Trauma patients who either have, or are at risk for coagulopathy, routinely have plasma administered. This provides coagulation factors to make up for lower levels in the injured patient and promotes the ability to clot. All hospitals with a blood bank have fresh frozen plasma (FFP) on hand, and busier ones may have thawed plasma (TP) available so that the patient does not have to wait the 45 minutes or so that it takes to thaw FFP.

But does freshly thawed FFP behave like thawed plasma that’s been sitting around for a while? The University of Texas – Houston trauma group presented some work that looked at this issue at the AAST conference last September. They looked at differences between freshly thawed FFP and plasma that had been thawed for 5 days. They examined the plasma’s ability to generate thrombin, the kinetics of clot formation along with the clot’s strength and stability, and clotting factor assays.

They found that the older thawed plasma showed decreased clotting potential, as well as diminished amounts of coag factors, especially V, VIII, von Willebrand factor and Protein S. The clotting response (measured by TEG) was slower and took longer to develop the maximum amount of clot.

Bottom Line: Older thawed plasma does not function the same as freshly thawed FFP in the lab. We don’t know if this difference has clinical significance in the coagulopathic trauma patient. However, it seems prudent to ask for the freshest bags of thawed plasma during massive tranfusion in hospitals that use it.

Reference: Multiple levels of degradation diminish stored plasma’s hemostatic potential. Holcomb et al. Oral presentation #10, 69th Annual Meeting of the AAST, September 22, 2010.