Use of Fresh Frozen Plasma (FFP)

Use of fresh frozen plasma

One unit of fresh frozen plasma (FFP) contains all coagulation factors.

Conventional coagulation tests (PT/INR) are commonly used to guide transfusion of FFP, but poorly predict bleeding risks in non-bleeding patients and before invasive procedures.

The transfusion of FFP should not be based on abnormal coagulation tests alone.

• Underlying causes of coagulopathy should be assessed and expert guidance sought.
• Consider transfusion risks (including circulatory overload) and benefits. 

Indications

Fresh frozen plasma (FFP) may be indicated to replace coagulation factors during:

• major haemorrhage requiring massive transfusion,
• replacement of a single coagulation factor where specific factor concentrates are not available,
• therapeutic plasma exchange for thrombotic thrombocytopenic purpura (TTP) patients,
• bleeding in patients with decompensated liver disease or
• bleeding in patients with acute disseminated intravascular coagulation,
• patients with a coagulopathy who are bleeding or undergoing invasive procedures.

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 Fresh frozen plasma transfusion 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 coagulopathy can be effectively corrected with specific therapy, such as vitamin K, cryoprecipitate, factor VIII or other specific factor concentrates,
• when Beriplex® (4-Factor PCC) is used in life-threatening warfarin-related bleeding as Beriplex® contains all 4 vitamin K dependent coagulation factors,
• in non-bleeding patients with abnormal coagulation tests,
• prior to procedure when the INR is only mildly elevated (INR < 1.8),
• in patients with liver disease who are not bleeding or prior to low bleeding risk procedures,
• as a volume expander.

Modifications

Secretor plasma Le(b+)

IgA deficient

Dosage

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

• 10-15 mL/kg for standard adult dose,
• higher dosing may be required in massive haemorrhage and should be guided by coagulation testing,
• 10-20 mL/kg for paediatric patients < 30 kg.

Updated July 2026