In the Field
Plasma is what stops trauma-induced coagulopathy from getting worse. Whole blood is preferred when available; plasma plus red cells in 1:1 ratio is the next step down; plasma alone has a defined role when red cells are not available. Freeze-dried plasma (FDP) changes the operational picture because it can ride in a pack without refrigeration and reconstitute in minutes. TCCC 2026 explicitly includes plasma in the fluid resuscitation hierarchy and specifies 1 to 2 units of plasma for moderate to severe TBI without evidence of hemorrhagic shock.
Common Mistake
Treating plasma as a volume expander rather than a coagulation product. The benefit is in the clotting factors, not the volume; in a casualty without coagulopathy and without need for clotting factor replacement, crystalloid is a cheaper way to expand volume. The other mistake is using plasma alone when whole blood or balanced component therapy (1:1:1 RBC to plasma to platelets) is available.
Technical Detail
Plasma forms: (1) Freeze-dried plasma (FDP, lyophilized plasma) - powder form, reconstituted with sterile water; shelf life approximately 2 years at room temperature; volume per unit varies by manufacturer (typically 200 to 250 mL reconstituted); used by French, German, Israeli, and US military forces. (2) Liquid plasma - refrigerated (1 to 6 degrees C) plasma never frozen; 26 to 40 day shelf life. (3) Thawed plasma - previously frozen fresh plasma thawed and refrigerated; 5 day shelf life after thawing. ABO compatibility considerations apply; group AB plasma is universal donor. TCCC 2026 fluid resuscitation hierarchy: cold-stored low-titer O whole blood, pre-screened low-titer O fresh whole blood, 1:1:1 plasma/RBC/platelets, 1:1 plasma/RBC, then plasma or RBC alone. For moderate or severe TBI without hemorrhagic shock: 1 to 2 units of plasma.
