Does FFP Increase Platelet Counts?
No, Fresh Frozen Plasma (FFP) does not increase platelet counts. FFP contains clotting factors (fibrinogen, factors V, VIII, and others) but does not contain functional platelets, and therefore cannot raise platelet counts 1.
What FFP Actually Contains
- FFP provides soluble coagulation factors at approximately 70% of normal levels, including the labile factors V and VIII 1, 2
- Each unit of FFP (250-300 ml) contains approximately 0.5 g of fibrinogen, but platelets are reduced to negligible levels (approximately 20,000/mm³) during the freezing process 2, 3
- The anticoagulant citrate in FFP actually binds calcium and can theoretically impair platelet function during massive transfusion 1
What Actually Increases Platelet Counts
Platelet transfusion is the only blood product that increases platelet counts 1:
- Platelet concentrates from whole blood contain 7.5 × 10¹⁰ platelets per unit and should increase the platelet count by 5-10 × 10⁹/L in a 70-kg recipient 1
- Apheresis platelet packs provide equivalent platelet doses in a single unit 1
- The recommended initial dose is 4-8 platelet concentrates or one apheresis pack 1
Platelet Transfusion Thresholds
Maintain platelet count >50 × 10⁹/L in bleeding patients 1:
- For surgical or obstetric patients with normal platelet function, transfusion is rarely indicated if platelets >100 × 10⁹/L and usually indicated when <50 × 10⁹/L with excessive bleeding 1
- Higher threshold of 100 × 10⁹/L is suggested for patients with multiple trauma who are severely bleeding or have traumatic brain injury 1
- Platelet transfusion may be indicated despite adequate counts if there is known or suspected platelet dysfunction (e.g., clopidogrel use) 1
Evidence Regarding FFP and Platelets
One small study in dengue fever patients showed a transient increase in platelet counts at 12 hours after FFP infusion, but this effect was not sustained at 24 or 48 hours 4. This finding is not generalizable to other clinical contexts and does not represent a standard indication for FFP use.
Common Clinical Pitfall
Do not confuse the indications for FFP with those for platelet transfusion:
- FFP is indicated for coagulopathy (PT >1.5× normal, INR >2.0, or aPTT >2× normal) with active bleeding 1, 2, 5
- Platelets are indicated for thrombocytopenia with bleeding or high bleeding risk 1
- In massive transfusion protocols, both products are often needed simultaneously but serve completely different hemostatic functions 1
Practical Guidance for Massive Bleeding
When managing massive hemorrhage with both coagulopathy and thrombocytopenia 1:
- Administer FFP at 10-15 ml/kg (typically 2-4 units) to correct clotting factor deficiencies 1, 2
- Separately administer 4-8 platelet concentrates or one apheresis pack to correct thrombocytopenia 1
- Monitor both coagulation parameters (PT/INR, aPTT) and platelet counts to guide further transfusion 1
- Four to five platelet concentrates provide coagulation factors equivalent to 1 unit FFP, but this is not their primary therapeutic purpose 1