B. R. Huebner1, C. C. Silliman1,3, R. Shepherd-Singh2, G. Stettler1, H. B. Moore1, G. Nunns1, A. Banerjee1, E. E. Moore1,2 1University Of Colorado Denver,Trauma Surgery,Aurora, CO, USA 2Denver Health Medical Center,Trauma Surgery,Aurora, CO, USA 3Bonfils Blood Center,Denver, CO, USA
Introduction:
Emerging evidence supports plasma-first resuscitation in the treatment of trauma-induced-coagulopathy (TIC). The logistics of plasma-first resuscitation require thawed plasma (TP) be readily available due to the thawing time of fresh frozen plasma (FFP) (30-minutes at 37°C). The current standard is storage of TP for up to 5 days at 4°C for use in major hemorrhage scenarios, but there remains a 2.2% outdated wastage rate accounting for 129,000 discarded units each year. This 5-day lifespan of TP prevents smaller hospital from having it readily available, and is based on factors V, VII, and VIII levels at outdate. However, the key plasma proteins in attenuating fibrinolysis and correction of TIC remain unknown as does their change in activity level over the thawed storage time. We hypothesize that TP retains the ability to inhibit tPA-induced fibrinolysis at 14 days storage at 1-4°C.
Methods:
Pooled FFP was thawed and stored at 1-4°C at the following intervals: 14, 10, 7, 5, 3, and 1-day prior to the experiment. Healthy volunteers participated: 80% men, not pregnant or taking any medications at the time of blood draw (n=5). Blood was drawn into citrated tubes followed by a 50% dilution of whole blood (WB) with the above TP intervals as well as FFP, normal saline (NS), albumin, and WB control. Samples underwent citrated tPA-modified (75ng/ml) thromboelastography (TEG). TEG parameters including R-time, angle, maximum amplitude (MA), and LY30 were examined.
Results:
14-day TP retained the ability to inhibit tPA-induced hyperfibrinolysis (median LY30% 8.4) similar to FFP (6.4%), WB (14.6%) and superior to albumin (59.3%, p<0.00001) and NS (58.1%, p<0.00001) (figure 1). All TP intervals demonstrated similar clot characteristics to FFP including rate of clot initiation (R-time), rate of clot formation (angle), maximum clot strength (MA), and resistance to clot breakdown (LY30, figure 1) on tPA-challenge TEG. 14-day TP retained superior clot strength (median MA, 61.5mm) to albumin (21.6, p=0.001) and normal saline (32.2, p=0.0003). 14-day TP also had a faster rate of clot formation (median anlge, 66.2°) compared to albumin (34.8°, p=0.002) and normal saline (41.6°, p=0.006).
Conclusion:
TP plasma retained the ability to inhibit tPA-induced fibrinolysis as well as speed of clot formation (angle) and strength of clot formation (MA) over 14-day storage at 1-4°C. A clinical trial is needed to validate these in vitro results but consideration should be made to increasing the storage life of TP.
