B. A. Cotton1, J. C. Cardenas1, E. Hartwell1, C. E. Wade1, J. B. Holcomb1, N. Matijevic1 1University Of Texas Health Science Center At Houston,Acute Care Surgery/Surgery,Houston, TX, USA
Introduction: While the transfusion of plasma has increased over the last decade, the
availability of this product has seen dramatic changes that continue to threaten the current
supply. The conversion to male predominant plasma has further limited potential donors
of emergency release products used for intial resuscitaion in trauma. During this same
period, investigators have demonstrated a sexual dimorphism in response to sepsis and
injury, with less multiple organ failure and improved survival observed in premenopausal
females. Plasma from female donors who are pregnant or taking oral contraceptives often
has a green appearance. This green discoloration (due to increased ceruloplasmin levels)
frequently results in these units being discarded or removed from the donor pool for
commercial use, purely based on its appearnace. The purpose of this pilot study was to
evaluate the hemostatic potential and capacity of green plasma compared to standard
color plasma.
Methods: We obtained plasma from 12 blood group-matched female donors from our
local blood center. Six of these units had a normal appearing hue (STANDARD) and six
were grossly green-appearing plasma (GREEN). These units were then evaluated by
thrombelastography (TEG), calibrated automated thrombogram (CAT) and factor level
measurements. Univariate analysis was then performed using Wilcoxon rank sum and
values are expressed in medians with 25th and 75th interquartile range.
Results: GREEN plasma had a more hypercoagulable TEG profile for all values (r-value:
1.6 vs. 3.1 min, p=0.004; k-time: 2.2 vs. 4.8 min, p=0.088, angle: 69 vs 42 degrees,
p=0.004; mA: 38 vs. 25 mm, p=0.054) when compared to STANDARD plasma.
Differences were also observed with coagulation factor levels comparison, with
GREEN plasma having higher levels than STANDARD (factor II: 107 vs. 96%, p=0.004;
factor VII: 124 vs. 106%, p=0.149; factor IX: 145 vs. 114%, p=0.077; factor X: 125 vs.
102%, p=0.006; factor XI: 121 vs. 101%, p=0.025). Using CAT, GREEN plasma had
higher lag time (4.1 vs. 3.6 min, p=0.037) and increased endogenous thrombin potential
(1669 vs. 1280 nM/min, p=0.114).
Conclusion: This pilot study demonstrates that plasma from female donors that has a green color has a
superior hemostatic profile than standard color plasma. Current AABB recommendations
for male-predominant plasma have further reduced the availability of emergency release
plasma for life-threatening bleeding. GREEN plasma should be further investigated for
its safety profile and hemostatic potential. Should it prove to be a safe and functionally
non-inferior (and potentially superior) product, GREEN plasma should be actively
re-introduced into the medical community for transfusion of critically injured and
bleeding patients.