Although FFP is widely used, there are few well-founded indications. A systematic review of all randomised trials of FFP indicates that most clinical indications for FFP that are often recommended by transfusion practice guidelines are not supported by evidence from randomised trials.

Typical clinical guideline for plasma transfusion

Major haemorrhage

Coagulopathy with a prothrombin time prolonged > 50% is likely after replacement of 1-1.5 blood volumes. Initial dose of FFP 15-20 ml/kg. Further doses only if bleeding continues and guided by PT and APTT (1C)

Thrombotic thrombocytopenic purpura (TTP)

Plasma exchange with FFP is effective in many cases (recommendation level 1A).

Other indications

Replacement of coagulation factor deficiency, if the appropiate plasma derivative or recombinant product is not available.