Key Takeaways

✅ Transfusion of plasma products is indicated for:

• Multiple factor deficiencies, such as in massive transfusion, fulminant liver disease and warfarin reversal
• Replacement fluid: plasmapheresis for thrombotic thrombocytopenia purpura (TTP)
• Bleeding or disseminated intravascular coagulation (DIC)
• Correction of single factor deficiencies when concentrate or recombinant factor is unavailable

✅ Transfusion of plasma products is NOT indicated for:

• Mildly prolonged coagulation tests; patients with INR<1.7
• Correction of abnormal lab tests resulting from vitamin K deficiency (unless urgent invasive procedures are planned or if the patient is actively bleeding)
• Volume expansion
• Nutritional or protein support
• Coagulopathy that can be corrected with specific therapy
• Immunoglobulin deficiencies

✅ The decision to transfuse and the assessment of response to plasma therapy should be based guided by patient’s clinical status and coagulation studies (PT, aPTT). INR can be used as a PT surrogate only in patients taking vitamin K antagonists (VKA).