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FFP Dosing

FFP 10-15 mL/kg for INR correction. Higher doses for INR >4. PCC preferred for urgent warfarin reversal.

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10-15 mL/kg standard PCC for urgent reversal Vitamin K concurrent

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Why: Proper FFP dosing corrects coagulopathy. PCC offers faster reversal when indicated.

How: Enter weight, current/target INR. Dose based on 10-15 mL/kg; units = mL ÷ 225.

10-15 mL/kg standardPCC for urgent reversal
Sources:AABB guidelines

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Calculate FFP DoseUse the calculator below to check your health metrics

💊 Warfarin Reversal - Urgent

Urgent surgery in anticoagulated patient

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🩸 Life-Threatening Bleeding

Major hemorrhage on anticoagulation

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🏥 Liver Disease Coagulopathy

Cirrhosis with elevated INR

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🚨 Massive Transfusion

Trauma with massive hemorrhage

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⚠️ DIC with Bleeding

Disseminated intravascular coagulation

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💉 Minor Procedure

Central line placement

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🧬 Factor Deficiency

Multiple factor deficiency

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💚 Vitamin K Deficiency

Nutritional or antibiotic-related

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Patient & INR Information

Clinical Context

For informational purposes only — not medical advice. Consult a healthcare professional before acting on results.

🏥 Health Facts

💉

~225 mL per unit

— Transfusion

⏱️

30-45 min thaw

— Blood bank

Understanding Fresh Frozen Plasma

Fresh Frozen Plasma (FFP) contains all coagulation factors at approximately 1 IU/mL. It is used to correct multiple factor deficiencies, reverse warfarin, and treat coagulopathies. Understanding proper dosing and alternatives is essential for effective transfusion therapy.

Fresh Frozen Plasma (FFP)

  • Volume: 200-250 mL per unit
  • Thaw Time: 30-45 minutes
  • Shelf Life: 24 hours after thaw (1-6°C)

Thawed Plasma

  • Volume: 200-250 mL per unit
  • Thaw Time: Pre-thawed
  • Shelf Life: 5 days after thaw

Cryoprecipitate

  • Volume: 15-20 mL per unit (pooled)
  • Thaw Time: 10-15 minutes
  • Shelf Life: 6 hours after thaw (pooled)

4-Factor PCC (Kcentra)

  • Volume: ~20-40 mL per vial
  • Thaw Time: Ready to use
  • Shelf Life: 4 hours after reconstitution

Appropriate Indications for FFP

✓ Appropriate Uses

  • • Warfarin reversal (with Vitamin K)
  • • Massive transfusion protocol
  • • DIC with active bleeding
  • • Multiple factor deficiencies
  • • Liver disease with bleeding
  • • TTP (plasma exchange)

✗ Inappropriate Uses

  • • Volume expansion (use crystalloid)
  • • Nutritional supplementation
  • • Wound healing
  • • Prophylaxis without elevated INR
  • • Mild INR elevation without bleeding
  • • Single factor deficiency (use specific factor)

Alternative Therapies

4-Factor PCC (Kcentra)

Indication: Warfarin reversal, urgent surgery, life-threatening bleeding

Dose: Based on INR: 25-50 units/kg

✓ Rapid correction (15-30 min), small volume, no thaw time
✗ Cost, thrombotic risk, not for liver disease

Vitamin K (Phytonadione)

Indication: Warfarin reversal (non-urgent), prevention of re-elevation

Dose: 1-10 mg IV/PO based on urgency

✓ Definitive reversal, low cost, sustains correction
✗ Slow onset (6-24 hours), resistance to re-anticoagulation

rFVIIa (NovoSeven)

Indication: Refractory bleeding, hemophilia with inhibitors

Dose: 15-90 mcg/kg

✓ Very rapid action, effective in some refractory cases
✗ Very expensive, thrombotic risk, short half-life

Fibrinogen Concentrate

Indication: Hypofibrinogenemia (<1.5 g/L with bleeding)

Dose: 25-50 mg/kg

✓ No thaw time, small volume, standardized dose
✗ Cost, only replaces fibrinogen

Transfusion Reactions to Monitor

Acute Reactions

  • TACO - Transfusion-associated circulatory overload: dyspnea, hypertension, pulmonary edema
  • TRALI - Transfusion-related acute lung injury: hypoxemia, bilateral infiltrates within 6h
  • Allergic - Urticaria, pruritus, anaphylaxis (rare)
  • Febrile - Temperature rise ≥1°C during/after transfusion
  • Hemolytic - Rare with FFP, but monitor for ABO incompatibility signs

Prevention & Management

  • TACO Prevention - Slow infusion rate, diuretics if at risk
  • TRALI Prevention - Use male-only plasma when possible
  • Allergic - Antihistamines, stop transfusion if severe
  • Monitoring - Vital signs q15min for first hour
  • Documentation - Report all reactions to blood bank

4-Factor PCC (Kcentra) Dosing Guide

For urgent warfarin reversal, 4-Factor PCC provides faster and more complete correction than FFP alone. PCC is preferred for life-threatening bleeding or emergent surgery in anticoagulated patients.

Pre-Treatment INRPCC Dose (units/kg)Max Dose (units)Notes
2.0 - <4.025 units/kg2500 unitsGive with Vitamin K 10mg IV
4.0 - 6.035 units/kg3500 unitsCheck INR at 30 min
>6.050 units/kg5000 unitsConsider additional FFP if needed

Important: PCC has thrombotic risk. Avoid in patients with recent arterial/venous thrombosis, DIC, or HIT. Monitor for thromboembolism after administration. Always give Vitamin K concurrently to prevent INR rebound.

Vitamin K (Phytonadione) Dosing

Life-Threatening Bleeding

10 mg IV

Slow infusion over 10-20 min. Repeat at 12h if INR still elevated.

Urgent (INR 5-9)

2.5-5 mg PO/IV

Check INR at 24h. Additional doses may be needed.

Non-Urgent (INR >10)

1-2.5 mg PO

Hold warfarin, recheck INR in 24-48h.

Special Populations

Liver Disease

  • • INR may not accurately predict bleeding risk
  • • Balanced coagulopathy (decreased pro- and anticoagulants)
  • • FFP effect often transient and incomplete
  • • Consider TEG/ROTEM-guided therapy
  • • Fibrinogen replacement often more important
  • • Avoid prophylactic FFP for procedures when possible

Massive Transfusion

  • • Target 1:1:1 ratio of PRBC:FFP:Platelets
  • • Early empiric FFP before lab results available
  • • Maintain fibrinogen >1.5 g/L
  • • Consider tranexamic acid (TXA)
  • • Warm all blood products
  • • Monitor calcium (citrate toxicity)

Quick Reference Guide

10-20
mL/kg FFP dose
~225
mL per unit
30-45
min thaw time
24
hour shelf life
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