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

Fresh Frozen Plasma Dosing

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

Standard Dosing Algorithm

Initial Dose for Active Bleeding with Coagulopathy

• Administer 10-15 ml/kg as the initial dose when treating coagulopathy with active bleeding 1, 2
• For a 70 kg patient, this equals approximately 700-1050 ml, or 3-4 units of FFP (each unit contains 250-300 ml) 1, 2
• Doses below 10 ml/kg are unlikely to achieve the 30% factor concentration threshold needed for hemostasis and should be avoided 1, 2

Massive Hemorrhage Protocol

• In massive transfusion scenarios (>10 units RBC in 24 hours or >6 units in 6 hours), maintain a 1:1 ratio of FFP:RBC until coagulation results become available 1, 2
• This high-ratio transfusion strategy should ideally approach 1:1 in trauma patients to prevent dilutional coagulopathy 1

Warfarin Reversal (Non-Bleeding or Minor Bleeding)

• Lower doses of 5-8 ml/kg FFP are usually sufficient for urgent warfarin reversal, representing approximately 1-2 units for most adults 1
• However, prothrombin complex concentrate (PCC) should be preferred over FFP for warfarin reversal when available, as it is faster and more effective 1, 3

Critical Dosing Thresholds and Laboratory Targets

When to Transfuse FFP

• FFP is indicated when PT >1.5 times normal (or INR >2.0), or aPTT >2 times normal with active microvascular bleeding 1
• Do not transfuse FFP to correct laboratory values alone without bleeding, as this exposes patients to unnecessary risks 1, 2

Dose-Response Relationship

• Higher doses (8 ml/kg median) show better response than lower doses (4 ml/kg) in correcting coagulopathy 1
• The standard therapeutic dose of 15 ml/kg achieves a minimum 30% concentration of plasma factors necessary for hemostasis 2

Administration Considerations

Infusion Rate

• Infuse FFP as rapidly as clinically tolerated in acute bleeding situations, prioritizing rapid correction of coagulopathy over specific infusion rates 1, 2
• The primary goal is rapid correction rather than adhering to a predetermined infusion rate 1

Thawing and Storage

• FFP can be thawed using dry oven (10 minutes), microwave (2-3 minutes), or water bath (20 minutes) 1
• Once thawed, FFP must be used within 30 minutes if removed from refrigeration, or can be stored at 4°C for up to 24 hours 1, 2

Blood Type Compatibility

• FFP should be ABO-compatible with the recipient; use group AB if blood type is unknown 1, 2

Important Clinical Caveats

When NOT to Use FFP

• Do not use FFP for volume expansion or hypovolemia—use crystalloids or colloids instead 1
• Do not use FFP for prophylactic correction of abnormal coagulation tests prior to low-risk invasive procedures in hemodynamically stable patients 1
• Do not use FFP to correct coagulopathy in cirrhotic patients without active bleeding, as it may increase portal pressure 1

Fibrinogen Replacement

• FFP is inefficient for isolated fibrinogen replacement, as four units contain only approximately 2 g of fibrinogen 1, 2, 3
• If fibrinogen is <1.5 g/L (or <2 g/L in obstetrics), prioritize cryoprecipitate or fibrinogen concentrate over FFP 1, 2, 3

Monitoring After Transfusion

• Recheck coagulation parameters after FFP transfusion to determine the need for additional doses 1
• Monitor hemoglobin and coagulation tests before and after administration 1

Serious Risks to Monitor

Major Complications

• Transfusion-related acute lung injury (TRALI) is the most serious complication, with FFP being one of the most frequently implicated products 1, 3
• Transfusion-associated circulatory overload (TACO), particularly concerning in neonates, elderly, and patients with cardiac dysfunction 1, 2
• Citrate toxicity with massive transfusion leading to hypocalcemia and hypomagnesemia 1
• ABO incompatibility reactions if blood type matching is not performed 1, 2
• Infectious disease transmission and allergic reactions 1, 3

Special Populations

Obstetric Hemorrhage

• Withhold FFP until 4 units of RBC have been transfused, unless early coagulopathy is diagnosed on testing 1
• After 4 units RBC with ongoing bleeding, give 4 units FFP and maintain 1:1 ratio until results available 1

Factor X Deficiency

• For factor X deficiency specifically, FFP dosing targets trough factor X levels above 10-20 IU/dL, using 20 ml/kg followed by 3-6 ml/kg twice daily 4
• However, plasma-derived factor X concentrate or prothrombin complex concentrates are preferred over FFP when available 4