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Understanding the Use of Fresh Frozen Plasma (FFP) in Correcting Coagulation Abnormalities: A Clinical Case Review

  • Writer: Mayta
    Mayta
  • May 22, 2024
  • 3 min read

"Ordering a group match and administering 2 units of FFP IV free flow while holding IV during the transfusion has a crucial impact on correcting elevated INR and PT levels. This targeted approach rapidly replenishes deficient clotting factors, normalizing coagulation times and stabilizing the patient. Following the FFP administration, reassessing PT, PTT, and INR ensures the effectiveness of the intervention, confirming that the bleeding risk is minimized. This protocol is vital for managing patients at high risk of bleeding, whether due to liver dysfunction, vitamin K deficiency, or other coagulopathies, thereby enhancing clinical outcomes and ensuring patient safety during critical periods." Case Overview

In this clinical case, we explore the rationale behind ordering a group match for Fresh Frozen Plasma (FFP), administering it to the patient, and subsequently reassessing coagulation parameters (PT, PTT, INR). This process is crucial for managing patients with coagulation abnormalities effectively.

Patient Profile

  • Age/Sex: 59-year-old male

  • Initial Lab Results:

  • PT (Prothrombin Time): 17.6 sec (High, reference range: 10.3-12.9 sec)

  • INR (International Normalized Ratio): 1.54 (Reference range: 0.8-1.2)

  • PTT (Partial Thromboplastin Time): 30.6 sec (Reference range: 22.6-31.5 sec)

  • WBC: 25.4 x10^3/µL (High, reference range: 4-10 x10^3/µL)

  • Hemoglobin (HGB): 9.7 g/dL (Low, reference range: 13-17 g/dL for males)

  • Hematocrit (HCT): 31.4% (Low, reference range: 40-50% for males)

  • Mean Corpuscular Volume (MCV): 68.5 fL (Low, reference range: 80-100 fL)

Interpreting Coagulation Abnormalities

  • Prolonged PT and Elevated INR: Indicate deficiencies in clotting factors, particularly those involved in the extrinsic pathway (Factors II, V, VII, X).

  • Normal PTT: Suggests that the intrinsic pathway (Factors VIII, IX, XI, XII) is not significantly affected.

Clinical Context

  • Anemia and Hypochromic Microcytosis: The presence of anemia and microcytic red blood cells suggests a chronic condition that may be linked to bleeding, iron deficiency, or a hemoglobinopathy.

  • High WBC: May indicate an underlying infection or inflammatory process.

  • Coagulation Profile: Points to potential issues such as liver dysfunction, vitamin K deficiency, or disseminated intravascular coagulation (DIC).

Why Order Group Match FFP?

  • Correct Coagulation Abnormalities:

  • FFP contains all necessary clotting factors, essential for correcting deficiencies highlighted by the patient's prolonged PT and elevated INR.

  • Group matching ensures compatibility and reduces the risk of transfusion reactions.

  • Preparation for Procedures:

  • Normalizing coagulation parameters is crucial before any invasive procedure or surgery to minimize bleeding risks.

  • Managing Active or Anticipated Bleeding:

  • In cases of active bleeding or high bleeding risk, FFP provides essential clotting factors to stabilize the patient.

Administration and Monitoring

  • Administering FFP:

  • 2 Units of FFP: This initial dose is standard for correcting coagulation factor deficiencies.

  • IV Free Flow: Rapid infusion is necessary if there is an urgent need to correct coagulopathy, such as during active bleeding.

  • Rechecking Coagulation Parameters Post-Transfusion:

  • Monitoring PT, PTT, and INR after FFP administration is vital to assess the effectiveness of the transfusion. Improvement in these parameters indicates successful replenishment of clotting factors.

Clinical Management Summary

  • Order FFP Group Match:

  • Ensure compatibility and prepare for potential transfusion needs.

  • Administer 2 Units of FFP IV Free Flow:

  • Correct coagulopathy urgently, especially in cases of active bleeding or preoperative preparation.

  • Reassess Coagulation Parameters:

  • Check PT, PTT, and INR post-transfusion to evaluate the response and guide further treatment.

By understanding each step's rationale, clinicians can better manage patients with coagulation abnormalities, anticipating potential needs for blood products and monitoring. This approach ensures safe and effective patient care, particularly in emergency or perioperative settings.

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Post: Blog2_Post

Message for International Readers
Understanding My Medical Context in Thailand

By Uniqcret, M.D.
 

Dear readers,
 

My name is Uniqcret, which is my pen name used in all my medical writings. I am a Doctor of Medicine trained and currently practicing in Thailand, a developing country in Southeast Asia.
 

The medical training environment in Thailand is vastly different from that of Western countries. Our education system heavily emphasizes rote memorization—those who excel are often seen as "walking encyclopedias." Unfortunately, those who question, critically analyze, or solve problems efficiently may sometimes be overlooked, despite having exceptional clinical thinking skills.
 

One key difference is in patient access. In Thailand, patients can walk directly into tertiary care centers without going through a referral system or primary care gatekeeping. This creates an intense clinical workload for doctors and trainees alike. From the age of 20, I was already seeing real patients, performing procedures, and assisting in operations—not in simulations, but in live clinical situations. Long work hours, sometimes exceeding 48 hours without sleep, are considered normal for young doctors here.
 

Many of the insights I share are based on first-hand experiences, feedback from attending physicians, and real clinical practice. In our culture, teaching often involves intense feedback—what we call "โดนซอย" (being sliced). While this may seem harsh, it pushes us to grow stronger, think faster, and become more capable under pressure. You could say our motto is “no pain, no gain.”
 

Please be aware that while my articles may contain clinically accurate insights, they are not always suitable as direct references for academic papers, as some content is generated through AI support based on my knowledge and clinical exposure. If you wish to use the content for academic or clinical reference, I strongly recommend cross-verifying it with high-quality sources or databases. You may even copy sections of my articles into AI tools or search engines to find original sources for further reading.
 

I believe that my knowledge—built from real clinical experience in a high-intensity, under-resourced healthcare system—can offer valuable perspectives that are hard to find in textbooks. Whether you're a student, clinician, or educator, I hope my content adds insight and value to your journey.
 

With respect and solidarity,

Uniqcret, M.D.

Physician | Educator | Writer
Thailand

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