Fresh Frozen Plasma (FFP) is the liquid portion of whole blood, separated from red blood cells, white blood cells, and platelets. The plasma is rapidly frozen at very low temperatures, typically \(-18\) degrees Celsius or colder, within eight hours of collection. This strict timeline and freezing process maintain the full activity of its complex biological contents. FFP is administered intravenously to patients experiencing severe bleeding or deficiencies in their blood’s natural clotting abilities.
Molecular Inventory: Key Components of Fresh Frozen Plasma
Fresh Frozen Plasma contains a wide array of proteins, carbohydrates, fats, and water. The therapeutic value of FFP lies in its rich concentration of plasma proteins, which are essential for maintaining blood function. Rapid freezing ensures that even the most fragile clotting factors remain fully functional for transfusion.
Coagulation Factors
FFP contains all the plasma coagulation factors necessary for the blood clotting cascade. These include Factor V and Factor VIII, which degrade quickly at warmer temperatures but are preserved by freezing. The plasma also provides high levels of fibrinogen (Factor I), which forms the final mesh-like clot structure. A single unit of FFP contains approximately 1 International Unit (IU) per milliliter of each coagulation factor.
Plasma Proteins and Natural Anticoagulants
FFP is a source of other plasma proteins besides clotting factors. Albumin, the most abundant protein, maintains the blood’s oncotic pressure by pulling fluid into the blood vessels. Immunoglobulins (antibodies) are present and support the recipient’s immune function. FFP also delivers natural anticoagulant proteins, such as Protein C, Protein S, and Antithrombin, which prevent excessive clotting.
Electrolytes and Other Molecules
FFP includes essential ions like sodium and potassium, which are important for cellular function and maintaining overall fluid balance. The plasma also carries other small molecules, including hormones and various metabolic components.
FFP’s Role in Restoring Hemostasis
The primary function of Fresh Frozen Plasma is to restore the body’s ability to stop bleeding (hemostasis). It achieves this by supplying a broad spectrum of clotting factors that may have been lost or consumed. Massive blood loss causes existing clotting factors to become diluted or used up, leading to coagulopathy.
Transfusing FFP directly replenishes these depleted factors, effectively “recharging” the coagulation cascade. This rapid replacement promotes the formation of a stable thrombus, or clot, at the site of injury. A standard dose of FFP, typically 10 to 20 milliliters per kilogram of body weight, is usually sufficient to raise the recipient’s factor levels by approximately 20%.
The transfusion also supports the circulatory system through plasma proteins like albumin. These proteins create an osmotic gradient that draws fluid into the blood vessels, sustaining blood volume and pressure. This effect is beneficial in patients with massive blood loss, although FFP is not intended for volume expansion alone.
When Transfusion is Required
FFP transfusion is reserved for specific clinical situations where a patient is actively bleeding or faces a high risk of bleeding due to confirmed deficiencies in multiple clotting factors. The most common indication is massive hemorrhage, often due to severe trauma. In these emergency settings, FFP is administered as part of a massive transfusion protocol to rapidly stabilize the patient’s clotting ability.
FFP is also used to treat specific acquired coagulation deficiencies, such as those resulting from severe liver disease. The liver is the primary site of production for most clotting factors, and its failure can lead to an inability to clot effectively. While abnormal lab results alone do not justify transfusion, FFP is indicated when these patients are bleeding or require an invasive procedure.
FFP is also used for the immediate reversal of the effects of the blood-thinning medication warfarin. Warfarin inhibits the synthesis of several coagulation factors, and FFP provides an immediate source of these factors when a patient requires emergency surgery or is experiencing uncontrolled bleeding. FFP remains an option when other targeted treatments are unavailable or when the patient has multiple factor deficiencies.