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freeze dried plasma hemorrhage

Benjamin R Huebner, Ernest E Moore, Hunter B Moore, Angela Sauaia, Gregory Stettler, Monika Dzieciatkowska, Kirk Hansen, Anirban Banerjee, Christopher C Silliman
BACKGROUND: Systemic hyperfibrinolysis is an integral part of trauma-induced coagulopathy associated with uncontrolled bleeding. Recent data suggest that plasma-first resuscitation attenuates hyperfibrinolysis; however, the availability, transport, storage, and administration of plasma in austere environments remain challenging and have limited its use. Freeze-dried plasma (FDP) is a potential alternative due to ease of storage, longer shelf life, and efficient reconstitution. FDP potentially enhances clot formation and resists breakdown better than normal saline (NS) and albumin and similar to liquid plasma...
May 12, 2017: Transfusion
Mauren Villalta, Andrés Sánchez, María Herrera, Mariángela Vargas, Álvaro Segura, Maykel Cerdas, Ricardo Estrada, Indika Gawarammana, Dan E Keyler, Kimberly McWhorter, Roy Malleappah, Alberto Alape-Girón, Guillermo León, José María Gutiérrez
A new whole IgG, freeze-dried, polyspecific antivenom was prepared from the plasma of horses immunized with the venoms of the snakes Daboia russelii, Echis carinatus, Hypnale hypnale, and Naja naja from Sri Lanka. The preclinical neutralizing ability of this antivenom against several toxic and enzymatic activities of these four venoms was analyzed, and compared with that of a batch of VINS antivenom (India) being currently used in Sri Lanka. The activities tested were: lethality, hemorrhagic, in vitro coagulant, proteinase and phospholipase A2...
November 2016: Toxicon: Official Journal of the International Society on Toxinology
Justin J J Watson, Shibani Pati, Martin A Schreiber
Traumatic hemorrhage is the leading cause of preventable death after trauma. Early transfusion of plasma and balanced transfusion have been shown to optimize survival, mitigate the acute coagulopathy of trauma, and restore the endothelial glycocalyx. There are a myriad of plasma formulations available worldwide, including fresh frozen plasma, thawed plasma, liquid plasma, plasma frozen within 24 h, and lyophilized plasma (LP). Significant equipoise exists in the literature regarding the optimal plasma formulation...
November 2016: Shock
Mikael Gellerfors, Joacim Linde, Dan Gryth
Massive hemorrhage with coagulopathy is one of the leading causes of preventable death in the battlefield. The development of freeze-dried plasma (FDP) allows for early treatment with coagulation-optimizing resuscitation fluid in the prehospital setting. This report describes the first prehospital use of FDP in a patient with carotid artery injury due to a high-velocity gunshot wound (HVGSW) to the neck. It also describes in-flight constitution and administration of FDP in a Medevac Helicopter. Early administration of FDP may contribute to hemodynamic stabilization and reduction in trauma-induced coagulopathy and acidosis...
October 2015: Prehospital and Disaster Medicine
Sean P McCully, David T Martin, Mackenzie R Cook, Nicole T Gordon, Belinda H McCully, Tim H Lee, Rondi K Dean, Elizabeth A Rick, Alexis M Moren, Kelly A Fair, Vicente J Undurraga, Kathrine M Watson, Nathan W Anderson, Martin A Schreiber
BACKGROUND: Compared with lyophilized plasma (LP) buffered with other acids, LP with ascorbic acid (AA) attenuates systemic inflammation and DNA damage in a combat relevant polytrauma swine model. We hypothesize that increasing concentrations of AA in transfused LP will be safe, will be hemodynamically well tolerated, and will attenuate systemic inflammation following polytraumatic injury and hemorrhage in swine. METHODS: This prospective, randomized, blinded study involved 52 female swine...
July 2015: Journal of Trauma and Acute Care Surgery
Geir Strandenes, Ivar Austlid, Torunn O Apelseth, Tor A Hervig, Jan Sommerfelt-Pettersen, Maryanne C Herzig, Andrew P Cap, Heather F Pidcoke, Einar K Kristoffersen
BACKGROUND: Formulation of a medical preparedness plan for treating severely bleeding casualties during naval deployment is a significant challenge because of territory covered during most missions. The aim of this study was to evaluate the concept of "walking blood bank" as a supportable plan for supplying safe blood and blood products. METHODS: In 2013, the Royal Norwegian Navy conducted antipiracy operations from a frigate, beginning in the Gulf of Aden and ending in the Indian Ocean...
June 2015: Journal of Trauma and Acute Care Surgery
Geir A Sunde, Bjarne Vikenes, Geir Strandenes, Kjell-Christian Flo, Tor A Hervig, Einar K Kristoffersen, Jon-Kenneth Heltne
BACKGROUND: The last decade of military trauma care has emphasized the role of blood products in the resuscitation of hemorrhaging patients. Damage-control resuscitation advocates decreased crystalloid use and reintroduces blood components as primary resuscitative fluids. The systematic use of blood products have been described in military settings, but reports describing the use of freeze dried plasma (FDP) or red blood cells (RBCs) in civilian prehospital care are few. We describe our preliminary results after implementing RBCs and FDP into our Helicopter Emergency Medical Service (HEMS)...
June 2015: Journal of Trauma and Acute Care Surgery
Sean P McCully, Tim H Lee, Belinda H McCully, Claire L Sands, Elizabeth A Rick, Rondi K Dean, Nathan W Anderson, David A Hampton, Scott G Louis, Jerome A Differding, Martin A Schreiber
BACKGROUND: Dysfunctional inflammation following traumatic hemorrhage can lead to multiple-organ failure and death. In our polytrauma swine model, lyophilized plasma (LP) reconstituted with sterile water and ascorbic acid suppressed systemic inflammation and attenuated DNA damage. However, it remains unknown whether the inflammatory response is affected by the type of fluid used to reconstitute LP. We hypothesized that common resuscitation fluids such as normal saline (LP-NS), lactated Ringer's solution (LP-LR), Hextend (LP-HX), or sterile water (LP-SW) would yield similar inflammation profiles and DNA damage following LP reconstitution and transfusion...
February 2015: Journal of Trauma and Acute Care Surgery
Yuzhu Bian, Thomas Ming Swi Chang
We crosslink hemoglobin (Hb), superoxide dismutase (SOD), catalase (CAT), and carbonic anhydrase (CA) to form a soluble polyHb-SOD-CAT-CA nanobiotechnological complex. The obtained product is a soluble complex with three enhanced red blood cell (RBC) functions and without blood group antigens. In the present study, 2/3 of blood volume was removed to result in 90-min hemorrhagic shock at mean arterial blood pressure (MAP) of 30 mmHg. This was followed by the reinfusion of different resuscitation fluids, then followed for another 60 min...
February 2015: Artificial Cells, Nanomedicine, and Biotechnology
A Sailliol, S Plang, C Martinaud, T Pouget, S Vedy, B Clavier, V Cellarier, C Roche, C Civadier, S Ausset
The French military blood institute (FMBI) is the only military blood supplier in France. FMBI operates independently and autonomously under the Ministry of Defense's supervision, and accordingly, to the French, European and NATO technical and safety guidelines. FMBI is in charge of the collection, preparation and distribution of blood products to supply transfusion support to armed forces, especially during overseas operations. In overseas military, a primary physician is responsible for haemovigilance in permanent relation with an expert in the FMBI to manage any adverse reaction...
November 2014: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
Xiao Yang, Xiaoqing Miao, Fangrui Cao, Shang Li, Nana Ai, Qi Chang, Simon M Y Lee, Ying Zheng
This work addressed solubility and membrane permeability problems of Biopharmaceutics Classification System (BCS) Class IV glycoside scutellarin (SG) by developing a nanosuspension of its aglycone scutellarein (S) as a precursor. An S nanosuspension containing poloxamer 188 was prepared using antisolvent precipitation where hydroxypropyl-β-cyclodextrin was utilized as a lyophilizing protectant. Particle size and polydispersity index after redispersion were 342.6 ± 18.2 and 0.32 ± 0.06 nm, respectively. The dissolution rate of the S nanosuspension was superior compared with the physical mixture...
November 2014: Journal of Pharmaceutical Sciences
Tim H Lee, Sean P McCully, Belinda H McCully, Claire Sands, David A Hampton, Scott G Louis, Beth Rick, Nathan Anderson, Jerome Differding, Martin A Schreiber
BACKGROUND: Low-volume ascorbic acid-buffered reconstituted lyophilized plasma (LP) provides logistic advantages, reduces the risks for large-volume resuscitation, modulates inflammation, and is equally effective for hemostatic resuscitation as full-volume LP. We compared the physiologic effects of resuscitation using LP reconstituted with sterile water (LP-SW), lactated Ringer's solution (LP-LR), normal saline (LP-NS), and Hextend (LP-Hx). METHODS: Plasma was collected from swine, lyophilized, and then reconstituted into four test solutions: LP-SW, LP-LR, LP-NS, or LP-Hx...
February 2014: Journal of Trauma and Acute Care Surgery
Elon Glassberg, Roy Nadler, Sami Gendler, Amir Abramovich, Philip C Spinella, Robert T Gerhardt, John B Holcomb, Yitshak Kreiss
While early plasma transfusion for the treatment of patients with ongoing major hemorrhage is widely accepted as part of the standard of care in the hospital setting, logistic constraints have limited its use in the out-of-hospital setting. Freeze-dried plasma (FDP), which can be stored at ambient temperatures, enables early treatment in the out-of-hospital setting. Point-of-injury plasma transfusion entails several significant advantages over currently used resuscitation fluids, including the avoidance of dilutional coagulopathy, by minimizing the need for crystalloid infusion, beneficial effects on endothelial function, physiological pH level, and better maintenance of intravascular volume compared with crystalloid-based solutions...
December 2013: Shock
Kenichi A Tanaka, Katherine Egan, Fania Szlam, Satoru Ogawa, John D Roback, Gautam Sreeram, Robert A Guyton, Edward P Chen
BACKGROUND: Platelet (PLT) and plasma transfusion remain the mainstay hemostatic therapy for perioperative bleeding. Several studies have indicated that acquired fibrinogen (FIB) deficiency can be the primary cause of bleeding after cardiac surgery. The aim of this study was to compare hematologic and transfusion profiles between the first-line FIB replacement and PLT transfusion in post-cardiac surgical bleeding. STUDY DESIGN AND METHODS: In this prospective, randomized, open-label study, 20 adult patients who underwent valve replacement or repair and fulfilled preset visual bleeding scale were randomized to 4 g of FIB or 1 unit of apheresis PLTs...
January 2014: Transfusion
Jürgen Bux, Dieter Dickhörner, Edgar Scheel
BACKGROUND: Transfusion of plasma is a basic treatment for complex coagulopathies as well as in major blood loss. Early transfusion of plasma after trauma with major hemorrhage has been recommended by retrospective studies. However, the use of plasma is often hampered by the need to maintain a cold chain and the time needed for thawing fresh-frozen plasma (FFP). With freeze-dried (lyophilized) plasma (FDP) both difficulties can be avoided. Here, we describe the production, quality characteristics, and our experiences with FDP...
December 2013: Transfusion
Tim H Lee, Philbert Y Van, Nicholas J Spoerke, Gregory J Hamilton, S David Cho, Kate Watson, Jerome Differding, Martin A Schreiber
BACKGROUND: Shock and severe tissue injury lead to an endogenous coagulopathy mediated by activation of Protein C and hyperfibrinolysis known as acute traumatic coagulopathy. Together, hemodilution, acidosis, inflammation, and hypothermia result in a global trauma-induced coagulopathy. Coagulopathy in trauma is associated with mortality. Early and effective hemostatic resuscitation is critical in restoring perfusion, correcting coagulopathy, and saving lives in exsanguinating trauma. Lyophilized plasma (LP) provides a logistically superior alternative to fresh frozen plasma (FFP)...
January 2013: Transfusion
Anne Sailliol, Christophe Martinaud, Andrew P Cap, Corinne Civadier, Benoit Clavier, Anne-Virginie Deshayes, Anne-Christine Mendes, Thomas Pouget, Nicolas Demazeau, Marine Chueca, François-Régis Martelet, Sylvain Ausset
Freeze-dried plasma was developed by the US Army for the resuscitation of combat casualties during World War II. The French Military Blood Institute began producing French lyophilized plasma (FLYP) in 1949, in accordance with French blood product guidelines. Since 2010, a photochemical pathogen inactivation process has been implemented to reduce the remaining transfusion-related infectious risk. All quality controls for this procedure verify that the hemostatic properties of FLYP are conserved. FLYP is compatible with all blood types, can be stored at room temperature for 2 years, and its reconstitution requires less than 6 minutes...
January 2013: Transfusion
Christophe Martinaud, Corinne Civadier, Sylvain Ausset, Catherine Verret, Anne-Virginie Deshayes, Anne Sailliol
BACKGROUND: French lyophilized plasma (FLyP) is used routinely by the French Armed Forces in war settings. The authors compared concentrations of coagulation proteins and global in vitro hemostatic properties in FLyP and in the same plasma before lyophilization to assess the impact of lyophilization on coagulation properties. METHODS: Twenty-four batches of plasma before and after lyophilization were tested for coagulation proteins. Thrombin generation time, thrombin antithrombin concentration, prothrombin fragment 1 + 2, and thromboelastography were assessed...
August 2012: Anesthesiology
Nikhil Vilas Joshi, Jennifer B Raftis, Andrew J Lucking, Amanda H Hunter, Mike Millar, Mike Fitzpatrick, Giora Z Feuerstein, David E Newby
Platelets are the principal component of the innate haemostatic system that protect from traumatic bleeding. We investigated whether lyophilised human platelets (LHPs) could enhance clot formation within platelet-free and whole blood environments using an ex vivo model of deep arterial injury. Lyophilised human platelets were produced from stored human platelets and characterised using conventional, fluorescent and electron microscopic techniques. LHPs were resuspended in platelet-free plasma (PFP) obtained from citrated whole human blood to form final concentrations of 0, 20 and 200 x 10⁹ LHPs/L...
July 2012: Thrombosis and Haemostasis
Anne Godier, Charles-Marc Samama, Sophie Susen
PURPOSE OF REVIEW: The scope of this review is to describe what is known about blood product ratios and their effects on acute trauma coagulopathy. Assessing how ratios matter to trauma patients is important to improve massive transfusion strategies. RECENT FINDINGS: A growing body of evidence supports that high ratios of fresh frozen plasma and platelets to red blood cells improve survival of the massively bleeding traumatized patient. Acting quickly is also critical...
April 2012: Current Opinion in Anaesthesiology
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