Fresh Frozen Plasma Use in Cats

In the Literature

Lane WG, Sinnott-Stutzman VB. Retrospective evaluation of fresh frozen plasma use in 121 cats: 2009-2016. J Vet Emerg Crit Care (San Antonio). 2020;30(5):558-566.

The Research …

There are extensive guidelines for appropriate use of fresh frozen plasma (FFP) in human medicine, but similar guidelines are not available in veterinary medicine.^1-3 Literature on use of FFP in cats is limited, and doses have not been reported, with the exception of nonspecies-specific recommendations of 6 to 20 mL/kg for treatment of coagulopathy.^4,5

This retrospective study reported findings on FFP administration in 121 cats. The goal was to document indications for use, doses, and frequency of adverse transfusion reactions. 

Multiple indications for transfusion were recorded in medical records and included suspected coagulopathy (84%), hemorrhage (35%), persistent hypotension (25%), and hypoalbuminemia (5%). Odds of survival to discharge were 2.4 times more likely in cats with improvement in coagulation parameters posttransfusion. Most cats receiving FFP for coagulopathy (58%) and hemorrhage (67%) survived, whereas only 26% of cats with persistent hypotension and 14% of cats with hypoalbuminemia survived. This was likely due to disease severity. 

The median FFP dose (6 mL/kg) was not associated with survival. There was a negative correlation between dose and body weight, likely due to the common practice of administering 1 unit of FFP per cat, causing larger cats to receive a smaller dose. 

Possible adverse transfusion reactions were seen in 16% of cats; increased body temperature and tachypnea were most common. Occurrence of an adverse transfusion reaction was not associated with survival. The rate of FFP transfusion was not significantly different between cats with and without a reaction.  

Indications for FFP use in cats parallel those in dogs and are similar to established guidelines in human medicine. Controversies surrounding use of FFP in human medicine are common, especially for prophylactic use in patients with prolonged clotting times but no clinical bleeding.^1,6 This study highlighted similar discrepancies, as approximately one-third of cats received FFP due to prolonged clotting times without clinical bleeding.

… The Takeaways

Key pearls to put into practice:

• Cats with improved pre- and posttransfusion clotting times were 2.4 times more likely to survive. Administering an appropriate starting dose (eg, 6 mL/kg) should therefore be considered in place of the common practice of giving 1 unit per cat, especially in larger cats.

• Increased temperature and tachypnea were the most common adverse transfusion reactions reported in this study. There was no correlation between adverse transfusion reactions and survival, and there was no difference in FFP transfusion rates between cats with and without an adverse transfusion reaction. Fear of transfusion reaction should not preclude use of FFP in treatment of coagulopathy in bleeding patients.

• Reduction in hemorrhage has not been consistently shown with prophylactic FFP use in human literature,^7,8 and prophylactic use of FFP is controversial in veterinary medicine. Further prospective studies in cats are warranted.