Makindo Medical Notes

Related Subjects: |Red blood cells |White blood cells |Lymphocytes |Platelets |Cryoprecipitate |Fresh Frozen Plasma |Blood Cell Maturation

🧪 Fresh Frozen Plasma (FFP) contains stable clotting factors, albumin, and immunoglobulins, and is widely used for patients with coagulation disorders. It is a key supportive therapy in bleeding, liver disease, and massive transfusion protocols.

ℹ️ About

• 🩸 FFP is the liquid component of whole blood after removal of red cells, white cells, and platelets. It is rich in clotting factors and plasma proteins that maintain coagulation and fluid balance.
• ❄️ Separated and frozen within 6 hours of donation at –25 °C to preserve labile factors (notably Factor V and VIII).
• 📦 Storage: up to 1 year at –25 °C or lower. Once thawed:
  • ⏱️ Use within 24 hours if kept at 2–6 °C
  • ⏱️ Within 30 minutes if left at room temperature
• ⚖️ Typical volume: 200–300 mL per unit. Adult dose = 10–15 mL/kg (~1 L in a 70 kg adult).
• 🎯 Goal: Normalise coagulation (aim INR ≤ 1.7, PT < 1.5, or APTT < 2× normal).
• 🧬 Contains:
  • All clotting factors (II, V, VII, VIII, IX, X, XI)
  • Fibrinogen
  • Albumin (oncotic support)
  • Immunoglobulins (immune defense)

🎯 Indications for FFP Transfusion

• 🩸 Coagulopathy with active bleeding – e.g. liver failure, DIC.
• 📊 Prolonged PT/APTT with bleeding – PT > 1.5, INR > 2, or APTT > 2× normal.
• 💊 Warfarin reversal – if PCC unavailable or contraindicated.
• 🚑 Massive transfusion – to correct dilutional coagulopathy.
• ⚡ DIC with bleeding – replace depleted clotting factors.
• 🧩 TTP (plasma exchange) – provides ADAMTS13.
• 🧬 Inherited factor deficiencies (e.g. Factor V/XI) when concentrates not available.
• 🫀 Liver disease – to prevent/treat bleeding pre-procedure.
• 🧾 ABO compatibility: must match patient. AB plasma is the universal donor; O plasma only to O recipients.

🚫 Contraindications

• 💧 Volume overload (caution in HF/CKD).
• 🤧 Allergic reactions – rare, can be severe.
• ⚠️ Correcting mild abnormal clotting tests without bleeding – not indicated.

⚠️ Risks and Complications

• 🤧 Allergy: from urticaria → anaphylaxis.
• 🫁 TRALI: immune-mediated lung injury, acute hypoxia within 6 hrs.
• 💦 TACO: circulatory overload → pulmonary oedema, especially in elderly/frail.
• 🦠 Infection risk: very low due to screening, but not zero.

📊 Comparison: FFP vs Cryoprecipitate

📚 References

• Transfusion Triggers for Platelets and Other Blood Products – PMC
• AABB Guidelines for Blood Transfusion
• Canadian Blood Services – Clinical Guide to FFP