Establishing a sustainable protocol for massive transfusion using thawed plasma and cryoprecipitate reconstituted from expired thawed plasma.

BACKGROUND

In Japan, thawed plasma (TP) is not used because of the short expiration time of fresh frozen plasma (FFP) post-thawing. We developed and implemented a new massive transfusion protocol (MTP) using TP and expired TP and evaluated its impact on plasma waste, transfusion response times, and patient outcomes.

STUDY DESIGN AND

METHODS

Phase 1: From November 2023 to March 2024, we investigated the clinical use of TP and the expiration rate of TP derived from 480 mL of FFP (blood type: AB). The cryoprecipitate was prepared from expired TP (TP-CRYO), and its coagulation factors were measured. Phase 2: From April 2024 to March 2025, TP-CRYO was incorporated into a regular stock of type-AB cryoprecipitate and administered to patients with massive bleeding. Clinical data, fibrinogen levels, and adverse events were investigated in patients who received TP and in those who received cryoprecipitate, including TP-CRYO.

RESULTS

During phase 1, TP was administered to 11 patients and 22 bags of TP expired. Compared with the conventionally prepared cryoprecipitate, TP-CRYO had slightly higher clotting activity and fibrinogen levels. During phase 2, TP was administered to 55 patients, using 42 bags of expired TP. One bag of TP-CRYO was discarded owing to early patient transfer, one due to fibrin formation, and three remained in stock. The other 37 were administered. The plasma waste rate decreased from 66.7% to 2.1%. No direct adverse events were associated with TP or TP-CRYO use.

DISCUSSION: We established a sustainable MTP using TP and in-house cryoprecipitate from TP-CRYO.