The authors are right in proposing clinical trials demonstrating the therapeutic indication of FFP. At a time in which everybody asks for evidence-based medicine (often because of economic reasons), which is understood as therapy, etc., being based on randomized double blind or controlled studies showing significant
advantages for the respective therapy, clinical experience and even logic seem not to be accepted. Sometimes blood bankers should rely on the experience of the clinicians. To hesitate with the administration of FFP in patients with
elevated INR before or during major surgery (going along with hemodilution) may cause hemostaseologically derived bleeding complications which cannot be easily stopped, and finally may force the clinicians to use the extremely expensive recombinant FVIIa. Heating of FFP is too slow in order to wait
until bleeding complications are manifest. Finally, one should not overestimate the risks of FFP. Only TRALI is really dangerous, but why don’t we use FFP only from male donors or at least not from multipara?

– Volker Kretschmer