Separating plasma from other blood components before transfusion
may improve outcomes for patients with traumatic brain injury (TBI) or shock, according to new findings from the University of Pittsburgh School of Medicine and UPMC. The study, published March 18 in
Cell Reports Medicine, suggests that while plasma may be more beneficial for these patients, those with traumatic bleeding might see better results from receiving whole blood.
The findings come from the
Shock, Whole Blood and Assessment of TBI (SWAT) trial, which analyzed data from more than 1,000 trauma patients, including a subset of 134 who received blood products before reaching the hospital. Researchers found that prehospital plasma, whether given alone or with whole blood, improved coagulation and reduced the need for post-admission transfusions in patients with severe shock or TBI markers.
According to the investigators, the findings highlight the potential benefit of “precision transfusion,” a strategy focused on giving the right blood product at the right time to the right patient. “We’re not just replacing the blood,” said senior author Timothy Billiar, MD. “It’s almost like a drug where we’re maximizing its benefits and minimizing side effects.”
In addition to exploring clinical outcomes, investigators conducted proteomic analysis to investigate how trauma patients' blood differs from that of healthy donors. Of more than 7,500 proteins tested, the researchers focused on 198 with well-documented roles in inflammatory and clotting processes following traumatic injury.
The analysis revealed that plasma administration positively influenced protein levels linked to clot formation, neuron survival, platelet function, wound repair and inflammation mediation.
Investigators noted, however, that the amount of plasma in a unit of whole blood is roughly equivalent to that in a separately administered plasma product, leaving open the question of why patients who received separated plasma had proteomic profiles more conducive to healing. According to co-senior author Jason Sperry, MD, MPH, plasma proteins may change over time when kept in whole blood, possibly because the blood cells release enzymes that act on the plasma proteins.
While plasma has a relatively short shelf life and specific storage requirements, Sperry emphasized that overcoming these logistical hurdles could significantly enhance trauma care, potentially saving lives in emergency settings.
“Our findings indicate that it is worthwhile to overcome these challenges,” Sperry said. “Getting the right blood products to the right patient at the right time is a life-saving endeavor, and I’m confident we’ll continue to lead innovations that make it possible.”
