Fresh Frozen Plasma Administration Guidelines

Primary Indications for FFP Use

The American Society of Anesthesiologists recommends administering FFP when patients are actively bleeding and have INR >1.5 (or PT >1.5 times normal, or aPTT >2 times normal) 1, 2, 4
The therapeutic dose is 15 ml/kg body weight to achieve minimum 30% concentration of plasma factors, typically translating to approximately 1,050 ml (3-4 units) for a 70 kg patient 1, 2, 4
Replacement of coagulation factors during major hemorrhage, particularly in trauma and obstetric bleeding, is indicated 1, 2, 3
In massive transfusion protocols, maintaining a 1:1 ratio of red blood cells to FFP until coagulation results become available is recommended 4
FFP is indicated for acute disseminated intravascular coagulation (DIC) with active bleeding, representing replacement of multiple consumed coagulation factors simultaneously 1, 2, 3
FFP is indicated for immediate reversal of warfarin-induced hemorrhage when prothrombin complex concentrate (PCC) is not available, with lower doses of 5-8 ml/kg FFP usually sufficient for warfarin reversal 1, 2, 3, 4
FFP is indicated for thrombotic thrombocytopenic purpura (TTP), usually administered via plasmapheresis, preferably using pathogen-inactivated FFP 1, 2
FFP is indicated for replacement of coagulation factors when specific factor concentrates are not available, although this is an uncommon indication in modern practice 1, 2

The American College of Physicians recommends against routine correction of mild-moderate coagulation abnormalities in non-bleeding critically ill patients before invasive procedures 1, 2, 3
Routine use in patients with cirrhosis/liver disease unless significant coagulopathy with active bleeding is present is not recommended 1, 2, 5
Isolated PT or aPTT abnormalities do not reflect "balanced hemostasis" in liver disease, and FFP fails to correct PT in non-bleeding patients with mild abnormalities and may increase portal pressure 1, 4, 5
FFP is not indicated for volume replacement or circulatory support, as it is not effective for hypovolemia 1, 2, 6
Prophylactic correction of laboratory values in non-bleeding patients exposes patients to unnecessary transfusion risks and is not recommended 5

FFP should be ABO-compatible with the patient, and if blood group is unknown, use group AB FFP (contains no anti-A or anti-B antibodies) 1, 2, 3, 4
Once thawed and stored at 4°C, FFP can be used for up to 24 hours, but once removed from refrigeration, FFP must be used within 30 minutes 1, 2, 4
Transfusion-related acute lung injury (TRALI) is the most serious complication, and male-only plasma implementation has reduced TRALI incidence 1, 5
Transfusion-associated circulatory overload (TACO), ABO incompatibility reactions, allergic reactions, and infectious disease transmission are potential risks 4, 5

Prophylactic FFP in non-bleeding patients with coagulopathy does not prevent bleeding and increases transfusion-related complications 4
Doses below 10 ml/kg are unlikely to achieve the 30% factor concentration threshold needed for hemostasis 4
Cryoprecipitate is preferred over FFP for hypofibrinogenemia (fibrinogen <1.5 g/L, or <2 g/L in obstetrics) 1, 4
Prothrombin complex concentrate (PCC) is preferred over FFP for urgent warfarin reversal 1, 4, 6
Fibrinogen concentrate may be used as an alternative when fibrinogen is <80-100 mg/dL with bleeding 5