Guideline for the use of fresh-frozen plasma. Medical Directors Advisory Committee, National Blood Transfusion Council.

OBJECTIVE: To make recommendations regarding the rational use of fresh-frozen plasma (FFP), since there is evidence of excessive and uncritical use of this blood component. OPTIONS: Alternatives to the use of FFP are presented: (i) specific factor concentrates for the treatment of the haemophilias and related inherited bleeding disorders; (ii) cryoprecipitate for the management of fibrinogen deficiency; (iii) vitamin K, where bleeding is associated with a deficiency of this vitamin; and (iv) crystalloids, plasma and synthetic colloids, the indicated components in the management of hypovolaemia and appropriate replacement fluids in most plasma exchange procedures. EVIDENCE: There is a marked paucity of objective data regarding indications for the use of FFP. Evidence was therefore obtained from previously published guidelines from the USA and the UK. Three clinical studies of massive blood transfusion, cardiopulmonary bypass and patients with coagulation abnormalities undergoing minor invasive procedures were reviewed. BENEFITS, HARMS AND COSTS: By following this guideline unnecessary costs to hospitals and patients will be avoided and the well-known risks of blood transfusion will be decreased. Appropriate use will also result in the greater availability of plasma for fractionation into concentrates for the treatment of the haemophilias, of which there is usually a shortage. RECOMMENDATIONS: Definite indications for the use of FFP: (i) replacement of single factor deficiencies; (ii) immediate reversal of warfarin effect; (iii) vitamin K deficiency associated with active bleeding; (iv) acute disseminated intravascular coagulation; (v) thrombotic thrombocytopenic purpura; and (vi) inherited deficiencies of inhibitors of coagulation. Conditional uses (if there is bleeding and evidence of disturbed coagulation): (i) massive transfusion; (ii) liver disease; and (iii) cardiopulmonary bypass surgery. No justification for the use of FFP: (i) hypovolaemia; (ii) plasma exchange procedures; (iii) nutritional support and protein-losing states; and (iv) treatment of immunodeficiency states. VALIDATION: This guideline was circulated in draft form for review by clinical users or groups representing blood users in the regions served by the various blood transfusion services.