When a person experiences traumatic injury, administering blood products before reaching the hospital—such as at the scene or during transport—can greatly improve their chances of survival and recovery. However, the effectiveness of blood components can vary depending on the type of injury. New research has shown that plasma, which is separated from other blood components, enhances recovery in patients with traumatic brain injury (TBI) or shock, while giving whole blood may be more beneficial for patients with traumatic bleeding.

This finding emerged from the Shock, Whole Blood, and Assessment of TBI (SWAT) multicenter study, conducted by researchers at the University of Pittsburgh School of Medicine (Pittsburgh, PA, USA) and UPMC (Pittsburgh, PA, USA). Over 1,000 patients with traumatic injuries who were likely to need emergency surgery were enrolled in the study, with blood samples collected at specific timepoints. A subset of 134 patients with blunt or penetrating injuries who received at least one unit of blood product (red blood cells, plasma, platelets, or whole blood) before reaching the hospital was further analyzed. The researchers applied computational methods to account for factors such as age and gender, ensuring the accuracy of their results. They found that patients who received a higher proportion of plasma—either alone or combined with whole blood—before hospital admission exhibited improved coagulation in those with severe shock and TBI markers, as well as reduced transfusion volumes after admission for TBI patients.

Plasma is the protein-rich component of blood, and to understand its impact, the research team delved into proteomics, which is the study of proteins that are crucial for the structure and function of organs and tissues. They analyzed over 7,500 proteins from healthy donor blood and the trauma patients' blood during recovery, observing clear differences. The researchers narrowed their focus to 198 proteins known to play roles in inflammation and clotting after traumatic injury. The analysis revealed that patients who received plasma had a distinct proteomic profile, suggesting that plasma administration influenced proteins involved in inflammation and clotting. Notably, plasma recipients had higher levels of proteins linked to later stages of clot formation, platelet function, neuron survival, wound repair, and inflammation regulation.

Although the amount of plasma in a unit of whole blood is roughly equivalent to that given separately as a plasma product, it remains unclear why plasma recipients had better outcomes and more favorable proteomic profiles. One possibility is that the storage conditions of whole blood and plasma differ—whole blood can be stored for 21 days, while plasma has a shelf life of just five days. The researchers speculate that over time, proteins in plasma stored within whole blood may undergo changes, potentially due to enzymes released by blood cells. Additionally, the proteomic profiles of different donors may vary, complicating the understanding of these outcomes. As the research team looks for ways to apply their findings to improve patient outcomes, they note the logistical challenges of transporting plasma. Since plasma must be kept refrigerated and expires quickly, it is not practical for most ambulances to carry it, leading to potential waste unless the service is exceptionally busy.

“We’ve heard about precision medicine – giving the right care to the right patient at the right time. This is precision transfusion – giving the right blood product to the right patient at the right time,” said senior author Timothy Billiar, M.D., George Vance Foster Professor and Chair of Pitt’s Department of Surgery and chief scientific officer at UPMC. “We’re not just replacing the blood – it’s almost like a drug where we’re maximizing its benefits and minimizing side effects.” 

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