Fresh Frozen Plasma (FFP)

What is fresh frozen plasma?

Fresh frozen plasma (FFP) is the liquid part of donated blood. It’s a potential treatment for severe blood loss, especially if you have a bleeding disorder that prevents your blood from clotting normally.

Donated blood consists of several parts, including blood cells, platelets and plasma. Plasma gives your blood its volume and contains proteins called “clotting” or “coagulation” factors. These proteins work with platelets to form clots and stop the bleeding if you’re injured.

But if you have a deficiency of one or more clotting factors and are losing too much blood, you may need a transfusion of FFP to restore your volume and add clotting factors.

To preserve just the plasma, a healthcare provider separates it from the other parts of whole blood. Within eight hours of collecting it, they freeze it at -18 degrees Celsius or lower until it’s ready to use. This is why it’s called fresh frozen plasma.

Other names for frozen plasma treatments

You may hear your healthcare provider use other names to refer to plasma treatments. The names reflect the process that preserves it:

• PF24. Plasma frozen within 24 hours of collection.
• PF24RT24. Plasma frozen within 24 hours, held at room temperature for up to 24 hours.
• Plasma cryoprecipitate reduced (cryo-poor plasma). Plasma that has had cryoprecipitate removed. This type has lower levels of certain clotting factors.

The differences between these types are important to your providers. They affect the levels of specific clotting factors you’ll get from the plasma. Your provider will choose the right plasma treatment for you based on the clotting factors you need.

Why would someone need fresh frozen plasma?

The most common reason you may need FFP is if you’re bleeding (or at risk of bleeding) and have a deficiency of one or more clotting factors. Hemophilia is probably the most well-known example of a clotting factor deficiency.

Usually, healthcare providers don’t use fresh frozen plasma unless other treatments aren’t available. For example, providers typically use clotting concentrates instead of FFP to treat severe bleeding in people with a clotting factor deficiency. Unlike FFP, clotting concentrates provide the proteins your blood needs to clot without the extra fluid.

You may also need FFP if:

• You’re bleeding or at risk of bleeding and on warfarin. Providers usually treat blood loss in people taking warfarin (a blood thinner) by giving vitamin K to reverse the blood thinning effects. But you may need FFP as a backup option if vitamin K isn’t working fast enough.
• You’re receiving treatment for thrombotic thrombocytopenic purpura (TTP). Fresh frozen plasma is a treatment for inherited forms of TTP. The plasma replaces a missing or altered enzyme that causes dangerous blood clots in people with this condition.
• You’ve experienced a severe injury that’s causing massive blood loss. You may receive FFP as part of a blood transfusion when you’ve lost too much blood.

What happens during a fresh frozen plasma transfusion?

Most transfusions happen in a hospital. For the transfusion, a provider thaws the stored FFP to a comfortable temperature before injecting it into your vein. Your provider will:

1. Insert an IV. A provider will insert a needle into your arm that connects to an intravenous line (IV). The line attaches to a bag with the plasma. The plasma flows from the bag into your vein, where it enters your bloodstream.
2. Monitor your vitals and blood clotting. Your provider will check your vital signs to make sure you’re OK throughout the process. They may do blood tests to see if your blood is clotting better. Tests may include a PT/INR test and a PTT test.
3. Administer the plasma. Your provider will administer the plasma until you receive a dose that helps your blood clot. A single unit of FFP contains approximately 200 to 250 milliliters (mL) of fluid. It takes about 30 minutes to transfuse. How much you need (and the time it takes) depends on how much you’re bleeding.

Depending on your situation, you may need a one-time transfusion. Or you may need transfusions every few hours until your bleeding is under control. This is because some clotting factors break down fast and become less effective at helping your blood clot. This is especially the case with factor VII.

Can fresh frozen plasma be given to any blood group?

Ideally, you’ll get FFP that’s identical to your ABO blood type. For example, if you have type A blood, it’s best to receive FFP from type A blood. If this isn’t an option, your provider can transfuse blood that’s compatible with yours. For example, people with type A blood can safely receive type O blood.

In emergencies, when providers don’t know your blood type, they’ll choose the safest available blood product. With FFP transfusions, providers usually use plasma collected from type A or AB blood. With these types, there’s less of a chance that a recipient’s blood will reject the donated blood.

What are the benefits of fresh frozen plasma?

Fresh frozen plasma can potentially save your life if you have a bleeding disorder and are losing too much blood. Providers don’t usually reach for FFS as a first-line treatment. Still, it can slow life-threatening bleeding in those situations when preferred treatments aren’t an option.

What are the risks or complications of this treatment?

Your healthcare provider will consider the potential risks of FFP before administering it. They’ll screen and prepare the FFP carefully beforehand. Still, as with most treatments, fresh frozen plasma can carry risks, like:

• Allergic reactions. Your immune system may flare up in response to the transfused plasma. Reactions can cause symptoms, like a rash or itching, that range from mild to severe.
• Infections. A transfusion can expose your blood to viruses present in the donor blood. Providers screen donated blood carefully to reduce the risk.
• Transfusion-related acute lung injury (TRALI). TRALI involves serious and potentially life-threatening swelling in your lungs. Although researchers are still debating causes, it likely happens when select parts of the donor’s blood aren’t compatible with your blood.
• Transfusion-associated circulatory overload (TACO). TACO involves having too much plasma in your circulatory system. The additional fluid overburdens your system. It can lead to high blood pressure and swelling in your lungs.

How long will it take for me to feel better?

Your recovery time depends on the reason you need fresh frozen plasma. Generally, it takes about a day to start feeling better after an FFP transfusion. In other words, you should make sure you give yourself plenty of time to rest after treatment.

Your provider will explain your recovery timeline. They’ll let you know when you should return for a follow-up visit to check how you’re doing.

When should I call my healthcare provider?

Your healthcare provider will release you from the hospital only when it’s safe to do so. Still, some side effects may not show up until after you go home. Contact your provider immediately if you experience:

• A fever and chills.
• Itching, a rash or hives.
• Nausea and vomiting.
• Headache or dizziness.
• Back pain.

When should I go to the ER?

Get to an ER immediately if you experience symptoms of TRALI or TACO. Both conditions cause symptoms that start within six hours of receiving a transfusion and can be life-threatening without treatment. Symptoms include:

• Trouble breathing.
• Rapid heartbeat.
• Fever.

What is the difference between fresh frozen plasma and cryoprecipitate?

Cryoprecipitate is a substance created when you thaw fresh frozen plasma. It’s rich in the clotting factors fibrinogen, factor VIII, factor XIII and Von Willebrand factor.

Sometimes, providers remove the cryoprecipitate and use it to treat bleeding disorders that involve not having enough of these clotting factors. The plasma that remains after you remove cryoprecipitate is called “plasma cryoprecipitate reduced” or “cryo poor plasma.”