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Fresh frozen plasma

Fresh frozen plasma (FFP) is the fluid portion of a unit of whole blood that is separated and frozen within 8 hours of collection to preserve labile coagulation factors, including all clotting factors except platelets, as well as fibrinogen, albumin, protein C, protein S, antithrombin, and tissue factor pathway inhibitors.^[1] It is stored at -18°C or colder and serves as a critical blood product for transfusion in clinical settings to replace plasma proteins and correct coagulopathies.^[2]

Preparation and Storage

FFP is prepared by centrifuging whole blood to separate the plasma, which is then rapidly frozen to maintain the activity of coagulation factors that degrade at room temperature.^[1] A standard unit contains approximately 200 to 250 milliliters of fluid and is free of erythrocytes and leukocytes.^[2] Before administration, it is thawed using a water bath at 30°C to 37°C for 20 to 30 minutes or an FDA-approved device for faster thawing in 2 to 3 minutes.^[1] Once thawed, FFP must be used immediately or stored at 1°C to 6°C for up to 24 hours, though some guidelines extend this to 5 days for thawed plasma.^[3] Variants include plasma frozen within 24 hours (PF24), which has similar uses but may not be suitable for cryoprecipitate production.^[2]

Clinical Uses and Indications

FFP is primarily indicated for patients with coagulation factor deficiencies accompanied by active bleeding or abnormal coagulation tests, such as prolonged prothrombin time (PT) or activated partial thromboplastin time (aPTT) greater than 1.5 times normal.^[1] Common applications include reversal of warfarin-induced anticoagulation in cases of bleeding, particularly intracranial hemorrhage; treatment of thrombotic thrombocytopenic purpura (TTP); management of massive transfusion protocols in trauma to prevent dilutional coagulopathy; and correction of congenital or acquired factor deficiencies when specific concentrates are unavailable.^[3]^[1] A typical adult dose is 10 to 20 mL/kg (4 to 6 units), which raises factor levels by about 20% and provides volume expansion of around 250 mL per unit.^[1] It is administered intravenously over 30 minutes, with ABO compatibility preferred to minimize reactions, though type A or AB plasma may be used in emergencies.^[2]

Risks and Considerations

While effective, FFP transfusion carries risks including allergic reactions, transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), and rare infections from donors.^[1] It is not recommended for volume expansion alone, protein supplementation without coagulopathy, or routine reversal of warfarin without bleeding.^[1] Monitoring post-transfusion involves assessing for bleeding cessation and repeating coagulation studies.^[1] Guidelines emphasize restrictive use to balance benefits against potential harms, particularly in non-bleeding scenarios like acute pancreatitis or non-massive surgical bleeding.^[3]

Introduction

Definition

Fresh frozen plasma (FFP) is the fluid portion of human blood separated from a unit of whole blood by centrifugation or collected via plasmapheresis and frozen within 8 hours of collection at a temperature of −18°C or colder to preserve labile clotting factors such as factors V and VIII.^[1] This process ensures the retention of essential coagulation components, distinguishing FFP as a key blood product for transfusion therapy.^[3] In contrast, plasma frozen within 24 hours after phlebotomy (PF24) is held at refrigerated temperatures (1–6°C) for up to 16 additional hours before freezing, resulting in slightly reduced activity of factors V and VIII compared to FFP.^[4] The U.S. Food and Drug Administration (FDA) regulates FFP under 21 CFR Part 640, requiring compliance with standards for collection, processing, and storage to maintain product integrity and safety for intravenous use.^[5] Additionally, FFP is listed on the World Health Organization (WHO) Model List of Essential Medicines as a vital blood and blood component for managing deficiencies in coagulation factors.^[6] A standard unit of FFP typically contains 200–300 mL of plasma with a straw-yellow color, which is thawed and administered intravenously to restore plasma volume and clotting function in patients with coagulopathy.^[2]^[7]

Historical Development

The use of plasma in transfusion medicine began in the 1930s with the development of methods to separate and store plasma from whole blood, initially focusing on liquid and dried formulations to address challenges in transportation and preservation.^[8] During World War II, plasma gained widespread adoption by American and British military forces for treating hemorrhagic shock and blood loss on the battlefield, where its ability to expand plasma volume without the logistical issues of whole blood proved invaluable, saving countless lives in combat zones.^[9]^[10] In 1935, the introduction of the prothrombin time (PT) test by Armand Quick provided a critical tool for assessing extrinsic coagulation pathways, enhancing the monitoring of anticoagulant therapy and underscoring the therapeutic potential of plasma products.^[11] This was followed in 1961 by the development of the activated partial thromboplastin time (aPTT) test by Samuel I. Rapaport and colleagues, which standardized evaluation of the intrinsic pathway and facilitated more precise use of plasma transfusions to correct coagulopathies.^[12] The late 1950s marked the emergence of fresh frozen plasma (FFP) as a key treatment for bleeding disorders, particularly hemophilia, where it served as the primary source of clotting factors before more concentrated options became available.^[13] In 1964, Judith Pool discovered cryoprecipitate while studying the thawing process of FFP, yielding a concentrated form rich in factor VIII that revolutionized hemophilia management by allowing targeted dosing with reduced plasma volume.^[14] Post-1960s advancements included standardized freezing protocols, typically at -18°C or below within 8 hours of collection, which preserved labile coagulation factors and supported broader clinical application; by the 1970s, FFP usage surged due to these improvements and expanded surgical practices, reaching nearly 2 million units transfused annually in the United States by the mid-1980s.^[15] The HIV/AIDS epidemic in the 1980s profoundly impacted FFP safety, as thousands of hemophilia patients and other recipients contracted HIV through unscreened plasma-derived products, prompting urgent regulatory responses including donor screening and the introduction of HIV antibody testing for blood donations in 1985.^[16] This crisis accelerated pathogen inactivation methods and viral testing protocols, fundamentally enhancing the safety of FFP and all plasma components.^[17]

Preparation and Storage

Production Methods

Fresh frozen plasma (FFP) is primarily produced from whole blood donations collected via a single uninterrupted venipuncture, ensuring minimal damage and manipulation of the donor's blood cells. The process begins with the collection of approximately 450-500 mL of whole blood into an anticoagulant solution, such as citrate-phosphate-dextrose, to prevent clotting during handling.^[1] This method yields plasma as one component alongside red blood cells and platelets. Following collection, the whole blood unit undergoes centrifugation to separate the plasma from cellular components. Typically, a two-step centrifugation process is employed: an initial light spin to separate red blood cells, followed by a heavier spin to isolate platelets if needed, leaving the supernatant plasma.^[18] This separation must occur within 8 hours of phlebotomy to preserve the labile coagulation factors, such as factors V and VIII.^[19] The plasma is then transferred to a storage container and prepared for freezing. Freezing of the plasma initiates promptly after separation, with the unit placed in a controlled environment to achieve a core temperature of -18°C or colder within 8 hours of the initial collection. Plasma freezers or dry ice-ethanol baths are commonly used to ensure rapid and uniform freezing, preventing the formation of ice crystals that could degrade proteins.^[4] Once frozen, the product is quarantined pending quality testing before release for storage. An alternative production method involves apheresis, where plasma is collected directly using an automated machine that separates and returns cellular components to the donor.^[20] This yields higher volumes of plasma per donation (400 to 600 mL) without collecting whole blood, and the collected plasma follows similar centrifugation if needed and freezing protocols to meet FFP standards.^[4] Apheresis-derived FFP is therapeutically equivalent to whole blood-derived FFP in terms of coagulation factor content.^[21] Prior to freezing and release, all plasma units undergo rigorous quality control, including testing for infectious diseases such as HIV, hepatitis B and C, human T-lymphotropic virus, and syphilis, in accordance with FDA regulations. These tests employ nucleic acid amplification and serological methods to detect pathogens, ensuring the safety of the product; units testing positive are discarded.^[22] Additional checks verify volume, appearance, and sterility. A variation in production involves solvent-detergent (S/D) treated plasma, where pools of up to 1,500 individual plasma units (matched by ABO group) are thawed, treated with agents like tri(n-butyl) phosphate and Triton X-100 to inactivate lipid-enveloped viruses, and then refrozen into smaller units.^[23] This pathogen-reduced product maintains coagulation factor activity while enhancing viral safety beyond standard testing.^[24]

Storage Requirements

Fresh frozen plasma (FFP) must be stored in a frozen state at temperatures of -18°C or colder to preserve its coagulation factors and proteins, with a shelf life of up to 12 months from the date of collection.^[25] According to guidelines from the Joint United Kingdom Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC), FFP can be stored at -25°C or below for up to 36 months, provided the storage equipment maintains consistent temperatures without fluctuations that could compromise product integrity.^[26] Some facilities use ultra-low temperature freezers reaching -30°C or lower to extend viability, but all frozen units require protection from light and mechanical stress during storage.^[1] Thawing of FFP is performed to prepare it for transfusion, typically in a water bath maintained at 30-37°C for 20-30 minutes while the unit remains in its protective overwrap to prevent contamination.^[27] Alternatively, FDA-cleared thawing devices can accelerate the process to 2 to 3 minutes by ensuring uniform heat distribution without exceeding safe temperatures.^[28] The thawing method must avoid overheating, as temperatures above 37°C can degrade labile clotting factors, and partial thawing during handling should be prevented by immediate refreezing if not fully utilized.^[1] Once thawed, FFP is stored at 1-6°C and must be transfused within 24 hours to minimize bacterial growth and factor degradation, as per standard FDA regulations.^[27] Recent FDA approvals in 2024 have extended post-thaw storage to up to 5 days at 1-6°C for certain thawed plasma variants, such as pathogen-reduced or cryoprecipitate-reduced products, enabling greater flexibility in emergency settings while maintaining hemostatic efficacy.^[29] Transportation of frozen FFP requires maintaining the unit in a fully frozen state using dry ice in insulated containers or specialized cryogenic freezers capable of sustaining -18°C or lower.^[30] Core temperature monitoring with data loggers is essential during transit to detect any excursions above -18°C that could lead to partial thawing and loss of potency, ensuring the product arrives viable at its destination.^[31]

Composition

Biochemical Makeup

Fresh frozen plasma (FFP) consists primarily of water, accounting for approximately 90-92% of its volume, with the remaining 8-10% comprising dissolved solids such as proteins, electrolytes, nutrients, and metabolites.^[32] The total protein concentration in FFP is typically 6-8 g/dL, which includes albumin at 3.5-5 g/dL and globulins at 2-3.5 g/dL, contributing to oncotic pressure and transport functions.^[33] These proteins, along with other non-coagulation elements, maintain the structural and osmotic integrity of the plasma.^[1] Electrolytes in FFP include sodium at 150-170 mEq/L and potassium at 3-5 mEq/L, reflecting concentrations influenced by the collection process.^[34] Nutrients such as glucose (approximately 500-550 mg/dL) and amino acids are present, supporting metabolic needs upon transfusion, while metabolites like urea and creatinine are also retained.^[34] The osmolarity of FFP ranges from 280-320 mOsm/L, closely mirroring normal plasma to ensure isotonicity, and its pH is maintained between 7.2 and 7.4.^[35] FFP is anticoagulated using citrate-phosphate-dextrose (CPD) or analogous solutions during collection, which chelates calcium and results in low ionized calcium levels (<0.5 mmol/L).^[36] The freezing process preserves additional constituents, including hormones, vitamins, and trace minerals, which remain stable for storage.^[1] In contrast to serum, FFP retains fibrinogen and other clotting precursors within its protein fraction, distinguishing it as a complete plasma derivative.^[32]

Coagulation Factors and Proteins

Fresh frozen plasma (FFP) contains a range of coagulation factors essential for hemostasis, categorized as labile or stable based on their sensitivity to processing and storage conditions. Labile factors, particularly factor V and factor VIII, are preserved effectively when plasma is separated and frozen within 8 hours of collection, maintaining activities typically between 50% and 150% of normal plasma levels.^[37] These factors are critical for the intrinsic and common pathways of coagulation, with their rapid freezing preventing significant degradation during initial handling.^[1] Stable coagulation factors, including factors II, VII, IX, and X, exhibit near 100% activity in FFP, approaching levels found in fresh whole plasma.^[4] Fibrinogen concentrations range from 200 to 400 mg/dL, providing a substrate for clot formation, while von Willebrand factor is also retained at approximately 100% activity to support platelet adhesion.^[1] These components remain robust due to their inherent stability during the freezing process at -18°C or below.^[4] FFP also preserves natural anticoagulants such as antithrombin III, protein C, and protein S, which are maintained at levels sufficient for treating hereditary or acquired deficiencies.^[1] These inhibitors regulate thrombin and other procoagulant enzymes, ensuring a balanced hemostatic profile in transfused patients.^[4] In comparison to FFP, plasma frozen within 24 hours (PF24) shows a 20-30% decline in factor V and VIII activities due to room-temperature holding prior to freezing, though other factors remain comparable.^[4] Post-thaw, labile factors like V and VIII undergo further degradation, with significant losses occurring within 24 hours at 1-6°C, necessitating prompt use to retain efficacy.^[1] When frozen promptly after collection, FFP retains more than 70% of original factor levels, particularly for factor VIII, aligning with quality standards for therapeutic use.^[38]

Clinical Applications

Indications and Uses

Fresh frozen plasma (FFP) is primarily indicated for the treatment of multiple coagulation factor deficiencies in patients with active bleeding or those requiring invasive procedures when the international normalized ratio (INR) exceeds 1.5.^[1] This approach addresses complex coagulopathies where specific factor concentrates are unavailable or inappropriate, ensuring rapid replacement of labile clotting factors to prevent or control hemorrhage.^[39] In emergency settings, FFP is recommended for reversing warfarin-induced coagulopathy, particularly in cases of life-threatening bleeding such as intracranial hemorrhage, often in combination with vitamin K.^[40] For specific rare deficiencies, FFP serves as a source of antithrombin III when concentrates are not accessible, and it is used for Factor V deficiency due to the lack of commercial concentrates.^[1] Additionally, FFP is integral to plasma exchange procedures in thrombotic thrombocytopenic purpura (TTP), where it replaces deficient ADAMTS13 enzyme and removes autoantibodies.^[41] In massive transfusion protocols for trauma-induced coagulopathy, FFP is administered as part of balanced resuscitation, typically in a 1:1:1 ratio with red blood cells and platelets to mitigate dilutional coagulopathy.^[39] Current guidelines emphasize a restrictive approach to FFP use, recommending it only for active bleeding rather than prophylaxis in non-bleeding patients with abnormal coagulation tests, based on evidence from the AABB's 2010 standards and ongoing endorsements through 2025.^[3] The World Health Organization supports essential access to FFP in low-resource settings to ensure safe and rational transfusion practices, prioritizing evidence-based indications to optimize outcomes and minimize risks.^[42]

Administration and Dosage

Fresh frozen plasma (FFP) is typically administered intravenously to replace coagulation factors in patients with deficiencies and active bleeding or those requiring reversal of warfarin effects. The standard therapeutic dose is 10-20 mL/kg body weight, which generally raises plasma coagulation factor levels by approximately 20-30%.^[1] For adults, this equates to 4-6 units, totaling 800-1500 mL, depending on unit volume (typically 200-250 mL per unit).^[43] Dosing should be guided by clinical response and laboratory parameters rather than fixed volumes to avoid unnecessary transfusion.^[3] FFP must be ABO-compatible with the recipient's blood type, with group AB plasma preferred for universal compatibility if type-specific is unavailable.^[1] Infusion begins immediately after thawing, starting at a rate of 10-20 mL/min for the first 15-30 minutes to monitor for reactions, then increasing to 30 mL/min if tolerated, completing each unit over 30-60 minutes.^[44] The total infusion time should not exceed 4 hours to minimize bacterial contamination risk.^[1] Premedication with antihistamines or acetaminophen is not routinely required for FFP transfusion, as prophylactic use does not significantly reduce reaction rates in most patients.^[45] However, for individuals with a history of allergic reactions to blood products, premedication with an antihistamine such as diphenhydramine may be considered on a case-by-case basis.^[46] During and after infusion, patients should be monitored for signs of transfusion-related acute lung injury (TRALI), transfusion-associated circulatory overload (TACO), or allergic responses, with vital signs checked every 15 minutes initially.^[1] Post-infusion coagulation studies, including prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT), are recommended to assess efficacy, targeting values less than 1.5 times the upper limit of normal.^[1] In special populations, dosing adjustments account for body size and clinical context. For pediatric patients, a dose of 10-15 mL/kg is standard, often used in neonates for coagulopathy or exchange transfusions.^[1] In obstetrics, particularly for major postpartum hemorrhage, FFP is administered at 12-15 mL/kg or in a 1:1 ratio with red blood cells as part of massive transfusion protocols, per guidelines from organizations like the American Association of Blood Banks (AABB) and Royal College of Obstetricians and Gynaecologists (RCOG).^[47]^[3]

Risks and Complications

Adverse Reactions

Fresh frozen plasma (FFP) transfusion carries several potential adverse reactions, primarily related to infectious transmission, immunologic responses, volume overload, coagulation disturbances, and other complications. Although modern screening has greatly reduced infectious risks, they remain a concern. The risk of transmitting HIV is approximately 1 in 7.8 million units, hepatitis B virus about 1 in 153,000 units, and hepatitis C virus around 1 in 2.3 million units, thanks to nucleic acid testing (NAT) and other donor screening measures implemented since the early 2000s.^[1]^[48] Immunologic adverse reactions include transfusion-related acute lung injury (TRALI), a serious condition characterized by acute respiratory distress occurring within 6 hours of transfusion, with an incidence of approximately 1 in 5,000 units transfused. TRALI is often mediated by donor anti-leukocyte antibodies and is a leading cause of transfusion-related fatalities, though mitigation strategies like male-only plasma donation have reduced its occurrence. Allergic and anaphylactoid reactions, manifesting as urticaria, pruritus, nausea, or respiratory distress, occur in about 1.37% of FFP units transfused, particularly in patients receiving multiple units.^[49]^[1]^[50] Volume-related complications, such as transfusion-associated circulatory overload (TACO), arise from the rapid infusion of FFP's fluid volume, leading to pulmonary edema and hypertension, especially in elderly patients or those with cardiac or renal impairment; incidence rates vary but can reach 1% among transfused patients receiving plasma products. Coagulation-related issues include paradoxical thrombosis due to the procoagulant factors in FFP, such as fibrinogen and von Willebrand factor, which may promote clot formation in susceptible individuals, with studies showing increased postoperative deep vein thrombosis risk following intraoperative FFP administration.^[51] Other reactions encompass febrile non-hemolytic transfusion reactions, involving fever and chills without hemolysis, reported in up to 1-2% of transfusions; acute hemolysis from ABO incompatibility, which can cause severe intravascular destruction if mismatched units are given; and citrate toxicity during rapid or massive infusions, leading to hypocalcemia, arrhythmias, and metabolic alkalosis due to citrate's calcium-binding properties, necessitating calcium supplementation in high-volume scenarios.^[1]^[1]^[52]

Contraindications

Fresh frozen plasma (FFP) is contraindicated in cases of isolated coagulation factor deficiencies that can be effectively treated with specific factor concentrates, such as recombinant factor VIII for hemophilia A, rather than broad-spectrum plasma therapy.^[1] Similarly, FFP should not be used for hypofibrinogenemia alone, where cryoprecipitate is the preferred agent due to its higher fibrinogen concentration and targeted efficacy.^[53] Prophylactic administration of FFP in non-bleeding patients, including for mild coagulopathy or elevated INR without active hemorrhage, is also contraindicated, as it offers no proven benefit and may increase risks such as mortality and transfusion-related acute lung injury.^[54] Relative contraindications include conditions predisposing to volume overload, such as heart failure or renal impairment, where the large fluid volume of FFP (typically 200-250 mL per unit) can precipitate pulmonary edema or exacerbate cardiac strain.^[55] In patients with hypersensitivity to plasma components or IgA deficiency, FFP is relatively contraindicated due to the risk of severe allergic reactions.^[1] For stable warfarin reversal without bleeding, FFP is not recommended; instead, prothrombin complex concentrates (PCC) are preferred per updated 2025 guidelines, which emphasize faster and more reliable anticoagulation correction with lower volume.^[56] Regarding pregnancy and breastfeeding, there are no established absolute contraindications for FFP, but its use should be limited to situations where benefits clearly outweigh potential risks, as safety data remain limited.^[57] Overall, these contraindications underscore the need for targeted therapies to minimize unnecessary exposure to FFP's risks.^[54]

Current Usage and Alternatives

Frequency of Use and Trends

In the United States, fresh frozen plasma (FFP) usage peaked around 2008-2010 with approximately 4.5 million units transfused annually, reflecting increased adoption in trauma and surgical settings.^[58] By 2019, national surveys indicated a continued downward trend in plasma transfusions, with distributions stabilizing but overall usage declining due to stricter clinical guidelines; this pattern persisted post-2020 amid ongoing emphasis on evidence-based restrictions.^[59] For instance, the 2021 National Blood Collection and Utilization Survey reported about 2.2 million units transfused, a notable reduction from the prior decade's highs.^[60] The 2023 National Blood Collection and Utilization Survey reported 1,882,000 units transfused (95% CI: 1,765,000–1,998,000), indicating further modest decline and stabilization.^[61] In the United States, FFP usage expanded dramatically from 2000 to 2010, increasing roughly tenfold to meet rising demands in hemostasis management and fractionation for plasma-derived therapies.^[62] However, between 2020 and 2025, trends shifted toward stabilization or modest decline, driven by the adoption of alternatives and refined transfusion protocols, though discard rates remain elevated in high-volume settings like trauma centers.^[63] The COVID-19 pandemic temporarily disrupted collections in 2020, with a minimal annualized drop in donations and transfusions compared to 2019, followed by recovery to pre-pandemic levels by 2023 as supply chains adapted.^[64] Key factors influencing these patterns include AABB guidelines promoting evidence-based plasma transfusion, which have curtailed prophylactic use by emphasizing targeted indications to minimize risks without proven benefits.^[3] In the US, pediatric applications account for a substantial share; according to a 2010 study using 2002-2009 data, about 53% of FFP infusions occurred in infants under 1 year, often in neonatal intensive care units for coagulopathy management.^[65] Market indicators underscore sustained infrastructure investment despite clinical usage moderation; the global FFP freezer sector is projected to reach $1.6 billion by 2025, supporting storage needs for ongoing distributions.^[66]

Alternatives

Prothrombin complex concentrates (PCCs), particularly four-factor formulations, serve as a targeted alternative to fresh frozen plasma (FFP) for rapid reversal of warfarin-associated bleeding, offering faster correction of international normalized ratio (INR) with lower infusion volumes compared to FFP.^[67] The 2020 American College of Cardiology (ACC) expert consensus pathway recommends four-factor PCC over FFP for vitamin K antagonist reversal in most cases due to its efficacy and reduced risk of fluid overload.^[68] A 2025 systematic review further supports PCC's benefits in oral anticoagulant-related intracranial hemorrhage, highlighting its speed and lower volume requirements.^[69] Liquid plasma (LP), a never-frozen variant stored refrigerated, provides an accessible alternative to FFP in trauma and massive transfusion protocols, with a 26-day shelf life that facilitates prehospital and military use without thawing delays.^[70] U.S. military adoption of LP expanded from 2023 to 2025, as outlined in Central Command protocols, due to its extended stability and equivalence in coagulation factor activity to thawed FFP.^[71] Cryoprecipitate-poor plasma (CPP) offers a volume-reduced option for therapeutic plasma exchange in thrombotic thrombocytopenic purpura (TTP), demonstrating similar efficacy to FFP in reducing mortality and relapse rates per a 2023 meta-analysis.^[72] Cryoprecipitate is a concentrated source for fibrinogen replacement in hypofibrinogenemia, delivering 200-250 mg of fibrinogen per unit to correct deficiencies more efficiently than FFP in scenarios like massive hemorrhage.^[73] Recombinant factor VIII concentrates treat hemophilia A by providing the missing clotting protein without plasma-derived risks, marking a standard since their 1992 FDA approval and ongoing use in prophylaxis.^[74] Fibrinogen concentrates have shown equivalence to partial FFP replacement in maintaining levels above 1 g/L during therapeutic plasma exchange for patients with mild-to-moderate bleeding risk, as evidenced by a 2024 pilot study.^[75] Non-product strategies, such as patient blood management programs incorporating viscoelastic testing (e.g., thromboelastography or rotational thromboelastometry), guide targeted transfusions to minimize FFP use by assessing real-time hemostasis and reducing overall allogeneic product requirements in perioperative and trauma settings.^[76] Recent advancements include extending thawed plasma storage to 5 days at refrigerated temperatures while preserving key coagulation factors, as confirmed in 2025 studies supporting its utility in urgent care.^[77] Synthetic clotting agents, such as platelet-mimicking nanoparticles, are in phase I/II trials for trauma-induced coagulopathy, demonstrating potential to stabilize clots and reduce bleeding in preclinical models from 2023-2025.^[78] These alternatives contribute to observed declines in FFP utilization trends.

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The authors have investigated the constituents of fresh frozen plasma stored in citrate phosphate dextrose (CPD) at -20 degrees C. The results indicate ...
[36]
Coagulation factor stability and sterility of thawed fresh frozen ...
Coagulation factors in thawed fresh frozen plasma ; Factor V activity (%), 62-139, 98.7 ± 16.6 ; Factor VIII activity (%), 50-150, 97.7 ± 30.4 ; Factor IX activity ...Missing: concentrations | Show results with:concentrations
[37]
Levels of factor VIII and factor IX in fresh-frozen plasma produced ...
The levels reported by Cardigen and Naghadeg were 55% and 34.8%, respectively. The FVIII levels fell within the standard haematology range (0.5–2 IU/mL) in 90% ...
[38]
https://pmc.ncbi.nlm.nih.gov/articles/PMC3320779/
[39]
Treatments for reversing warfarin anticoagulation in patients with ...
Jul 8, 2011 · Intravenous vitamin K in addition to fresh frozen plasma or prothrombin complex concentrate is recommended be used to reverse warfarin-associated intracranial ...
[40]
Comparison of Plasma Exchange with Plasma Infusion in the ...
Aug 8, 1991 · Plasma exchange is more effective than plasma infusion in the treatment of thrombotic thrombocytopenic purpura.
[41]
Plasma therapy leads to an increase in functional IgA and IgM ...
May 23, 2019 · In the early 1970s, fresh frozen plasma (FFP) was given to agammaglobulinemia patients. FFP infusions are well tolerated and increased serum IgG ...
[42]
Safe and rational clinical use of blood
WHO recommends for the safe and rational use of blood to reduce unnecessary and unsafe transfusions and to improve patient outcomes and safety, thus minimizing ...
[43]
[PDF] GUIDELINES FOR THE ADMINISTRATION OF PLASMA
Fresh frozen plasma (FFP) is plasma frozen within six to eight hours of collection (de- pending on the anticoagulant used), and stored at minus 18 degrees ...
[44]
Administration | Australian Red Cross Lifeblood
The infusion rate for blood components depends on the clinical context, age ... Fresh frozen plasma 30 minutes; Cryoprecipitate 30-60 minutes per ...
[45]
Acetaminophen and Diphenhydramine Premedication for Allergic ...
Febrile non-hemolytic and allergic reactions are the most common transfusion reactions, but usually do not cause significant morbidity.
[46]
Case Studies and Whitepapers | Diagnostic Laboratories Insights
If a patient has a history of transfusion reaction, the decision to premedicate should be made on a case-by-case basis.
[47]
[PDF] Blood Transfusion in Obstetrics - RCOG
FFP at a dose of 12–15 ml/kg should be administered for every 6 units of red cells during major obstetric haemorrhage.
[48]
Infectious Complications of Blood Transfusion - StatPearls - NCBI
Jul 31, 2023 · By 2016 NAT testing was well underway in the United States and should decrease transfusion transmission risk to <1:1 x 106 as with HCV and HIV ...
[49]
TRALI - Definition, mechanisms, incidence and clinical relevance - NIH
In most patients (81%), recovery was rapid and complete. The incidence was 1:5,000 units transfused and the TRALI patients were comprised of mainly surgical ...
[50]
Incidence of allergic reactions with fresh frozen plasma or ... - PubMed
This study sought to determine the incidence of allergic reactions with FFP or CPP as replacement in therapeutic plasma exchange (TPE).
[51]
Contemporary risk factors and outcomes of transfusion-associated ...
Apr 1, 2019 · Among 20,845 transfused patients who received 128,263 blood components from May 2015 until July 2016, TACO incidence was 1 case per 100 ...
[52]
Risk factors for postoperative thrombosis-related complications in ...
Apr 18, 2023 · One study reported that intraoperative fresh frozen plasma infusion increased the risk of postoperative deep vein thrombosis in patients ...
[53]
Citrate metabolism in blood transfusions and its relationship due to ...
In massive transfusion, an excessive amount of citrate can produce a transient hypocalcaemia and hypomagnesaemia that may affect the cardiac rate and function.
[54]
CRYO (cryoprecipitate) dosing, indications, interactions, adverse ...
Contraindications. Cryo should not be given for replacement of isolated factor deficiencies of factor VIII, von Willebrand factor, or factor XIII if the ...
[55]
None
### Contraindications for Fresh Frozen Plasma Transfusion (Summary)
[56]
Plasma Dosage - MDCalc
Relative contraindications: heart failure, pulmonary edema, etc. Plasma should be ABO-compatible with recipient. Result:
[57]
Updated recommendations for warfarin reversal in the setting of four ...
Jan 13, 2025 · Main recommendations: For urgent warfarin reversal, 4FPCC should be used instead of 3FPCC, using the same suggested dose. Vitamin K co- ...Missing: ACCP | Show results with:ACCP
[58]
Fresh Frozen Plasma: Side Effects, Uses, Dosage ... - RxList
High infusion rates can induce hypervolemia with consequent pulmonary edema or cardiac failure; Excessive bleeding due to hyperfibrinolysis can occur due to ...
[59]
Adverse Effects of Plasma Transfusion - PMC - NIH
Risks commonly associated with FFP include: (1) transfusion related acute lung injury; (2) transfusion associated circulatory overload, and (3) allergic/ ...
[60]
Supplemental findings of the 2019 National Blood Collection ... - NIH
Between 2017 and 2019, HHS regions 3 and 8 showed the largest change in response rate with a decrease by 15% and 16.5%, respectively.
[61]
Current U.S. Blood Donation & Transfusion Data Available -
Apr 21, 2023 · “There were 2,215,000 units (95 percent CI, 2,084,000–2,347,000 units) of plasma transfused in the U.S. in 2021, an increase of 1.4 percent from ...
[62]
Improving Blood Collection Operations at the American Red Cross
Dec 15, 2023 · For example, from 2000-2010, the use of fresh-frozen plasma, the raw material for cryo production, increased tenfold and grew to more than 2.4 ...
[63]
Causes and Solutions for Blood and Blood Component Wastage in ...
May 1, 2024 · The overall discard rate was 18%. Platelets were the most commonly discarded component (91.6%), followed by plasma (4.4%) and packed red blood ...
[64]
Impact of the COVID-19 pandemic on blood donation and ... - NIH
Apr 13, 2023 · The COVID-19 pandemic resulted in reduced blood donations and transfusions in some months during 2020 but only a minimal annualized decline compared with 2019.
[65]
[PDF] Dohmeyer-CryoXpert-Medical-Catalogue.pdf
The use of Fresh Frozen. Plasma has increased tenfold since the years 2000-2010 and has reached almost 4 million units in the world annually. This trend may.<|separator|>
[66]
Is Fresh Frozen Plasma Use Changing In U.S. Pediatric Hospitals?
Nov 19, 2010 · Children under 1 year of age accounted for the majority (53%) of all FFP infusions. The prevalence of FFP use over time is shown in figure 1.Missing: infants | Show results with:infants
[67]
Fresh Frozen Plasma Freezers 2025 Trends and Forecasts 2033
Rating 4.8 (1,980) Aug 28, 2025 · The global fresh frozen plasma (FFP) freezer market is experiencing steady growth, projected to reach \$1607.6 million in 2025, ...
[68]
Fixed-Dose Four-Factor Prothrombin Complex Concentrate for ...
Aug 7, 2025 · Background: Four-factor prothrombin complex concentrate (4F-PCC) is used for warfarin reversal and off-label management of bleeding in patients ...Missing: ACCP guidelines
[69]
ACC Consensus on Management of Anticoagulant-Related Bleeding
Jul 14, 2020 · For patients taking warfarin or other VKA, use of a four-factor prothrombin complex concentrate (4f-PCC) is advised for reversal. Fresh ...
[70]
Prothrombin complex concentrate for reversal of oral anticoagulants ...
Feb 4, 2025 · PCC was shown conclusively superior compared with FFP in reversing INR among participants with VKA-related critical bleeding with a trend ...Missing: ACCP | Show results with:ACCP
[71]
[PDF] Liquid plasma as a practical alternative to whole blood for ...
LP offers a 26-day refrigerated shelf life compared to the 5-day limit of thawed fresh frozen plasma (FFP) and elim- inates the challenges associated with ...Missing: advancement | Show results with:advancement
[72]
[PDF] urgent resuscitation using blood products and walking blood bank sop
Sep 5, 2025 · “Never frozen” liquid plasma has a shelf life of 26 or 40 days and may be more readily available. Check with the issuing facility for.
[73]
Cryoprecipitate-Poor Plasma Instead of Fresh Frozen Plasma As ...
Nov 2, 2023 · Our meta-analysis shows that the safety and efficacy of CPP in TTP patients is at least similar to FFP in reducing mortality, relapse rate, and improving ...
[74]
Cryoprecipitate and fibrinogen concentrate - UpToDate
Jul 8, 2025 · Cryoprecipitate and fibrinogen concentrates can provide fibrinogen, but there are differences in composition and possible adverse effects, and ...
[75]
Recombinant factor VIII: past, present and future of treatment of ...
The development of recombinant factor VIII (rFVIII) was initially driven by the necessity to treat hemophilia A (HA) patients with FVIII concentrates.
[76]
A Pilot Study on the Replacement of Fibrinogen with ... - PubMed
Dec 16, 2024 · Fibrinogen concentrate supplementation and partial FFP replacement can both maintain fibrinogen levels > 1 g/L after TPE, but modest differences in classical ...
[77]
Viscoelastic Testing Prior to Non-surgical Procedures Reduces ...
TEG or ROTEM significantly reduces blood product utilization prior to non-surgical procedures, with no increase in post-procedure bleeding or mortality.
[78]
Storage of thawed cryoprecipitate for 5 days at refrigerated ...
Aug 19, 2025 · Current guidelines and standards stipulate that each bag or unit of cryoprecipitate should contain at least 140 mg of fibrinogen and 70 IU of ...
[79]
A potential game-changer for emergency medicine: Synthetic platelets
Jul 2, 2024 · The researchers found that the synthetic platelets can help stiffen the clot and stabilize it, which then aids the wound-healing process after clotting happens.Missing: agents | Show results with:agents