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Guidelines for the Use of FFP

Despite concerns about the overuse of FFP, utilization has steadily increased over the past two decades. FFP utilization is significantly higher in the US than in other developed countries where the utilization curve has been rather flat over the same time period. Clinical data show that a significant percentage of the FFP transfused is to non-bleeding patients with abnormal coagulation studies despite the fact that there is little or no evidence of the efficacy of prophylactic plasma transfusions. Multiple studies have shown that as many as 50% of FFP transfusions do not conform to current published guidelines. Current indications for FFP transfusion include:
  • Treatment of bleeding in patients with multiple coagulation deficiencies secondary to liver disease
  • Reversal of warfarin or correction of vitamin K deficiency in bleeding patients or patients before emergency invasive procedures
  • Warfarin-related intracranial hemorrhage
  • Massive transfusion
  • Bleeding associated with disseminated intravascular coagulation (DIC)
  • Treatment of coagulation factor deficiencies for which concentrates are not available (such as Factors V and XI)
  • Plasma exchange in thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS)
When plasma is administered for coagulation factor replacement the dosage is 10 – 20 mL/kg. One dose should result in an increase in coagulation factor activity by approximately 20% immediately after infusion. Coagulation testing (PT, aPTT and/or factor assays) along with the patient’s clinical status should be monitored. When treating patients with coagulation factor deficiencies, coagulation screening tests should be indicative of factor levels of 30% or lower or the INR should be 2.0 or higher before administration of FFP.