BLOOD COMPONENTS: Instituting a thawed plasma procedure: it just makes sense and saves cents

Wehrli, Gay; Taylor, Nancy E.; Haines, Annette L.; Brady, Tim; Mintz, Paul D.

doi:10.1111/j.1537-2995.2009.02342.x

Cited by 35 publications

(26 citation statements)

References 12 publications

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“…54 It should be noted that using fixed ratios may increase the wastage of FFPs and PCs, although recently published data indicate that this problem can be adequately addressed. 55 Conversely, most transfusion data suggest that early balanced transfusion decreases overall use of blood products while improving survival. 56 Unquestionably, clear clinical goals for when to stop the MTP should be in place.…”

Section: Discussionmentioning

confidence: 99%

How I treat patients with massive hemorrhage

Johansson

Stensballe

Oliveri

et al. 2014

Blood

179

127

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Massive hemorrhage is associated with coagulopathy and high mortality. The transfusion guidelines up to 2006 recommended that resuscitation of massive hemorrhage should occur in successive steps using crystalloids, colloids, and red blood cells (RBCs) in the early phase and plasma and platelets in the late phase. With the introduction of the cell-based model of hemostasis in the mid-1990s, our understanding of the hemostatic process and of coagulopathy has improved. This has contributed to a change in resuscitation strategy and transfusion therapy of massive hemorrhage along with an acceptance of the adequacy of whole blood hemostatic tests to monitor these patients. Thus, in 2005, a strategy aiming at avoiding coagulopathy by proactive resuscitation with blood products in a balanced ratio of RBC:plasma:platelets was introduced, and this has been reported to be associated with reduced mortality in observational studies. Concurrently, whole blood viscoelastic hemostatic assays have gained acceptance by allowing a rapid and timely identification of coagulopathy along with enabling an individualized, goal-directed transfusion therapy. These strategies joined together seem beneficial for patient outcome, although final evidence on outcome from randomized controlled trials are lacking. We present how we in Copenhagen and Houston, today, manage patients with massive hemorrhage.

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Section: Discussionmentioning

confidence: 99%

How I treat patients with massive hemorrhage

Johansson

Stensballe

Oliveri

et al. 2014

Blood

179

127

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“…The AB blood type accounts for only 3% of the population but up to 25% of all plasma transfused, with higher proportions in trauma patients. 25 Initial implementation of the increased thawed plasma lifespan (from 24 to 96 hours) significantly decreased discarded plasma, 14,15 and a similar decrease in discard rate of this valuable resource could be expected with expansion to 14 days. And while certain coagulation factors are known to lose significant activity over a 14-day thawed storage time, 5,19 we have shown that a substantial dilution with 14-day TP resulted in enhancement of clot formation compared to whole blood.…”

Section: Discussionmentioning

confidence: 89%

“…This would lead to greater availability of TP at smaller hospitals and limit the amount of plasma wastage at larger hospitals with TP currently available. 14,15 …”

Section: Discussionmentioning

confidence: 99%

14-Day thawed plasma retains clot enhancing properties and inhibits tPA-induced fibrinolysis

Huebner¹,

Moore

Moore³

et al. 2017

Journal of Surgical Research

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Background Plasma-first resuscitation attenuates trauma-induced-coagulopathy (TIC), however, the logistics of plasma-first resuscitation require thawed plasma (TP) be readily available due to the obligatory thawing time of FFP. The current standard is storage of TP for up to 5 days at 4°C, based on factor levels at outdate, for use in patients at risk for TIC, but there remains a 2.2% outdated wastage rate. However, the multitude of plasma proteins in attenuating TIC remain unknown. We hypothesize that TP retains the ability to enhance clotting and reduce tPA-induced fibrinolysis at 14 days storage. Methods FFP was thawed and stored at 4°C at the following intervals: 14, 10, 7, 5, 3, and 1-day prior to the experiment. Healthy volunteers underwent blood draws followed by 50% dilution with above TP stored intervals as well as FFP, normal saline (NS), albumin, and whole blood (WB) control. Samples underwent tPA-modified (75ng/ml) thrombelastography (TEG) with analysis of R-time, angle, maximum amplitude (MA), and LY30. Results TEG properties did not change significantly over the thawed storage. 14-day TP retained the ability to inhibit tPA-induced hyperfibrinolysis (median LY30% 9.6%) similar to FFP (5.6%), WB (14.6%) and superior to albumin (59.3%) and NS (58.1%). 14-day TP also retained faster clot formation (median angle, 66.2°) and superior clot strength (MA, 61.5mm) to albumin (34.8°, 21.6mm) and NS (41.6°, 32.2mm). Conclusion TP plasma stored for 14 days retains clot enhancing ability and resistance to clot degradation similar to FFP. A clinical trial is needed to validate these in vitro results.

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“…Nascimento et al [29] documented higher FFP wastage (measurement criteria not stated) in the "1:1:1" cohort of their study. On the other hand, Wehri et al [30] found that having a thawed plasma program reduced plasma discard by 76.3% in their hospital. However, this was achieved in part by extending the shelf-life of pre-thawed refrigerated plasma to 5 days [30].…”

Section: The Controversymentioning

confidence: 96%

“…proper refrigeration before transfusion, increasing the shelf-life of thawed plasma [30], timely deactivation of "1:1:1"), and blood bank policy that accepts returned unused products.…”

Section: The Controversymentioning

confidence: 99%

The traditional vs “1:1:1” approach debate on massive transfusion in trauma should not be treated as a dichotomy

Holcomb²,

et al. 2015

The American Journal of Emergency Medicine

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BLOOD COMPONENTS: Instituting a thawed plasma procedure: it just makes sense and saves cents

Cited by 35 publications

References 12 publications

How I treat patients with massive hemorrhage

How I treat patients with massive hemorrhage

14-Day thawed plasma retains clot enhancing properties and inhibits tPA-induced fibrinolysis

The traditional vs “1:1:1” approach debate on massive transfusion in trauma should not be treated as a dichotomy

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