Fresh frozen plasma

General

Indications
  • Rapid reversal of warfarin anticoagulation (in setting of bleeding or need for invasive procedure)
  • Bleeding and multiple coagulation defects (e.g. DIC with significant PT/PTT elevation)
  • Correction of coagulation defects for which no specific factor is available
  • Transfusion of more than one blood volume with evidence of active bleeding + coagulopathy

Adult Dosing
  • 1 bag = 1 unit = 250 mL
  • 10-20 mL/kg (4-6 units in 70kg adult) will increase factors by ~20-30%
  • Transfuse at least 15 mL/kg at a time (4 units in 70-kg adult)

Pediatric Dosing
  • Neonates/small children: 10-20 mL/kg will increase factor levels by 15-25%

Special Populations

Contraindications
  • Allergy to class/drug
  • ABO incompatibility

Adverse Reactions

Serious
  • Hemolytic transfusion reactions
  • Febrile non-hemolytic reactions
  • Transfusion-associated circulatory overload (TACO)
  • Transfusion-related acute lung injury (TRALI)
  • Transfusion-associated graft-versus-host disease
  • Anaphylaxis
  • Sepsis

Common
  • Headache, paresthesia
  • Nausea
  • Pruritus, urticaria

Pharmacology
  • Half-life:
  • Metabolism:
  • Excretion:
  • Mechanism of Action:

Comments
  • Contains all coagulation factors and fibrinogen
    • 40 mL/kg raises any factor by 100% (each unit is ~200mL)
  • May cause fluid overload
  • ABO compatibilty a must but crossmatch before transfusing not
  • INR of FFP is ~1.6; therefore transfusing for INR <1.7 is not advised[1]
  • Retains active coagulation factors for up to 5 days after being thawed

See Also
  • Transfusions

References
  1. Holland LL and Brooks JP. Toward rational fresh frozen plasma transfusion: The effect of plasma transfusion on coagulation test results. Am J Clin Pathol. 2006;126(1):133-9.
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