title: Better hemostatic profiles of never-frozen liquid plasma compared with thawed fresh frozen plasma.
abstract: BACKGROUND
  Immediate use of thawed fresh frozen plasma (FFP) when resuscitating hemorrhagic shock patients has become more common. According to the AABB (formerly known as American Association of Blood Banks), FFP is the preferred product that can be used up to 5 days after thawing. However, limited data exist on the clinical use and hemostatic profiles of Food and Drug Administration-approved liquid plasma (LQP), which can be stored at 1 °C to 6 °C for up to 26 days. We characterized changes in LQP hemostatic potential during 26 days of cold storage.
  
  
  METHODS
  Ten FFP and 10 LQP single-donor units, matched by sex and blood group, were analyzed. FFP was thawed and kept refrigerated for 5 days and LQP for 26 days. Plasma samples were evaluated at Days 0 and 5 for thawed plasma (TP) and 0, 5, 10, 20, and 26 for LQP, by thrombelastography, thrombogram, platelet counts, platelet microparticles, clotting factors, and natural coagulation inhibitors.
  
  
  RESULTS
  LQP had a better capacity to form a clot and generate thrombin compared with TP. LQP's hemostatic potential, expressed as endogenous thrombin potential (total amount of thrombin [nM] formed over time [minute]), initially exceeded that of TP (1,425 vs. 1,184, p < 0.05) but decreased to levels similar to TP by Day 26 (1,201 vs. 1,103, p = 0.15). Significantly higher platelet microparticles were found in LQP on Day 26 compared with those in LQP on Day 0 (23.6 x 10(9)/L vs. 3 x 10(9)/L, p < 0.001) or those in TP on Day 5 (2.8 x 10(9)/L). By Day 26, the majority of clotting factors and inhibitors retained more than 88% of their initial activities in LQP, with the few exceptions of factors well known to be unstable.
  
  
  CONCLUSIONS
  The hemostatic profiles of LQP were better and sustained five times longer than the more commonly used TP, indicating that never-frozen plasma can be considered for use in the United States in trauma patients requiring immediate plasma resuscitation.
authors.affiliation: Center for Translational Injury Research, Department of Surgery, University of Texas Health Science Center at Houston, Texas 77030, USA. Nena.matijevic@uth.tmc.edu
authors.forename: Nena
authors.initials: N
authors.lastname: Matijevic
authors.forename: Yao-Wei
authors.initials: YW
authors.lastname: Wang
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Hartwell
authors.forename: James M
authors.initials: JM
authors.lastname: Barbeau
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000032:analysis / Q000037:antagonists & inhibitors; D001793:Blood Preservation; D006487:Hemostasis; D006801:Humans; D008297:Male; D010949:Plasma; D010976:Platelet Count; D013916:Thrombelastography; D013917:Thrombin / Q000032:analysis; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D001779:Blood Coagulation Factors; D013917:Thrombin