Query: fresh frozen plasma

title: French lyophilized plasma versus normal saline for post traumatic coagulopathy prevention and correction: PREHO PLYO protocol for a multicenter randomized controlled clinical trial
abstract: Post trauma bleeding induces an acute deficiency in clotting factors, which promotes bleeding and hemorrhagic shock. However, early plasma administration may reduce the severity of trauma induced coagulopathy (TIC) Unlike fresh frozen plasma, which requires specific hospital logistics, French lyophilized plasma (FLYP) is storable at room temperature and compatible with all blood types, supporting its use in prehospital emergency care. We aim to test the hypothesis that by attenuating TIC, FLYP administered by prehospital emergency physicians would benefit the severely injured civilian patient at risk for hemorrhagic shock.  This multicenter randomized clinical trial will include adults severely injured and at risk for hemorrhagic shock, with a systolic blood pressure 70 mmHg or a Shock Index 1.1. Two parallel groups of 70 patients will receive either FLYP or normal saline in addition to usual treatment. The primary endpoint is the International Normalized Ratio (INR) at hospital admission. Secondary endpoints are transfusion requirement, length of stay in the intensive care unit, survival rate at day 30, usability and safety related to FLYP use, and other biological coagulation parameters.  With this trial, we aim to confirm the efficacy of FLYP in TIC and its safety in civilian prehospital care. The study results will contribute to optimizing guidelines for treating hemorrhagic shock in civilian settings.

title: Therapeutic plasma exchange as a routine therapy in septic shock and as an experimental treatment for COVID 19: we are not sure
abstract: We read with interest the recent editorial by Keith et al. who concluded that their practice has changed based on their experience, and they now often utilize therapeutic plasma exchange (TPE) earlier in the clinical course of septic shock with multiple organ failure (MODS) and acute respiratory distress syndrome (ARDS) rather than using it as a "rescue therapy"  We would like to make some comments. They quoted several studies, including one from Knaup et al. in order to support their argument [2] They assert that TPE is unique by offering benefit on multiple levels by removing inflammatory cytokines, stabilizing endothelial membranes, and resetting the hypercoagulable state  Knaup et al. stated that a major difference between TPE and modern extracorporeal adsorption strategies is based on the fact that the exchange of septic shock plasma with fresh frozen plasma may not lead to an unselective depletion of proand anti inflammatory cytokines and will rather replenish protective factors (within FFPs) that have been consumed by the sepsis  It is currently impossible when employing an unselective removal technique to know if we are doing something good by removing an excess of pro inflammatory mediators or something wrong by removing anti inflammatory mediators. At this time, we are unable to clearly identify at the bedside which patients are in a pro inflammatory state that could kill them or an anti inflammatory state that could help them to survive. The fact that the inflammation is huge during COVID 19 does not justify the non selective removal of inflammation components, when some elements may be saving patients. TPE also has the potential to cause harm by diluting or attenuating the host's adaptive response to infection by depletion of immunoglobulins and complement component 3 and 4 in individuals treated with plasmapheresis  Importantly, in the case of SARSCoV 2 outbreak, TPE will remove the protective antibodies formed by the patient, which is not desirable. In conclusion, TPE may not restore immune homeostasis but may rather aggravate immunoparalysis  We agree with the authors that this outbreak should serve as an impetus to investigate therapies targeting the pathways that lead to morbidity and mortality in these syndromes  This does not mean that we have received a signed blank check to start a therapy without deeply reviewing the rationale and the quality of existing data.

title: Freeze dried plasma in major haemorrhage: a systematic review
abstract: Freeze dried plasma (FDP) has logistical advantages in terms of storage and reconstitution time compared to fresh frozen plasma. In vitro studies show FDP to be equivalent to fresh frozen plasma regarding coagulation and clotting capacities. FDP is used in an increasing number of countries. We wanted to evaluate the clinical effects of FDP in major haemorrhage compared to standard care.

title: Efficacy of albumin and compounded plasma for plasma exchange in acquired thrombotic thrombocytopenic purpura
abstract: Thrombotic thrombocytopenic purpura (TTP) is a rare life threatening thrombotic microangiopathy. Therapeutic plasma exchange (TPE) is the first line treatment for TTP. In our institution, albumin plus plasma (fresh frozen plasma [FFP] and/or cryoprecipitate reduced plasma [CRP] has been used as replacement fluid since 2014. We aimed to evaluate the efficacy of albumin combined with plasma as TPE for TTP.

title: Plasma
abstract: Transfusion associated lung injury: case report A 5 year old girl developed transfusion associated lung injury (TRALI) after receiving plasma transfusion for thrombotic thrombocytopenic purpura (TTP) The girl with congenital TTP, was hospitalised with acute hemolytic crisis. Over the following 24 hours, she was transfused with 45 mL/kg of plasma [fresh frozen plasma; route and dose administered not stated] However, on the following morning, she developed respiratory failure requiring intubation [duration of treatment to reaction onset not clearly stated] The girl received RBCs, but the next day, she suddenly developed severe hypoxemia followed by hypotension. Her condition proved refractory to high ventilator settings, high frequency oscillatory ventilation and inhaled nitric oxide. A CT scan showed pulmonary oedema. Then she was cannulated onto veno venous extracorporeal membrane oxygenation (ECMO) using a dual lumen cannula. She was successfully supported with ECMO for an 88 hours run, additionally she was infused with heparin. Throughout the ECMO run, her plasma free hemoglobin levels were 50 130 mg/dL and only RBC transfusion was required. After 7 days, she was decannulated and discharged.

title: Liquid plasma reduces waste and health care expenses compared with thawed plasma at a Level I trauma center.
abstract: Balanced resuscitation strategies have led to increased utilization of plasma. Fresh frozen plasma that is thawed and never used is a large source of blood component wastage. Thawed plasma (TP) and can only be stored for 5 days. Liquid plasma (LP) has never been frozen and can be stored for 26 days. Due to longer storage duration, we hypothesized that using LP would result in decreased waste and cost savings compared with TP.  We performed a retrospective review of all trauma patients at our Level I trauma center in the years 2015 to 2016. We compared 2015 when only TP was used to 2016 when both TP and LP were used. All plasma units ordered for trauma patients were tracked until the time of transfusion or wastage. Wastage rates were compared between years and plasma type.  There were 5,789 trauma patients admitted to our institution from 2015 to 2016. There were 4,107 plasma units ordered with 487 (11.9% units wasted. During 2015, 2,021 total units of plasma were ordered with 273 (13.5% units wasted which was a significantly higher rate than 2016 when 2,086 total units of plasma were ordered and 214 (10.3% units were wasted (p 0.0013) During 2016, 1,739 units of TP were ordered and 204 (11.7% units were wasted which was significantly higher than LP wastage, 347 units ordered and 10 (2.9% units wasted (p 0.001) Of the 477 wasted TP units, 76.9% were ordered no more than two times before being wasted and 95.8% were ordered no more than three times before being wasted. Of the 10 LP units wasted, 40% were ordered no more than two times before being wasted, and 50% were ordered no more than three times before being wasted. If TP was wasted at the same rate as LP, 368 fewer units of plasma would have been wasted representing US $39,376 (US $107/unit) of wasted health care expenses.  At a Level I trauma center, the addition of LP to the blood bank for trauma resuscitations significantly reduced plasma wastage rates and health care expenses.

title: Plasma Transfusion Promoted Reprogramming CD4+ T Lymphocytes Immune Response in Severe Sepsis Mice Model Through Modulating the Exosome Protein Galectin 9
abstract: Sepsis is a life threatening disease that results in excessive stimulation of the host's immune cells. In the animal study, the purpose was to investigate the roles of fresh frozen plasma (FFP) transfusion in shaping the CD4+ T lymphocytes immune response through modulating the secreted exosome protein Galectin 9 in mice with severe sepsis. By using Western blot analysis, we first identified that the protein Galectin 9 is highly accumulated in the blood plasma of severe sepsis mice, and with transmission electron microscopy (TEM) and protein analysis, we found that Galectin 9 is a secreted exosome protein. Thereafter, we treated the severe sepsis mice with the antibiotic Cefuroxime Axetil; one group of mice received FFP transfusion and the other group of mice received normal saline. Surprisingly, the FFP transfusion reduced the secretion of exosome protein Galectin 9 and there was crosstalking between the exosome protein Galectin 9 and CD4+ T lymphocytes in mice with severe sepsis. Results showed that the proliferation of T helper (Th) cells (Th1 and Th17) was promoted, and regulatory T (Treg) cells' maintenance was inhibited in the sepsis mice after receiving FFP transfusion. Correspondingly, this immune reprogrammed activity shaped the inflammatory cytokine secretion with an increase in the interleukin (IL) 1b, IL 6, and interferon gamma levels, while it decreased IL 10 levels. Taken together, it was suggested that FFP transfusion promoted reprogramming of CD4+ T lymphocytes' immune response through inhibiting the secretion of exosome protein Galectin 9 in mice with severe sepsis to relieve immunosuppression.

title: Safety of Plasma Infusions in Parkinson's Disease
abstract: Young plasma infusions have emerged as a potential treatment for neurodegenerative disease, and convalescent plasma therapy has been used safely in the management of viral pandemics. However, the effect of plasma therapy in Parkinson's disease (PD) is unknown.

title: Therapeutic Plasma Exchange Improved Pregnancy associated Thrombotic Microangiopathy but not the Pregnancy Outcome in Patient with Systemic Lupus Erythematosus
abstract: Thrombotic microangiopathy (TMA) is a rare but life threatening complication of systemic lupus erythematosus (SLE) and is associated with adverse pregnancy outcomes. We herein report a 30 year old pregnant woman with SLE complicated by TMA. Because her condition was unresponsive to initial corticosteroid and fresh frozen plasma infusion treatment, we attempted plasma exchange (PE) Although thrombocytopenia and microangiopathic hemolytic anemia gradually improved, fetal death was confirmed at 23 weeks of gestation. This case suggests that PE is an effective therapeutic option but might be insufficient to maintain pregnancy in patients with SLE complicated by TMA.

title: Plasma resuscitation with adjunctive peritoneal resuscitation reduces ischemic intestinal injury following hemorrhagic shock
abstract: Impaired intestinal microvascular perfusion following resuscitated hemorrhagic shock (HS) leads to ischemia reperfusion injury, microvascular dysfunction, and intestinal epithelial injury, which contribute to the development of multiple organ dysfunction syndrome in some trauma patients. Restoration of central hemodynamics with traditional methods alone often fails to fully restore microvascular perfusion and does not protect against ischemia reperfusion injury. We hypothesized that resuscitation (RES) with fresh frozen plasma (FFP) alone or combined with direct peritoneal resuscitation (DPR) with 2.5% Delflex solution might improve blood flow and decrease intestinal injury compared with conventional RES or RES with DPR alone.  Sprague Dawley rats underwent HS (40% mean arterial pressure) for 60 minutes and were randomly assigned to a RES group (n 8) sham, HS crystalloid resuscitation (CR) (shed blood two volumes CR) HS CR DPR (intraperitoneal 2.5% peritoneal dialysis fluid) HS FFP (shed blood two volumes FFP) and HS DPR FFP (intraperitoneal dialysis fluid two volumes FFP) Laser Doppler flowmeter evaluation of the ileum, serum samples for fatty acid binding protein enzyme linked immunosorbent assay, and hematoxylin and eosin (H&E) staining were used to assess intestinal injury and blood flow. p Values of <0.05 were considered significant.  Following HS, the addition of DPR to either RES modality improved intestinal blood flow. Four hours after resuscitated HS, FABP 2 (intestinal) and FABP 6 (ileal) were elevated in the CR group but reduced in the FFP and DPR groups. The H&E staining demonstrated disrupted intestinal villi in the FFP and CR groups, most significantly in the CR group. Combination therapy with FFP and DPR demonstrated negligible cellular injury in H&E graded samples and a significant reduction in fatty acid binding protein levels.  Hemorrhagic shock leads to ischemic reperfusion injury of the intestine, and both FFP and DPR alone attenuated intestinal damage; combination FFP DPR therapy alleviated most signs of organ injury. Resuscitation with FFP DPR to restore intestinal blood flow following shock could be an essential method of reducing morbidity and mortality after trauma.