 3, 6

• Transfusion-related acute lung injury (TRALI) - the most serious complication
• Transfusion-associated circulatory overload (TACO) - particularly dangerous in neonates, elderly, and those with cardiac/renal dysfunction
• ABO incompatibility reactions
• Allergic reactions
• Infectious disease transmission
• New onset acute lung injury occurs more frequently in transfused patients (18% vs. 4%) 6

Common Pitfalls to Avoid

• Inadequate dosing: Ordering 1-2 units when 3-4 units are needed wastes time and resources 3
• Delayed administration: Mortality increases when FFP is delayed in massive hemorrhage 3
• Prophylactic use: Transfusing for laboratory abnormalities alone in non-bleeding patients increases complications without benefit 1, 4, 6
• Ignoring fibrinogen: FFP has low fibrinogen content (4 units contain only ~2g); use cryoprecipitate or fibrinogen concentrate when fibrinogen <1.0 g/L 1, 3
• Using FFP for specific factor deficiencies: FFP concentration is too low for hemophilia or isolated factor deficiencies; use specific factor concentrates instead 7