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Fresh forzen plasma

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fresh frozen plasma indications risks administration guideline

Fresh frozen plasma (FFP) is the liquid portion of donated blood, separated and frozen soon after collection to preserve clotting proteins.

What it contains

  • Multiple coagulation factors, including fibrinogen
  • Albumin and immunoglobulins
  • Natural anticoagulants such as protein C and protein S

Main uses

FFP is given to replace multiple clotting-factor deficiencies, particularly when there is significant bleeding or an urgent invasive procedure. Examples:
  • Massive hemorrhage or massive transfusion
  • Disseminated intravascular coagulation (DIC) with bleeding
  • Liver disease with clinically important coagulopathy and bleeding
  • Urgent reversal of warfarin-related bleeding when prothrombin complex concentrate is unavailable
  • Plasma exchange for thrombotic thrombocytopenic purpura (TTP)
  • Rare isolated factor deficiencies when a specific concentrate is unavailable
The AABB plasma overview notes that plasma is used for bleeding disorders involving one or more factor deficiencies when a specific factor product is not available, and as part of initial massive-transfusion treatment.

Not routinely used for

  • Simple volume replacement or hypotension
  • Nutritional protein replacement
  • Mildly abnormal INR/PT in a patient who is not bleeding
  • Correction of laboratory values alone before low-risk procedures

Important risks

  • Allergic or anaphylactic transfusion reactions
  • Febrile reactions
  • TACO: transfusion-associated circulatory overload
  • TRALI: transfusion-related acute lung injury
  • Hemolytic reaction from ABO incompatibility
  • Very low, but not zero, risk of infection transmission
Plasma carries notable transfusion risks, especially TACO and TRALI, as summarized by the International Society of Blood Transfusion.

Practical points

  • FFP should be ABO-compatible with the recipient.
  • It must be thawed before transfusion.
  • Typical dosing is often weight-based and guided by active bleeding, coagulation tests, fibrinogen level, and where available, viscoelastic testing such as TEG/ROTEM.
  • It should be prescribed and monitored by a qualified clinical team.
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