Freeze dried plasma: a French army specialty

Abstract

We read with interest the article by Nascimento and colleagues [1] on fresh frozen plasma (FFP) in massive bleedings. We fully agree with their conclusion when they say that we need immediately available universal donor AB plasma. Hemorrhagic shock is the primary cause of avoidable mortality in combatants. Data from the recent US army war experience show clearly that in cases of massive transfusion the transfusion policy strongly impacts mortality. Namely, for massive bleeding the ratio between red blood cells and clotting factors should be close to the composition of whole blood [2]. Plasma is thus essential for massive transfusions. But FFP use is impractical in uncertain environments such as a battlefi eld. During military operations, refrigerated transportation and storage are logistical problems. Th awing of FFP takes a long time, with an important loss of plasma in austere environments. For example, Mabry and colleagues [3] report that, during the Mogadishu urban battle, the available FFP was stored in bags that fractured one-third of the time upon thawing. For these reasons, the French army has used freezedried and secured plasma (FDSP) since 1994. Plasma separated from fresh blood of at least ten donors is lyophilized to produce FSDP. Blood type selection allows the dilution and neutralization of natural anti-A and antiB hemagglutinins. Th is FDSP is thus compatible with any blood type. In addition, FDSP is shelf-stable in ambient temperatures for 2 years and easily rehydrated with 200 ml of water for injections in less than 3 minutes, allowing immediate provision with the fi rst packed red blood cells [4]. FDSP contains all clotting factors and proteins. After more than 2 years storage at ambient temperature, the fi brinogen and clotting factor levels of FDSP are equivalent to FFP [4]. Th e securization process is quarantine (i.e. the plasma is held until the donor returns and is retested after a period that is longer than the window period of known viruses). Plasma as FDSP is thus a logistically superior product, without compromising hemostatic properties, quickly available in cases of emergency for any blood type.