Recommended Dose of Fresh Frozen Plasma (FFP)
The recommended initial dose of FFP for an adult patient is 10-15 ml/kg body weight, which typically translates to approximately 3-4 units (700-1050 ml) for a standard 70 kg adult. 1, 2, 3
Standard Dosing Protocol
Administer 10-15 ml/kg as the initial therapeutic dose to achieve the minimum 30% concentration of plasma coagulation factors required for hemostasis 1, 2, 3
For a 70 kg patient, this equals approximately 700-1050 ml or 3-4 units (each unit contains 250-300 ml) 2, 3
Doses below 10 ml/kg are unlikely to achieve therapeutic effect and fail to reach the critical 30% factor concentration threshold needed for adequate hemostasis 2, 3
Clinical Context Matters
The dosing strategy differs based on the clinical scenario:
Massive Hemorrhage/Trauma
- Use high-ratio transfusion protocols with at least 1:2 FFP:RBC ratio, ideally approaching 1:1 until coagulation results become available 3
- Administer FFP early in massive bleeding rather than waiting for laboratory confirmation of coagulopathy 3
Warfarin Reversal
- Lower doses of 5-8 ml/kg FFP are usually sufficient for urgent warfarin reversal, representing approximately 1-2 units for most adults 2, 3
- However, prothrombin complex concentrate (PCC) should be preferred over FFP when available 2, 3
Hereditary Angioedema (when specific therapies unavailable)
- Doses of 10-15 ml/kg have shown effectiveness, though response times are slower (median 4 hours) compared to specific therapies 1, 2
- Some case reports suggest 20 ml/kg may be required for optimal response, particularly in severe laryngeal attacks 1
Critical Dosing Considerations
FFP is indicated only when PT/INR >1.5 times normal (or INR >2.0) or aPTT >2 times normal WITH active bleeding 1, 3
Studies demonstrate that higher doses are more effective—a median dose of 8 ml/kg shows better coagulopathy correction than 4 ml/kg 2
Recheck coagulation parameters after transfusion to determine if additional doses are needed 2, 3
Research shows that FFP transfusion in patients with INR <1.6-1.7 does not reliably reduce INR and exposes patients to unnecessary risk 4
Important Limitations and Alternatives
FFP has relatively low fibrinogen content—four units contain only approximately 2 g of fibrinogen, making it inefficient for isolated fibrinogen replacement 2, 3
For hypofibrinogenemia (<1.5 g/L or <2 g/L in obstetrics), use cryoprecipitate or fibrinogen concentrate instead 2, 3
Prophylactic FFP in non-bleeding patients with mild-moderate coagulopathy does not prevent bleeding and increases transfusion-related complications 3, 5
Administration Practicalities
Infuse as rapidly as clinically tolerated in acute bleeding situations—the primary goal is rapid correction of coagulopathy rather than adhering to a specific infusion rate 2
FFP must be ABO-compatible with the patient; use group AB FFP if blood type is unknown 2, 3
Once thawed and stored at 4°C, FFP can be used for up to 24 hours, but must be used within 30 minutes once removed from refrigeration 2, 3
Serious Risks to Monitor
Transfusion-related acute lung injury (TRALI) is the most serious complication, with FFP being one of the most frequently implicated blood products 1, 3
Other significant risks include transfusion-associated circulatory overload (TACO), ABO incompatibility, infectious disease transmission, and allergic reactions 1, 3
Research shows that patients receiving FFP had a higher frequency of requiring red cell transfusion compared to controls 6