Fresh Frozen Plasma Dosing: 10-15 ml/kg
The recommended dose of fresh frozen plasma (FFP) is 10-15 ml/kg body weight, which represents the standard initial dose endorsed by multiple international guidelines for correction of coagulopathy with bleeding. 1, 2
Standard Dosing Protocol
For an average 70 kg adult, this translates to approximately 700-1050 ml, or 2-4 units of FFP (each unit contains 250-300 ml). 2
Key Dosing Principles
The 10-15 ml/kg dose is designed to achieve a minimum 30% plasma factor concentration, which is the threshold needed for hemostasis. 2, 3
Doses below 10 ml/kg are unlikely to provide therapeutic benefit and should be avoided. 2
Higher doses may be required for established coagulopathy—more than 15 ml/kg may be necessary when coagulopathy is already present rather than being prevented. 1
Clinical Context Affects Dosing
The actual volume administered varies based on clinical indication, with real-world data showing:
Bleeding patients receive higher median doses (11.1 ml/kg) compared to preprocedural prophylaxis (9.8 ml/kg) or prophylaxis without procedure (8.9 ml/kg). 4
Patients with higher pretransfusion INR receive larger volumes, ranging from 8.9 ml/kg at INR ≤1.5 to 15.7 ml/kg at INR >3. 4
In massive hemorrhage requiring 1:1:1 transfusion protocols (RBC:FFP:platelets), the FFP dose should be 15 ml/kg as part of the initial resuscitation. 1, 2
Critical Dosing Thresholds and Efficacy
FFP transfusion is only indicated when PT or aPTT exceeds 1.5 times normal (or INR >2.0) with active bleeding. 1, 2
Important Limitations
FFP has minimal effect on correcting INR when pretransfusion INR is <1.7—only 50% of patients with INR 1.7 show significant change after FFP. 5
Posttransfusion INR corrections are consistently small unless pretransfusion INR exceeds 2.5. 4
FFP contains relatively low fibrinogen content (four units provide only ~2 g fibrinogen), making it inefficient for isolated fibrinogen replacement. 2, 3
Common Pitfalls to Avoid
Administering 1-2 units (inadequate dosing) is insufficient to correct established coagulopathy and exposes patients to transfusion risks without benefit. 3
Approximately 31% of FFP treatments in ICUs are given to patients without PT prolongation, and 41% to patients without bleeding and only mild INR elevation (<2.5)—these represent inappropriate use. 4
FFP should never be used for volume expansion, albumin replacement, or prophylactic correction of mild coagulopathy in non-bleeding patients. 2, 6
Alternative Therapies for Specific Situations
For isolated hypofibrinogenemia (<1.0-1.5 g/L), cryoprecipitate or fibrinogen concentrate is more effective than FFP and should be used instead. 2, 3
For urgent warfarin reversal, prothrombin complex concentrate (PCC) at 30 IU/kg is superior to FFP 20 ml/kg, achieving INR ≤1.2 in 67% versus 9% of patients. 7
Administration Considerations
FFP should be infused as rapidly as clinically tolerated in acute bleeding situations—the goal is rapid correction of coagulopathy, not adherence to a specific infusion rate. 2
FFP must be ABO compatible with the recipient. 2
Once thawed, FFP must be used within 30 minutes if removed from refrigeration, though thawed FFP stored at 4°C can be used for up to 24 hours. 2