When a patient comes into the emergency room with a traumatic injury on television, you might hear one of the doctors tell a nurse to “hang a bag of FFP,” or fresh frozen plasma. FFP is the fluid portion of a unit of whole blood frozen soon after donation and then thawed at the time of use. You might not think anything of the medical jargon the actors use, but in real life, hanging a bag of FFP could save someone’s life. Plasma-based products made from whole blood and plasma donations, like FFP, are critical for treating trauma and shock.
The definition of physical trauma is a sudden injury that results in wounds, broken bones, or internal damage and requires immediate medical attention. According to the National Institute of General Medical Sciences (NIGMS), there are two main types of physical trauma:
One result of trauma can be shock. Shock is the body's response to a sudden drop in blood pressure. Not having enough blood circulating around the body can be a life-threatening medical emergency. The body's natural response is to narrow blood vessels in the extremities, called vasoconstriction, to help keep blood flowing to vital organs.
Almost 10% of all worldwide deaths are trauma-related, and many trauma survivors owe their lives to plasma donors. Using plasma, the yellowish liquid that comprises over 55% of your blood, to treat trauma and shock has been routine for many years. During World War II, plasma was considered essential for treating wounded soldiers. Blood loss from battlefield wounds can result in dangerously low blood pressure, shock, and extreme loss of fluids. Instead of doing full blood transfusions, medics began using dried plasma in WWII–which can be stored for long periods of time without refrigeration and was easily transported–mixed with water as a transfusion. Dried plasma is still widely used in war settings today, for things like combat burn care, where FFP is not immediately available.
Outside of combat medicine, plasma is used alone as well as in combination with other blood products like albumin, packed red blood cells (PRBCs), and platelets to support those who have increased bleeding from trauma or who are experiencing shock. FFP contains all coagulation factors except platelets and has to be compatible with the ABO group of the recipient to avoid potential hemolysis. Plasma and other blood products have coagulation factors that help stop bleeding, proteins such as albumin that control blood pressure by maintaining the appropriate volume of fluid throughout the body, and antibodies that are needed to replenish those that have been lost.
Albumin can also be purified and used on its own to treat trauma and shock. Albumin’s function is to help ensure that blood stays within arteries and veins, carrying hormones, vitamins, and enzymes through the body. Without albumin, fluid leaks out of blood vessels and builds up in other parts of your body, like your lungs and abdomen. In emergency situations, an albumin infusion is delivered directly to the body through an intravenous line (IV). There can be adverse side effects associated with FFP transfusions, which makes albumin a viable option if an individual is at high risk for things like allergic reactions and infections.
Initially, during trauma, plasma (either as FFP or albumin), PRBCs, and platelets are transfused in an even ratio. Whole blood transfusions can also be done at this early stage. Doctors then calculate which factor of blood the patient is in most need of based on their symptoms, altering that ratio of FFP, albumin, PRBC, and platelets. For example, continuing with the 1:1:1 ratio when albumin is specifically low (hypoproteinemia) could cause volume overload in order to significantly raise albumin concentration.
In situations where a significant amount of blood is needed due to severe bleeding, a 2018 study from the New England Journal of Medicine showed that about 77% of patients who received plasma on their way to the hospital in a medical helicopter were still alive after 30 days. This is compared to 67% of patients who did not receive plasma on their way to the hospital via medical helicopter. The patients who received plasma also had lower mortality rates within the first 24 hours; their blood clotted faster, and they needed fewer blood transfusions. February 2023 Critical Care conducted a study of more than 900 traumatic hemorrhage patients using a new blood product that combined red blood cells and plasma in one bag. While further studies are needed to confirm the evidence, overall, those who received the combined transfusion had a 1.5 times higher survival rate within 24 hours than those who received red blood cells alone.
Plasma also treats many chronic, rare disorders like primary immunodeficiency and hemophilia. Since plasma cannot be synthetically produced, everyone from trauma patients to those living with hemophilia to someone undergoing surgery is solely reliant on consistent and dedicated donors who give enough plasma for all its various lifesaving purposes.
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