What does fresh frozen plasma (FFP) contain?

What Fresh Frozen Plasma Contains

Fresh frozen plasma contains all factors of the soluble coagulation system, including the labile coagulation factors V and VIII, with approximately 0.5-1.0 IU/mL of each clotting factor (Factors II, V, VII, VIII, IX, X, XI, XII), fibrinogen (approximately 2 g per four units), von Willebrand factor, protein C, protein S, antithrombin III, and alpha-2-antiplasmin. 1, 2

Specific Coagulation Factor Content

• Procoagulant factors: FFP contains Factor II (prothrombin), Factor V, Factor VII, Factor VIII, Factor IX, Factor X, Factor XI, and Factor XII, with more than 95% of units containing greater than 0.50 U/mL of these factors 3

• Labile factors: Factors V and VIII are present to a varying degree and are the most temperature-sensitive components, which is why rapid freezing to below -25°C is critical for maintaining their integrity 1, 4

• Fibrinogen content: Four units of FFP contain approximately 2 g of fibrinogen total, which is notably less than the approximately 4 g fibrinogen found in two pools of cryoprecipitate 1, 2

• von Willebrand factor (VWF): Present in FFP, though 92% of units contain greater than 0.50 IU/mL of VWF antigen, and 87% contain greater than 0.50 IU/mL of Factor VIII 3

Natural Anticoagulant Proteins

• Protein C, Protein S, and Antithrombin III: These natural anticoagulants are present in FFP with activities reduced by less than 10% even after 18-24 hour storage, with final levels above the lower limit of normal range in greater than 95% of units 3

• Alpha-2-antiplasmin: This fibrinolysis inhibitor is also contained in FFP with minimal reduction during storage 3

Volume and Physical Characteristics

• Standard volume: Approximately 250-300 mL per bag 1, 4, 2

• Leucodepleted: FFP is leucodepleted plasma that has been rapidly frozen to below -25°C 1, 4

Important Clinical Context

• Factor concentration threshold: The therapeutic dose of 15 ml/kg is designed to achieve a minimum 30% concentration of plasma factors, which is the threshold needed for hemostasis 4, 5

• Male-only plasma: In the UK since 2003, FFP is preferentially sourced from male donors to reduce the incidence of transfusion-related acute lung injury (TRALI), as anti-HNA and anti-HLA antibodies occur at higher frequency in multiparous women 1, 4

• ABO compatibility: FFP should be ABO-compatible with the recipient; group AB FFP is preferred when blood group is unknown because it contains no anti-A or anti-B antibodies 1, 4, 5