Fresh frozen plasma 5 mark answer

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Fresh Frozen Plasma (FFP)

Definition and Preparation

Fresh frozen plasma is plasma separated from whole blood (single donor) and rapidly frozen within 8 hours of collection at -18°C or lower (some centers store at -40°C to -50°C). Freezing preserves the labile coagulation factors V and VIII, which otherwise degrade during storage. It has a shelf life of up to 1 year when frozen, and once thawed it can be stored at 1-6°C and transfused within 5 days. Thawing takes 20-40 minutes and cannot be accelerated by artificial heating.

Roberts and Hedges' Clinical Procedures in Emergency Medicine
Tintinalli's Emergency Medicine

Composition

Each unit of FFP has a volume of 200-250 mL and contains:

All plasma coagulation factors: I (fibrinogen), II, V, VII, VIII, IX, X, XI, XII, XIII
Von Willebrand factor (vWF)
Natural anticoagulant proteins: Antithrombin, Protein C, Protein S
Approximately 2 mg/mL of fibrinogen (though less than cryoprecipitate)
The INR of a unit of FFP is approximately 1.5

Note: PF24 (plasma frozen within 24 hours) is comparable to FFP, with a slight reduction in factor V and approximately 25% decrease in factor VIII.

Miller's Anesthesia, 10e

Indications

Bleeding from warfarin overanticoagulation - when prothrombin complex concentrate (PCC) is unavailable; each 30-minute delay in FFP administration reduces the chance of reversing coagulopathy by 20%
Multiple coagulation factor deficiencies - e.g., in liver disease, DIC
Massive transfusion - modern protocols use a 1:1:1 ratio of packed RBCs : FFP : platelets
Isolated factor deficiency (II, V, VII, X, XI, XIII) when specific factor concentrate is unavailable
Therapeutic plasma exchange - for TTP (thrombolytic thrombocytopenic purpura) and Guillain-Barre syndrome
Hereditary angioedema - when C1 esterase inhibitor concentrate is unavailable

FFP is indicated when INR is ≥1.7-1.8; below this threshold it provides no clinical benefit. Each unit raises coagulation factor levels by 2-5% in an average adult; a dose of 15 mL/kg (~4 units in a 70-kg adult) is required for clinically meaningful correction.

Tintinalli's Emergency Medicine; Miller's Anesthesia

Blood Group Compatibility

ABO compatibility is required - type AB is the universal donor for FFP
Rh (D) compatibility is NOT essential - but large volumes given to Rh-D negative women risk Rh-D sensitization
Type O plasma is NOT a universal donor (it contains anti-A and anti-B antibodies, unlike type O red cells)
Roberts and Hedges'; Tintinalli's

Contraindications / Situations Where FFP is NOT Indicated

Reversal of direct oral anticoagulants (DOACs: dabigatran, rivaroxaban, apixaban, edoxaban) - no evidence of benefit
Prophylaxis before procedures (e.g., central venous catheter insertion) in coagulopathic patients - not supported by evidence
Simple volume expansion - safer alternatives exist
INR < 1.7 - FFP cannot lower INR below 1.5 regardless of dose
Tintinalli's; Miller's Anesthesia

Complications (Adverse Effects)

Complication	Notes
TRALI (Transfusion-Related Acute Lung Injury)	Acute hypoxia + non-cardiogenic pulmonary edema within 6 hours; FFP is a common cause; leading cause of transfusion-related mortality
TACO (Transfusion-Associated Circulatory Overload)	Volume overload, especially in CHF or renal insufficiency
Allergic/anaphylactic reactions	Due to sensitization to foreign plasma proteins
Hemolytic transfusion reactions	ABO incompatibility
Infection transmission	Hepatitis B/C, HIV, malaria
Citrate toxicity	With massive transfusion - hypocalcemia

Bailey and Love's Surgery 28e; Miller's Anesthesia, 10e

Key Points to Remember:

FFP contains ALL coagulation factors; cryoprecipitate is richer in fibrinogen and factor VIII
Universal donor = Type AB plasma
Dose: 15 mL/kg for significant correction
TRALI is the most feared complication
PCC is now preferred over FFP for warfarin reversal when available

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