Use of fresh frozen plasma (FFP)

Indications

Fresh frozen plasma (FFP) is used for patients with a coagulopathy who are bleeding or at risk of bleeding, and where a specific therapy or factor concentrate is not appropriate or unavailable.

FFP may be indicated to replace labile plasma coagulation factors during massive transfusion, cardiac bypass, bleeding in patients with decompensated liver disease or acute disseminated intravascular coagulation.

Plasma exchange with FFP is an accepted treatment for patients with thrombotic thrombocytopenic purpura (TTP).

It’s appropriate to use FFP in cases of warfarin overdose with life-threatening bleeding in addition to Prothrombinex Compex Concentrates (PCC) (vitamin K-dependent factor concentrates e.g. Prothrombinex-VF). Where PCCs are not available, FFP is suggested in patients with life-threatening or clinically significant bleeding; and for urgent preoperative warfarin reversal.

Refer to the National Blood Authority’s Patient Blood Management Guidelines and other evidence-based clinical guidelines for specific guidance to support clinical decisions about appropriate transfusion practices and the use of blood components.

Our Prescribing fresh frozen plasma resource provides guidance for FFP transfusion based on the above guidelines.

When is FFP not indicated?

Do not use FFP in the following circumstances:

  • when you can correct coagulopathy effectively with specific therapy, such as vitamin K, cryoprecipitate, factor VIII or other specific factor concentrates
  • in plasma exchange procedures except for treatment in thrombotic thrombocytopenic purpura (TTP), or
  • treatment of immunodeficiency states.

Dosage

In most cases, the dose will be 15 mL/kg. Consider:

  • 15-20 mL/kg for adults, and
  • 10-20 mL/kg for paediatric patients < 30 kg.
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