From the Guidelines
A typical fresh frozen plasma (FFP) transfusion order would be: "Transfuse 10-15 mL/kg of FFP (approximately 2-4 units for an average adult) over 1-2 hours". For a 70 kg adult, this translates to about 700-1050 mL of FFP. The transfusion should be ABO-compatible with the recipient, though Rh compatibility is not required for FFP. Prior to administration, the patient's coagulation parameters should be checked, including PT/INR and aPTT, as indicated by the guidelines for management of bleeding following major trauma 1.
Some key points to consider when ordering FFP transfusion include:
- FFP contains all coagulation factors and is indicated for patients with coagulation factor deficiencies, especially in cases of active bleeding, before invasive procedures, or to reverse warfarin anticoagulation, as recommended by the AAGBI guidelines 1.
- Each unit of FFP (about 250 mL) typically raises coagulation factor levels by 5-10%.
- The transfusion should be completed within 4 hours of thawing to preserve coagulation factor activity.
- Patients should be monitored for transfusion reactions including fever, urticaria, and transfusion-related acute lung injury (TRALI).
- FFP should not be used simply as routine circulatory volume replacement, and its use in patients with cirrhosis/liver disease should be limited to those with significant coagulopathy, as stated in the AAGBI guidelines 1.
Vital signs should be monitored before, during, and after transfusion to ensure the patient's safety and the effectiveness of the transfusion. It is essential to follow the guidelines and recommendations from reputable sources, such as the AAGBI guidelines 1, to ensure the appropriate use of FFP transfusion and minimize potential risks.
From the Research
Fresh Frozen Plasma Transfusion Order
- The decision to transfuse fresh frozen plasma (FFP) should be based on a thorough risk/benefit assessment, considering the patient's individual needs and circumstances 2.
- In critically ill patients with coagulopathy, FFP can be used to correct international normalized ratio (INR) and facilitate procedures, but its effectiveness may vary depending on the underlying condition and the dose administered 3.
- The use of four-factor prothrombin complex concentrate (4-PCC) in addition to FFP has been shown to improve survival and reduce transfusion requirements in trauma patients with coagulopathy 4, 5.
- A 1:1 ratio of FFP to packed red blood cells (RBC) has been suggested as a potential strategy to reduce coagulopathy in massively transfused patients, but its effectiveness in improving survival is still unclear 6.
- The transfusion of FFP and platelets should be guided by a careful assessment of the patient's risk of bleeding and the potential benefits of transfusion, taking into account the limited evidence and the known risks of blood product transfusion 2.
Key Considerations
- The dose and timing of FFP administration can impact its effectiveness in correcting coagulopathy 3.
- The use of 4-PCC in addition to FFP may offer benefits in terms of reduced transfusion requirements and improved survival, but further studies are needed to confirm these findings 4, 5.
- The optimal ratio of FFP to RBC in massively transfused patients remains unclear, and further research is needed to determine the most effective strategy 6.
- A thorough risk/benefit assessment should be performed before transfusing FFP or platelets, taking into account the patient's individual needs and circumstances 2.