Most guidelines and transfusion protocols recommend the use of fresh frozen plasma (FFP) either in massive bleeding or in significant bleeding complicated by coagulopathy.18-19 Such guidelines include:
- 'Management of bleeding following major trauma: an updated European guideline', Rossaint et al. 2010 – early treatment with thawed FFP in patients with massive bleeding. The initial recommended dose is 10-15 ml/kg. Further doses will depend on coagulation monitoring and the amount of other blood products administered.20
- 'Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant', O’Shaughnessy et al. 2004 – FFP is used in cases of excessive bleeding or to prevent bleeding in those patients with abnormal coagulation tests that are undergoing an invasive procedure. Its use has been extended to patients with a coagulopathy but who are not bleeding.21
FFP is also used to manage isolated coagulation factor deficiencies if specific factor concentrates are not available, and to reverse oral anticoagulants.
Approximately 4 units of FFP (i.e. about 800 ml) will produce a 10% increase in coagulation factors.11, 21
The hemostatic effect of FFP declines progressively after thawing (due to a potentially considerable amount of time in storage); within 24 hours, von Willebrand factor, antithrombin III, factors XIII, XII, XI, X, and IX decrease. Only factors V, VIII, VII, II, and fibrinogen remain reasonably stable.11, 21
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