In the future, pathogen-reduced (PR), PLT additive solution (PAS) CS-PLTs seem more practical due to low risks of bacterial contamination and storage-related clotting. This should make longer storage of CS-PLTs feasible (e.g., 10 days or more). With a longer shelf life, PR PAS CS-PLTs could potentially be used in a wider range of patient populations.

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Factors associated with a poor outcome following renovascular injuries include blunt trauma, the presence of a grade V injury, and an attempted arterial repair. Patients with blunt major vascular injuries (grade V) are likely to have associated major parenchymal disruption, which contributes to the poor function of the revascularized kidney. These patients may be best served by immediate nephrectomy, provided that there is a functioning contralateral kidney.

Objective Major trauma is an independent risk factor for developing venous thromboembolism (VTE). While increases in thrombin generation and/or procoagulant microparticles (MP), have been detected in other patient groups at higher risk for VTE, such as cancer or coronary artery disease, this association has yet to be documented in trauma patients. This pilot study was designed to characterize and quantify thrombin generation and plasma MP in individuals early after traumatic injury. Methods Blood was collected in the trauma bay from 52 blunt injured patients (case) and 19 non-injured outpatients (controls) and processed to platelet poor plasma for 1) isolation of MP for identification and quantification by flow cytometry; and 2) in vitro thrombin generation as measured by calibrated automatic thrombography (CAT). Data collected are expressed as either mean ± standard deviation or median with interquartile range. Results Among cases, 39 men and 13 women (age = 40 ± 17), the injury severity score was 13 ± 11, INR 1.0 ± 0.1, PTT 25 ± 3 (sec), and platelet count 238 ± 62 (thousands). The numbers of total (cell-type not specified) procoagulant MP, as measured by Annexin V staining, were increased compared to non-trauma controls (541 ± 139/μl and 155 ± 148/μl, respectively, p<0.001). There was no significant difference in the amount of thrombin generated in trauma patients compared to controls; however, peak thrombin was correlated to injury severity, (Spearman correlation coefficient R= 0.35, p=0.02). Conclusion Patients with blunt trauma have greater numbers of circulating procoagulant MP and increased in vitro thrombin generation. Future studies, to characterize the cell-specific profiles of MP and changes in thrombin generation kinetics post-traumatic injury will determine whether they contribute to the hypercoagulable state observed after injury.

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Use of plasma-first resuscitation in the helicopter system creates a field ready, mobile blood bank, allowing early resuscitation of the patient demonstrating need for massive transfusion. There was early treatment of trauma-induced coagulopathy. Although there was not a survival benefit demonstrated, there was resultant damage control resuscitation extending to 24 hours in the plasma-first cohort.