Frozen plasma (FP) is obtained by freezing collected plasma within a timeframe that ensures preserved function of labile coagulation factors. One unit of FP is ~280 mL. FP contains all stable coagulation system factors, albumin, and globulins. It may be stored at ≤−18 degrees Celsius for up to 12 months. Thawed plasma should not be refrozen.
FP transfusion is indicated in case of:
1) International normalized ratio (INR) >1.7 and ≥1 of:
a) Significant bleeding.
b) Prior to an invasive procedure with a risk of bleeding (plasma is generally not required prior to minor procedures, eg, paracentesis, thoracentesis, central line insertion).
2) Prophylactic or therapeutic coagulation factor replacement in patients with single factor deficiency if specific coagulation factor concentrates with inactivated infectious factors are not available.
3) Thrombotic thrombocytopenic purpura (TTP).
4) Massive transfusion.
Different INR targets may be appropriate in patients with liver disease.
Plasma should not be used for the reversal of warfarin or direct anticoagulants. Plasma also should not be used for blood volume replacement in patients with no coagulation factor deficiency, in patients with coagulation factor deficiencies when an appropriate coagulation factor concentrate is available, or for fibrinogen replacement therapy.
In stable adult patients transfuse slowly (50 mL/h) for the first 15 minutes. Plasma should be dosed at 10 to 15 mL/kg (~4 units in an average-sized adult). The recommended infusion time is 30 to 120 minutes per unit, with a maximum time of 4 hours. If clinically indicated, prothrombin time (PT)/INR and activated partial thromboplastin time (aPTT) may be checked after transfusion to assess response.