Important Facts: Fresh Frozen Plasma

1. Definition: Fresh frozen plasma (FFP) is platelet-poor plasma, separated from whole blood within 6-8 hours of blood collection and frozen in a dedicated freezer (at or below -20 C). It contain all coagulation factors and plasma proteins (such as albumin). Fresh frozen plasma may remain stable for 1 year if maintained in a dedicated freezer (one that does not undergo freeze-thaw cycles like household freezers) at or below -20 C. One unit of FFP is defined as that obtained from a single whole blood transfusion bag.

2. The approx volume of one bag of FFP is 250ml

3. FFP contains an average of 1 IU/mL of each coagulation factor, including the labile factors V and VIII.

4. FFP must be ABO compatible. Rh factor need not be considered. The guideline are as

Patient’s ABO blood group  
ABO blood group of plasma for transfusion
AB (if required urgently)
O (1st Choice) or A / B / AB (2nd, 3rd and last choice)
A or AB
B or AB
AB (A if AB unobtainable)

5. Indications: Transfusion is indicated in patients with documented coagulation factor deficiencies and active bleeding, or who are about to undergo an invasive procedure.
  • Single-factor deficiencies. Currently, specific concentrates are available for FXIII, FXI, FIX, FVIII:C, FVIII:C complexed with von Willebrand factor (Humate P), FVII, FVIIa, fibrinogen, antithrombin, protein C, and C1 esterase inhibitor.
  • Multiple-factor deficiencies, hypo/dysfibrinogenemia, and/or disseminated intravascular coagulopathy. Frozen plasma is indicated for use in patients with multiple-factor deficiencies associated with severe bleeding and/or disseminated intravascular coagulopathy.
  • Thrombotic thrombocytopenic purpura.
  • Need for urgent reversal of warfarin effect
  • Liver disease, especially in the setting of liver biopsy.

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.

6. Dosing:

Volume of 1 Unit Plasma: 200-250 mL
1 mL plasma contains 1 u coagulation factors thus 1 Unit contains 220 u coagulation factors

Factor recovery with transfusion = 40%, 1 Unit provides ~80 u coagulation factors

Thus In a 70 kg Patient:
1 Unit Plasma increases most factors ~2.5%
4 Units Plasma increase most factors ~10%

7. Therapeutic Effect: 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 4 units, (the amount will vary depending on the patient's size and clotting factor levels.)

Some related Questions:

Important Questions related to FFP which can be asked in Entrance Exams.
1. Volume of 1 Unit of FFP?

2. Which is wrong statement regarding FFP?
a. It is indicated in Warfarin toxicity.
b. ABO compatibility is not required.
c. Is freezed below -18 degree Celsius.
d. None of above.

3. What is the normal dose required to get desired effect?

4. Indications of FFP?

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