Plasma Transfusion

Aka: Plasma Transfusion, Transfusion of Fresh Frozen Plasma, Fresh Frozen Plasma, FFP

1. See Also
   1. Blood Product
   2. Emergent Reversal of Anticoagulation
   3. Massive Hemorrhage
2. Precautions
   1. Specific factor recombinant or concentrate products are preferred when available
   2. Prothrombin Complex Concentrate (PCC4) is preferred in warfarin Anticoagulation and major bleeding
3. Indications
   1. Warfarin use or INR >1.6 and PCC4 not available AND
      1. Active major bleeding or
      2. Intracranial Hemorrhage
      3. Prevent bleeding prior to emergent major procedure or
      4. Inherited single Clotting Factor deficiency with no available safe factors available
   2. Acute Disseminated Intravascular Coagulation (DIC) with active bleeding (FFP only, not thawed plasma)
   3. Microvascular bleeding during Massive Transfusion (>1 Blood Volume or 5L blood in a 70 kg male)
   4. Replacement fluid for thrombotic microangiopathy (typically in combination with exchange transfusion)
      1. Thrombotic Thrombocytopenic Purpura
      2. Hemolytic Uremic Syndrome
   5. Hereditary Angioedema (if C1 esterase inhibitor is unavailable)
   6. Multifactorial or global Coagulopathy
   7. Massive Hemorrhage Protocol
4. Preparations
   1. Fresh Frozen Plasma
      1. Contains 200-250 ml per unit
      2. Contains all Coagulation Factors
      3. Does not contain platelets
      4. Increases Fibrinogen 7-10 mg/dl per unit
      5. Dosing: 10-20 ml/kg
   2. Thawed Plasma
      1. May be kept at 33.8 to 42.8 F (1 to 6 C) for up to 5 days
      2. Contains all Coagulation Factors, but lower levels of factor V and factor VIII
      3. Do not use in DIC (use FFP instead)
5. References
   1. Liumbruno (2009) Blood Transfus 7(2): 132-50 [PubMed]
   2. Raval (2020) Am Fam Physician 102(1):30-8 [PubMed]
   3. Sharma (2011) Am Fam Physician 83(6): 719-24 [PubMed]