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).

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