What is the recommended dose of Fresh Frozen Plasma (FFP) for an adult cancer patient with impaired coagulation profile?

Fresh Frozen Plasma Dosing for Adult Cancer Patients with Coagulopathy

Recommended Dose

For an adult cancer patient with impaired coagulation profile and active bleeding, administer 10-15 ml/kg of FFP, which translates to approximately 2-4 units (500-1000 ml) for a 70 kg adult. 1

Dosing Algorithm Based on Clinical Context

Active Bleeding with Coagulopathy

• Initial dose: 10-15 ml/kg (approximately 700-1050 ml for a 70 kg patient, or 3-4 units of 250-300 ml each) 1
• This dose is indicated when PT > 1.5 times normal (or INR > 2.0) with active bleeding 1
• Infuse as rapidly as clinically tolerated in acute bleeding situations, prioritizing rapid correction over specific infusion rates 1
• Recheck coagulation parameters after transfusion to determine need for additional doses 1

Massive Hemorrhage Protocol

• Maintain a 1:1 ratio of RBC:FFP if massive transfusion is ongoing (>10 units RBC in 24 hours or >6 units in 6 hours) 1
• Administer FFP early in massive bleeding rather than waiting for laboratory confirmation 1

Pre-Procedural Correction

• Do NOT transfuse FFP prophylactically for mild-moderate coagulation abnormalities (INR ≤ 1.5) in non-bleeding patients before low-risk procedures 1, 2
• For high-risk procedures with active bleeding: use the standard 10-15 ml/kg dose 1

Critical Dosing Thresholds

Doses below 10 ml/kg are unlikely to achieve the 30% factor concentration threshold needed for hemostasis. 1 The evidence demonstrates that:

• Lower doses (5-8 ml/kg) may be sufficient only for urgent warfarin reversal 1
• Studies show 8 ml/kg is more effective than 4 ml/kg for correcting coagulopathy 1
• The standard therapeutic dose of 15 ml/kg achieves minimum 30% concentration of plasma factors 3

Important Caveats for Cancer Patients

When NOT to Use FFP

• Do not use FFP to correct laboratory values alone without bleeding - this exposes patients to unnecessary risks including TRALI, circulatory overload, and infectious transmission 1, 2
• Do not use for volume expansion or albumin replacement 1
• Prophylactic FFP in non-bleeding patients with coagulopathy does not prevent bleeding and increases transfusion-related complications 1

Alternative Considerations

• If fibrinogen is low (<1.5 g/L): prioritize cryoprecipitate or fibrinogen concentrate over FFP, as FFP contains only approximately 2 g fibrinogen per 4 units, making it inefficient for isolated fibrinogen replacement 1
• For specific factor deficiencies (e.g., Factor X deficiency): consider factor concentrates or prothrombin complex concentrates (PCCs) instead of FFP 4

Practical Administration Details

• Thawing time: 10 minutes (dry oven), 2-3 minutes (microwave), or 20 minutes (water bath) 1, 3
• Once thawed: must be used within 30 minutes if removed from refrigeration, or can be stored at 4°C for up to 24 hours 1, 3
• ABO compatibility: FFP should be ABO-compatible; use group AB if blood type unknown 1, 3
• Volume per unit: approximately 250-300 ml 1, 3

Monitoring for Complications

Watch for these serious risks during and after FFP transfusion:

• Transfusion-related acute lung injury (TRALI) - the most serious complication 1
• Circulatory overload (TACO) - particularly concerning in cancer patients who may have compromised cardiac function 1
• Citrate toxicity with massive transfusion (hypocalcemia/hypomagnesemia) 1
• ABO incompatibility reactions 1

Evidence Quality Note

The dosing recommendations are consistent across multiple high-quality guidelines including the American Society of Anesthesiologists, American College of Surgeons, and British Society for Haematology 1. Research evidence confirms that FFP transfusion for mild coagulation abnormalities (INR ≤ 1.5) fails to correct PT in 99% of patients and provides no hemostatic benefit 5.