Fresh frozen plasma is ineffective for reversal of coagulation factor dilution in an in vitro model

As fresh frozen plasma (FFP) loses coagulation factor activity during the production process, FFP therapy may not be feasible to completely replenish coagulation factor concentrations in a clinical setting. The aim of this study was to describe the results of early replacement coagulation factors with FFP in a simplified and idealized in vitro model of dilution. Six ml of whole blood drawn from healthy volunteers was first diluted. Imitating blood loss and replacement with FFP thereafter, 20%, 40%, 60% and 80% of the diluted whole blood was removed and replaced with FFP. Levels of coagulation factors were analyzed with standard assays. FFP did not result in replenishing of coagulation factors. Rather, a trend to a further decrease of most coagulation factors was seen. In this in vitro study, a modelled, limited dilution was stabilized but not reversed by replacing (imitated) blood loss with FFP. As continued coagulation factor consumption and additional dilution due to volume replacement occur in the clinical setting, our data suggest that the use of coagulation factor concentrates seem necessary to replenish coagulation factor activities. FFP does not reverse dilution – An in vitro study 131 FFP transfusion strategies for the prevention and correction of dilutional coagulopathy (4). In this study, the authors calculated that the equivalent of a wholeblood transfusion is necessary to correct or prevent dilutional coagulopathy during resuscitation of a patient with major trauma. The aim of this study was to evaluate the influence of early FFP transfusion on coagulation factor concentrations using an idealized and simple in vitro model of mild dilution. We hypothesized that early administration of FFP sufficiently reverses the dilution of coagulation factors.