A unit of fresh frozen plasma (FFP) contains all coagulation factors. Use it 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.
You may give fresh frozen plasma to replace labile plasma coagulation factors during massive transfusion, cardiac bypass, liver disease or acute disseminated intravascular coagulation in the presence of bleeding and abnormal coagulation.
It is 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 eg 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. (1)
Fresh frozen plasma is an accepted treatment for patients with thrombotic thrombocytopenic purpura often in conjunction with plasma exchange.
Do not use fresh frozen plasma 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
treatment of immunodeficiency states
- when you can safely and adequately replace blood volumes with volume expanders, such as 0.9% Sodium Chloride Injection, Hartmann’s Solution, or appropriate colloids.
The volume transfused depends on the clinical situation and patient size, and should be guided by laboratory assays of coagulation function. The general guide is 10–15 mL/kg per dose.
- Tran HA, Chunilal SD, Harper PL, Tran H, Wood EM, Gallus AS. An update of consensus guidelines for warfarin reversal. MJA 2013;198($):198-199.