Fresh frozen plasma (FFP) transfusion is indicated for the correction of coagulopathy where there is bleeding, or to prevent bleeding in children undergoing an invasive procedure. It is not indicated for volume expansion.
Following a government directive, Methylene Blue treated Non UK sourced FFP is used for all children under 16 years of age.
The Trust procedure guideline blood product transfusion: fresh frozen plasma provides guidance on the administration of FFP.
The guidelines are not rigid and allow flexibility in certain circumstances. In this instance, contact the Blood Transfusion Laboratory (ext 8527) or the Biomedical Scientist on call (bleep 0590) to discuss your request.
In the event of blood shortages
Provision of FFP will be dependent on availability of normal supplies from the NHSBT (National Health Service Blood and Transplant).
In the event of a national shortage the Great Ormond Street Hospital (GOSH) Emergency Blood Management Plan will be followed. The plan has been developed to ensure the effective use of blood and blood products at all times, but especially when national stocks have fallen to low levels.
The plan can be found in the Blood transfusion policy and information folder, Appendix 2, and viewed online in the GOSH document library.
Fresh frozen plasma (FFP) guidelines for use
| Condition | FFP indicated?
Yes/no
| Comments |
Factor II deficiency
Factor V deficiency
Factor X deficiency
Factor XI deficiency
| Yes
| If concentrate not available or not indicated.
Discuss with the haematology consultant.
|
Multi Factor deficiency
| Yes
| With severe bleeding and/or DIC.
|
| DIC | Yes | With bleeding.
|
Warfarin reversal (with no bleeding)
| No | n/a
|
Warfarin reversal (with bleeding)
| Yes | n/a
|
Heparin reversal (unfractionated)
| No | Requires: Protamine Sulphate (refer to BNF).
Discuss with haematology SpR/consultant.
|
Heparin reversal (low molecular weight)
| Yes | Requires: Protamine Sulphate (refer to BNF).
Discuss with haematology SpR/consultant. |
Vitamin K deficiency (with no bleeding)
| Yes | n/a
|
Vitamin K deficiency (with bleeding)
| Yes | n/a |
Liver disease
| No | Unless coagulation times corrected with normal plasma. |
Surgical bleeding
| Yes | With TEG monitoring or coagulation testing. |
| ECMO | Yes | With coagulation testing.
|
Table showing guidelines for use of fresh frozen plasma (FFP).
Plasma exchange
| Condition | FFP indicated? Yes/no
| Comments |
| ABO mismatch heart transplant | Yes
| If isohaemagglutinins levels are high.
|
Acute vasculitis
| Yes | n/a |
Guillain Barre
| Yes | n/a |
Multi organ failure
| Yes | n/a |
| SLE | Yes | n/a |
TTP (mainly adults)
| Yes | Daily exchange for a planned time period.
|
HUS (mainly children)
| Yes | Daily exchange for a planned time period.
|
Table showing plasma exchange.
Methylene Blue treated, US (United States) sourced, FFP will be supplied for children under 16 years of age.
The above table is for guidance only. In individual cases it may be necessary to vary from the suggested requirements. Special requirements should be discussed with the haematology SpR and/or the haematology consultant.
Reference 1:
British Committee for Standards in Haematology (2004) Guidelines for the use of Fresh Frozen Plasma, Cryoprecipitate and Cryosupernatant British Journal of Haematology 126: 11-28.
Reference 2:
British Committee for Standards in Haematology (2004) Transfusion Guidelines for Neonates and Older Children British Journal of Haematology 124: 433-453.
Reference 3:
McClelland DBL (editor) (2007) Handbook of Transfusion Medicine (4th edition) London, HMSO
Document control information
Lead author(s) Sylvia Hennem, Specialist Practitioner of Transfusion, Blood Transfusion
Additional authors
Sue Chapman, Nurse Consultant, Clinical Site Practitioners
Document ownerSylvia Hennem, Specialist Practitioner of Transfusion, Blood Transfusion
Approved byHospital Transfusion Committee & Clinical Practice Committee
First introduced: 30 June 2005
Date approved: 26 July 2011
Review schedule: Two years
Next review: 26 July 2013
Document version: 3.0
Replaces version: 2.0
