Dried plasma: state of the science and recent developments

Abstract

The early transfusion of plasma is important to ensure optimal survival of patients with traumatic hemorrhage. In military and remote or austere civilian settings, it may be impossible to move patients to hospital facilities within the first few hours of injury. A dried plasma product with reduced logistical requirements is needed to enable plasma transfusion where medically needed, instead of only where freezers and other equipment are available. First developed in the 1930s, pooled lyophilized plasma was widely used by British and American forces in WWII and the Korean War. Historical dried plasma products solved the logistical problem but were abandoned because of disease transmission. Modern methods to improve blood safety have made it possible to produce safe and effective dried plasma. Dried plasma products are available in France, Germany, South Africa, and a limited number of other countries. However, no product is available in the US. Promising products are in development that employ different methods of drying, pathogen reduction, pooling, packaging, and other approaches. Although challenges exist, the in vitro and in vivo data suggest that these products have great potential to be safe and effective. The history, state of the science, and recent developments in dried plasma are reviewed.

Plasma for burn shock resuscitation: is it time to go back to the future?

“…In that instance, plasma was delivered by the blood bank at the Massachusetts General Hospital to the bedside diluted half and half with normal saline; the assumption is that this was lyophilized plasma; however, the literature is not clear why is was diluted with normal saline. During World War II, widespread availability of plasma enabled it to play a prominent role in the resuscitation of combat casualties …”

Different resuscitation strategies and novel pharmacologic treatment with valproic acid in traumatic brain injury

“…Freeze-dried plasma has been shown to be as effective as FFP in large animal models of TBI and hemorrhage (Imam, 2013a; Halaweish, 2016). Freeze dried plasma is approved for clinical use in Europe, and has been used by NATO forces for many years with good results (Alam, 2011a; Pusateri, 2016). However, it is currently not approved by the Food and Drug Administration (FDA) for use in the USA.…”

Quality Assessment of Established and Emerging Blood Components for Transfusion

“…Several modified versions of plasma also offer enhancements over the traditional products with respect to ease of administration or safety. Dehydrated plasma is stable at room temperature and can therefore be more easily transported into austere environments remote from hospitals, rapidly rehydrated, and administered in the field [40]. Specifically, lyophilized plasma is available for military and/or civilian use in some countries, and spray-dried plasma is under investigation.…”

“…Plasma was originally introduced into clinical practice, during World War II, as a lyophilized product appropriate for battlefield use [40]. Such dehydrated plasma formulations attempt to replace conventional plasma with a product that does not require a cold-storage chain and which can be reconstituted more rapidly than frozen plasma can be thawed.…”