Fresh frozen plasma (FFP)

• Consideration should be given for risk of volume overload prior to utilizing FFP. Conditions associated with poor or compromised cardiac function may be relative contraindications
• FFP replaces all coagulation factors, but cannot fully correct coagulopathy; FIX Levels may only reach 20%
• FFP has a short half-life (FVII= ^~4-6 hours), and may require repeat dosing after 6 hours
• Adult Dose: 10-30 mL/kg (1 unit= ^~250 mL) or 2-6 units for adults
• VKA Reversal: FFP has only a partial effect on VKA reversal, and therefore should only be used as a single agent in the absence of severe bleeding. (Grade 2B). Reversal of anticoagulation in VKA patients with major bleeding requires administration of a PCC or rVIIa in preference to FFP

Cryoprecipitate

• 1 unit contains 200 mg of fibrinogen and 100 units of FVIII (80-110 IU); 10 units will contain approximately 2 grams of fibrinogen, and raise the fibrinogen level by 70 mg/dL in a 70 kg patient
• May be considered as a part of reversal of fibrinolytic therapy or direct thrombin inhibitors. Rarely, cryoprecipitate may be used in uremic bleeding that does not respond to other measures

Platelets

• Indication: Active bleeding or periprocedural prophylaxis for patients with thrombocytopenia or a platelet function defect (i.e. antiplatelet therapy):
• Goal platelet count:
  • >50,000/microL for most bleeding episodes and surgical procedures
  • >80,000/microL for epidural anesthesia
  • >100,000/microL in DIC, CNS bleeding, CNS/ocular surgery
• 1 apheresis platelet unit is composed of 5-8 whole blood units, and is expected to raise the platelet count by ^~10-30,000/microL