Daban et al.
Critical Care 2010, 14:412
[Link]
LETTER
Freeze dried plasma: a French army specialty
Jean Louis Daban1, Patrick Clapson1, Sylvain Ausset*1, Anne V Deshayes2 and Anne Sailliol2
See related review by Nascimento et al., [Link]
We read with interest the article by Nascimento and For these reasons, the French army has used freeze-
colleagues [1] on fresh frozen plasma (FFP) in massive dried and secured plasma (FDSP) since 1994. Plasma
bleedings. We fully agree with their conclusion when they separated from fresh blood of at least ten donors is
say that we need immediately available universal donor lyophilized to produce FSDP. Blood type selection allows
AB plasma. the dilution and neutralization of natural anti-A and anti-
Hemorrhagic shock is the primary cause of avoidable B hemagglutinins. This FDSP is thus compatible with any
mortality in combatants. Data from the recent US army blood type. In addition, FDSP is shelf-stable in ambient
war experience show clearly that in cases of massive temperatures for 2 years and easily rehydrated with
transfusion the transfusion policy strongly impacts 200 ml of water for injections in less than 3 minutes,
mortality. Namely, for massive bleeding the ratio between allowing immediate provision with the first packed red
red blood cells and clotting factors should be close to the blood cells [4].
composition of whole blood [2]. FDSP contains all clotting factors and proteins. After
Plasma is thus essential for massive transfusions. But more than 2 years storage at ambient temperature, the
FFP use is impractical in uncertain environments such as fibrinogen and clotting factor levels of FDSP are
a battlefield. During military operations, refrigerated equivalent to FFP [4].
transportation and storage are logistical problems. The securization process is quarantine (i.e. the plasma is
Thawing of FFP takes a long time, with an important loss held until the donor returns and is retested after a period
of plasma in austere environments. For example, Mabry that is longer than the window period of known viruses).
and colleagues [3] report that, during the Mogadishu Plasma as FDSP is thus a logistically superior product,
urban battle, the available FFP was stored in bags that without compromising hemostatic properties, quickly
fractured one-third of the time upon thawing. available in cases of emergency for any blood type.
Authors’ response
Bartolomeu Nascimento Jr, Jeannie Callum and Sandro B Rizoli
We thank Daban and colleagues for their insightful traumatic bleeding is related to either clotting factor or
obser vations and agree with the comments on the volume replacement with reduced crystalloid exposure.
challenges to using AB FFP in trauma. Products such as Since most trauma patients are hypovolemic, large
freeze-dried plasma or lyophilized plasma are appealing volumes are often advantageous, but in circumstances
for trauma resuscitation since they have many of the where circulatory overload is a concern, the use of small
characteristics of an ideal resuscitation fluid for bleeding/ volume clotting factor concentrates, including freeze-
coagulopathic patients. Such an ideal fluid would be easy dried plasma, would be superior.
to prepare and rapid to administer, contain all clotting We lack experience with lyophilized plasma, which to
factors, not require blood typing and matching, be free of our knowledge is available only to military personnel of
infectious and immunological risks and have a long shelf some countries. Historically it was implicated in hepatitis
life. Concerning volume, it is unclear whether the benefit epidemics during the Korean War, but safer preparations
of early and aggressive FFP transfusion in massive are now available and the interest in this product is
growing, particularly over the past few years. Recent
*Correspondence: [Link]@[Link]
1
Service d’Anesthésie-Réanimation, Hôpital d’Instruction des Armées Percy,
experience with this product comes from the battlefield,
101 avenue Henri Barbusse, BP 406, 92141 Clamart cedex, France but mostly from animal models [4-6], in which lyo-
Full list of author information is available at the end of the article philized plasma was found to be equivalent to FFP in
correcting coagulopathy [5,6]. We agree that further
© 2010 BioMed Central Ltd © 2010 BioMed Central Ltd clinical studies with this product are needed.
Daban et al. Critical Care 2010, 14:412 Page 2 of 2
[Link]
Abbreviations 4. Daban JL, Deshayes AV, Clapson P, Batjom E, Schall JV, Clavier B, Ausset S,
FDSP = freeze-dried and secured plasma; FFP = fresh frozen plasma. Sailliol A: Le plasma cryodesséché : un produit stable et rapidement
disponible pour les opérations militaires. Société française d’anesthésie
Competing interests réanimation. Congress (51;2009;Paris). Ann Fr Anesth Reanim 2009,
SBR has received speaker’s fee and honorarium (as member of the Scientific 28:S141-S144.
Advisory Board) from NovoNordisk A/S, manufacturer of NovoSeven 4. Daban JL, Deshayes AV, Clapson P, Batjom E, Schall JV, Clavier B, Ausset S,
(recombinant factor VIIa). The other authors declare that they have no Sailliol A: Le plasma cryodesséché : un produit stable et rapidement
competing interests disponible pour les opérations militaires. Société française d’anesthésie
ré[Link] (51;2009;Paris). Ann Fr Anesth Reanim 2009,
Author details 28:S141-S144.
1
Service d’Anesthésie-Réanimation, Hôpital d’Instruction des Armées Percy, 5. Shuja F, Shults C, Duggan M, Tabbara M, Butt MU, Fischer TH, Schreiber MA,
101 avenue Henri Barbusse, BP 406, 92141 Clamart cedex, France. 2Centre de Tieu B, Holcomb JB, Sondeen JL, Demoya M, Velmahos GC, Alam HB:
Transfusion Sanguine des Armées Jean Julliard, 1 rue Lieutenant Raoul-Batany, Development and testing of freeze-dried plasma for the treatment of
BP 410, 92141 Clamart cedex, France. trauma-associated coagulopathy. J Trauma 2008, 65:975-985.
6. Spoerke N, Zink K, Cho SD, Differding J, Muller P, Karahan A, Sondeen J,
Published: 14 April 2010 Holcomb JB, Schreiber M: Lyophilized plasma for resuscitation in a swine
model of severe injury. Arch Surg 2009, 144:829-834.
References
1. Nascimento B, Callum J, Rubenfeld G, Neto J, Lin Y, Rizoli S: Clinical review:
Fresh frozen plasma in massive bleedings - more questions than answers.
Crit Care 2010, 14:202.
2. Spinella PC, Holcomb JB: Resuscitation and transfusion principles for
traumatic hemorrhagic shock. Blood Rev 2009, 23:231-240.
3. Mabry RL, Holcomb JB, Baker AM, Cloonan CC, Uhorchak JM, Perkins DE,
doi:10.1186/cc8937
Canfield AJ, Hagmann JH: United States Army Rangers in Somalia: an
Cite this article as: Daban JL, et al.: Freeze dried plasma: a French army
analysis of combat casualties on an urban battlefield. J Trauma 2000, specialty. Critical Care 2010, 14:412.
49:515-528.
