**** To be completed
- FFP has an INR of ~1.6 -> cannot lower below INR 1.7
- The usual volume of 1 unit is ~250 cc = plasma taken from one unit of blood
- Vitamin K dependent factors in concentration of 1 Unit/mL
- FFP must be ABO compatible
- 10-20 cc/kg (4-6 units in adults) will increase factors by ~20%
- It is frozen within eight hours of collection.
- FFP contains all coagulation factors in normal concentrations.
- may be transfused up to 5 days after thawing and contains slightly decreased levels of Factor V (66+-9%) and decreased Factor VIII levels (41+-8%)
- Plasma is free of red blood cells, leukocytes and platelets
- Rh factor need not be considered
- there are no viable leukocytes so plasma does not carry a risk of CMV transmission or GVHD
- documented coagulation factor deficiencies and active bleeding, or who are about to undergo an invasive procedure.
- Deficiencies may be congenital or acquired secondary to liver disease, warfarin anticoagulation, disseminated intravascular coagulation, or massive replacement with red blood cells and crystalloid/colloid solutions.
- FFP should not be used for Hemophilia B (Factor IX) deficiency unless Factor IX concentrate is not available.
- FFP, but not thawed plasma, can be used for Factor V deficiency.
- Recombinant or Factor VIII concentrates should be used to replace Factor VIII.
- Usually, there is an increase of at least 1.5 times the normal PT or PTT or an INR ≥ 1.6 before clinically important factor deficiency exists. This corresponds to factor levels <30% of normal.
- Reversal of warfarin anticoagulation with plasma is indicated only if significant bleeding or risk is present.
- Often it will require recurrent transfusion to maintain normal factor levels.
- Otherwise, reversal can be achieved by giving Vitamin K two to three days prior to a planned procedure.
- Rapid reversal for life threatening bleeding may be achieved with recombinant Factor VIIa (Novo7®) or PCC Plasma is indicated in the treatment of thrombotic thrombocytopenic purpura (TTP), usually in conjunction with plasma exchange.
- Plasma should not be used for volume expansion unless the patient also has a significant coagulopathy and is bleeding.
- Plasma – Dosage Volume of 1 Unit Plasma: 200-250 mL 1 mL plasma contains 1 u coagulation factors 1 Unit contains 220 u coagulation factors
- Factor recovery with transfusion = 40%
- 1 Unit provides ~80 u coagulation factors 70 kg X .05 = plasma volume of 35 dL (3.5 L) 80 u = 2.3 u/dL = 2.3% (of normal 100 u/dL) 35 dL each unit contains 13 mg/dl of fibrinogen
- In a 70 kg Patient: 1 Unit Plasma increases most factors ~2.5% 4 Units Plasma increase most factors ~10%
- Usually an increase in factor levels of at least 10% will be needed for any significant change in coagulation status, so the usual dose is four units, but the amount will vary depending on the patient’s size and clotting factor levels.
- Hematology consultation is advised concerning the dose of plasma.
- study shows most ffp transfused is inappropriate (crit care med 2007;35:1655)
- FFP can be thawed in warm running water in 5 minutes or microwave in 6 minutes with the same activity as waterbath (Anesth Analg 2006;103(4):969)
- FFP can probably be refrozen (Transfusion 1989;29(7):600)
- ABO Identical is better than compatible (Kenji Inaba Arch Surg 2010)
References and Links
- Holland LL, Brooks JP. Toward rational fresh frozen plasma transfusion: The effect of plasma transfusion on coagulation test results. Am J Clin Pathol. 2006 Jul;126(1):133-9. PubMed PMID: 16753596. [Free Fulltext]
- Nascimento B, Callum J, Rubenfeld G, Neto JB, Lin Y, Rizoli S. Clinical review: Fresh frozen plasma in massive bleedings – more questions than answers. Crit Care. 2010;14(1):202. doi: 10.1186/cc8205. Epub 2010 Jan 28. Review. PubMed PMID: 20156316; PubMed Central PMCID: PMC2875489.