Why is ffp given

Fresh frozen plasma is an accepted treatment for patients with thrombotic thrombocytopenic purpura often in conjunction with plasma exchange. The volume transfused depends on the clinical situation and patient size, and should be guided by laboratory assays of coagulation function. Skip to main content. Practice Clinical use of blood components Use of fresh frozen plasma Use of fresh frozen plasma A unit of fresh frozen plasma FFP contains all coagulation factors.

This site is intended for healthcare professionals. Sign in. Sign in Register. FFP of group O should only be given to O recipients grade B recommendation, level III evidence for infants and neonates, plasma should be free of clinically significant irregular blood group antibodies.

No anti-D prophylaxis is required if Rh D-negative patients receive Rh D-positive FFP grade B recommendation, level IIa evidence NICE guidelines recommendations regarding FFP transfusion are: transfusion of FFP should only be considered for patients with clinically significant bleeding but without major haemorrhage if they have abnormal coagulation test results for example, prothrombin time ratio or activated partial thromboplastin time ratio above 1.

In many countries, blood transfusion requires written informed consent, which is deferred only in life-threatening situations, including massive bleeding. The proposal to transfuse FFP early and aggressively raises important ethical considerations. The marked reduction in mortality recently reported with early and high FFP:RBC resuscitation has prompted many trauma centres to adopt this strategy. The evidence behind early formula-driven haemostatic resuscitation is concordant with recent advances in the understanding of early trauma coagulopathy, but they also have methodological flaws and bias that seriously question the survival benefit.

Many trauma centres keep thawed AB plasma uni-versal donor available at all times for resuscitation. In countries that have implemented policies favouring male-only plasma to minimize the risks of TRALI, supplying AB plasma becomes an even greater challenge. Other ethical, logistical and financial considerations include the potential waste of unused thawed FFP, a so far untouched issue, plus the financial costs of haemostatic protocols, and the use of AB plasma on non-AB patients potential increased risk from exposure to female FFP.

The answer to these challenges is not readily available or intuitive, particularly contrasting with the high mortality and lack of evidence supporting the existing guidelines. For now, the clinical decision continues to be based on observations, judgement and evidence transplanted from other fields.

Definitive answers will only come from better understanding the pathophysiology of coagulation and prospective clinical trials, which may be years away. The challenges to such clinical trials are summarized in Table 2. The current knowledge regarding coagulopathy and FFP precludes the development of evidence-based guidelines. Existing guidelines for the management of massive bleeding recommend late FFP transfusion, based on conventional coagulation assays, which correlate poorly with clinically bleeding.

Early formula-driven haemostatic resuscitation has challenged this approach and has proposed early and aggressive FFP transfusion at a FFP:RBC ratio near , thus treating or preventing early trauma coagulopathy.

Initial studies have reported significant reductions in mortality, but are uncontrolled and methodologically flawed, particularly by survivorship bias. Presently, clinical decisions should be based in assessing the pros and cons of both strategies while considering local resources and individual clinical context.

Prospective clinical trials are urgently needed to determine whether early formula-driven haemostatic resuscitation should be adopted or forgotten, to better understand trauma-associated coagulopathy and to develop evidence-based massive transfusion guidelines. Other areas for future research include improving the diagnosis of coagulopathy and evaluating novel products such as thawing microwaves for faster release of blood products. Br J Haematol.

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Can J Surg. Ann Surg. PubMed Google Scholar. Blood Coagul Fibrinolysis. Download references. The authors acknowledge Dr Alina Toma for the excellent contributions to references and editing of the manuscript. You can also search for this author in PubMed Google Scholar. Correspondence to Sandro Rizoli. The other authors declare that they have no competing interests. Reprints and Permissions. Nascimento, B.