Dried plasma retains hemostatic function and thermal stability during Arctic military operations

Dried plasma offers a practical alternative for remote damage control resuscitation, providing hemostatic support and volume replacement. The Arctic presents challenges that necessitate the need for blood-based resuscitation to extend the "golden hour." To address this, we evaluated the hemostatic and thermal stability of dried plasma following exposure during military Arctic operations.

OctaplasLG powder kits were deployed with Canadian Armed Forces medical providers during three Arctic operations. Dried plasma was subjected to substantial temperature fluctuations (-35.2 to 26.5°C) and multiple freeze-thaw cycles. Upon return, dried plasma was reconstituted and evaluated using hemostatic/coagulation panels and differential scanning calorimetry (DSC).

Arctic-exposed dried plasma retained visual integrity and protein concentration consistent with controls. Hemostatic function, including prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, factor V, factor VIII, plasminogen, antithrombin III, protein C, ADAMTS13, and viscoelastic profiles remained within normal ranges, with protein S activity below the lower limit. However, von Willebrand factor antigen levels were elevated in both dried plasma groups, though distribution remained normal and unlikely to be clinically significant for resuscitation. DSC thermograms revealed five characteristic thermal transitions consistent with controls, indicating preserved structural integrity. Enthalpy analysis demonstrated a strong correlation with fibrinogen concentration, suggesting its role in plasma stability.

Dried plasma retains its hemostatic and thermal stability following Arctic deployment, supporting remote damage control resuscitation in the absence of whole blood. Nonetheless, field implementation is challenged by the propensity of the diluent to freeze and the logistical requirement for warmed infusion.