Early blood product transfusion is important for optimal trauma care, but it is not well understood how different blood products affect coagulopathy and the immune response. Recently, several studies have suggested that whole blood administered early may be associated with improved survival, but other studies suggest that treatment effects may vary based on patient demographics and the type of injury. To compare the effects of early plasma transfusion with low-titer O whole blood (LTOWB), researchers followed a cohort (n=134; median age, 34 years; 64% male; 38% penetrating injury) of trauma patients with hemorrhagic shock from the Shock, Whole Blood and Assessment of Traumatic Brain Injury multicenter, observational study (n=1051). Based on a proteomic analysis of 198 proteins (central to inflammatory and hemostatic processes) at hospital admission and 4-and 24-hours later, trauma patients who received plasma (with or without LTOWB) had distinct patterns compared to those who did not receive any plasma. Notably, patients who received plasma had higher levels of fibrinogen and plasmin, lower levels of platelet factor 4, shorter international normalized ratio (INR), improved prothrombin times, and lower overall transfusion volumes over 24 hours compared to patients who did not receive plasma. Randomized controlled trials are needed to further understand the clinical implications of plasma and LTOWB for different subgroups of trauma patients.
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