from "Practice parameters for the use of fresh-frozen plasma, cryoprecipitate, and platelets" JAMA 271(10):777 (March 9, 1994)

Fresh Frozen Plasma

Clinical Indications:

1. History or clinical course suggestive of a coagulopathy due to a congenital or acquired deficiency of coagulation factors, with active bleeding, or prior to an operative or other invasive procedure. This must be documented by at least one of the

following:

a) PT > 1.5 times the midpoint of the normal range (usually >18sec).

b) aPTT > 1.5 times the top of the normal range (usually >55 to 60 sec.).

c) coagulation factor assay of less than 25% activity.

2. Massive blood transfusion: Replacement of more than 1 blood volume within several hours with evidence of a coagulation factor deficiency as in (1) and with continued bleeding.

3. Reversal of Warfarin effect: If immediate hemostasis is required to stop active bleeding or prior to emergency surgery or an invasive procedure (PT>18 sec.).

4. Documented congenital or acquired coagulation factor deficiency when used for bleeding or prophylactically for surgery or an invasive procedure:

a) congenital deficiency of factor II, V, VII, X, XI, or XIII.

b) von Willebrand's disease (if DDAVP is not effective and cryoprecipitate or vWF-containing factor VIII concentrates are not available.

c) congenital or acquired deficiency of factor VIII (if cryoprecipitate or save factor VIII concentrates are not available) or factor IX (if a safe factor IX is not available).

d)acquired deficiency of multiple factors such as seen in severe liver disease, DIC or vitamin K depletion.

5. Deficiency of antithrombin III (when concentrate is not available), heparin cofactor II, protein C, or protein S.

6. Hypoglobulinemic states in rare instances. (Generally IV immune globulin is preferable).

7. Plasma exchange for thrombotic thrombocytopenic purpura or hemolytic uremic syndrome.

8. Because of all the alternatives available and the many hazards associated with FFP transfusion, the us of FFP as a volume expander or to enhance wound healing is contraindicated.