Blood Component Therapy
Fresh Frozen Plasma (FFP)		  

Description
One unit of FFP is the plasma taken from a unit of whole blood. It is frozen within eight hours of collection. FFP contains all coagulation factors in normal concentrations. It is free of red blood cells, leukocytes and platelets. One unit is approximately 250mL and must be ABO compatible. Rh factor need not be considered. Since there are no viable leukocytes, FFP does not carry a risk of CMV transmission or Graft Vs. Host Disease (GVHD).

Indications
FFP transfusion is indicated in patients with 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.

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 FFP 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.

FFP is indicated in the treatment of thrombotic thrombocytopenic purpura (TTP), usually in conjunction with plasma exchange.

FFP should not be used for volume expansion unless the patient also has a significant coagulopathy and is bleeding.

Fresh Frozen Plasma - Dosage
  Volume of 1 Unit FFP: 200-250 mL
1 mL plasma contains 1 u coagulation factors
1 Unit FFP contains 200 u coagulation factors
Factor recovery with transfusion = 40%
1 Unit FFP provides ~80 u coagulation factors
70 kg X .05 = plasma volume of 35 dL (3.5 L)
80 u/35 dL = 2.3 u/dL = 2.3% (of normal 100 u/dL)

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


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 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.

Recommended Coagulation Parameters
for Common Procedures
Platelet Count* INR
  Lumbar Puncture ≥50,000 ≤1.5
  Paracentesis ≥30,000 ≤2.0
  Thoracentesis ≥50,000 ≤1.5
  Transbronchial Lung Biopsy ≥50,000 ≤1.5
  Subclav/IJ Line ≥30,000 ≤1.5
  Renal Biopsy ≥50,000 ≤1.5
  Liver Biopsy ≥50,000 ≤1.5
  Hickmann, Groshong Catheters ≥50,000 ≤1.5

*These numbers assume normal platelet function. Conditions that may affect platelet function include renal failure, medications, leukemias and myelodysplasias, and congenital disorders. Bleeding Time is a poor predictor of surgical bleeding. The Usefulness of Platelet Function Analysis (PFA) in predicting surgical bleeding is unknown.