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USU Researchers Investigate Freeze-Dried Plasma’s Use in Military Combat Casualty Care

A woman in Army fatigues, wearing safety glasses and rubber gloves works with freeze-dried plasma on a table in a temporary medical facility. A man in a button-up shirt and wearing a tie looks on along with another woman in Army fatigues. Dr. Vic MacDonals, product manager for the U.S. Army Medical Materiel Development Activity’s (USAMMDA) Pharmaceutical Systems Project Management Office, gives a demonstration of the reconstitution of freeze-dried plasma back to its usable state to Maj. Gen. Barbara Holcomb, commanding general of the U.S. Army Medical Research and Materiel Command during the VIP Medical Lanes display at Fort Detrick, Md. in 2016. (Image credit: Erin Bolling, USAMMDA public affairs)
By Christopher Austin

The Department of Defense and the Food and Drug Administration recently launched a joint program to prioritize the efficient development of safe and effective medical products intended to save the lives of American military personnel.  One such product being reviewed is freeze-dried plasma.

A man and a woman in fatigues kneel in front of a tent in a grassy field. In between them are a glass vial filled with distilled water and another with freeze-dried plasma.
Freeze-dried plasma is currently being manufactured and use by French forces, with the same
manufacturer supplying U.S. forces abroad until a U.S. manufacturer can be found.
(Image credit: Erin Bolling, USAMMDA public affairs)
Researchers at Uniformed Services University of the Health Sciences (USU) are now looking into freeze-dried plasma and its potential use for integration into all military emergency medical equipment.  Currently, the product is issued to Special Operations Forces (SOF), but not to conventional forces, and the USU team is looking into how the military can make it useful for those beyond the SOF community.

Army Maj. (Dr.) Grigory Charny, an assistant professor in the USU Department of Military and Emergency Medicine (MEM), is working with Army Maj. (Dr.) Steven Schauer, an assistant professor in MEM, and 2nd Lt. Sarah Mongold, a second-year student in the F. Edward Hébert School of Medicine at USU, to perform a case series with the Institute of Surgical Research on six of the more than 20 recorded cases where freeze-dried plasma has been used on U.S. service members.

Freeze-dried plasma was used by the U.S. military as early as World War II and continued through the Korean War, according to Charny. Its use was abandoned because there were repeated hepatitis outbreaks; early screening techniques were not as effective as they are now.

Closeup of a person’s hands as they hold a glass bottle of distilled water upside down in order to pour its contents into another glass bottle of freeze-dried plasma.
Freeze-dried plasma comes in a powder form so it doesn’t need to be
refrigerated. To be reconstituted, it needs to be mixed with distilled
water. (Image credit: U.S. Marine Corps Sgt. Salvador R. Moreno)
“We are looking at the cases to extrapolate the exact patient condition needed for giving the freeze-dried plasma, beneficial outcomes for doing so, how its use can be improved, and if there are any negative effects that come from its use,” said Charny.  The U.S. currently uses freeze-dried plasma from France.

By dehydrating plasma and reducing it to a powder, it can be kept fresh at a variety of temperatures and quickly reconstituted with distilled water to treat a wounded patient.

“Multiple things go into whether or not something can be used in the field. Is it temperature-stable? It has to be something that can work in the cold mountains of Afghanistan or the deserts of Iraq,” said Schauer. “It has to be tightly packed, lightweight, something that you can do with gloves on and in low light.”
 
Freeze-dried plasma could also be a useful tool in wilderness medicine, allowing medical providers to more readily transport life-saving plasma to wounded individuals in an austere or remote setting, according to the researchers.

“Getting blood and blood products to our casualties on the front lines continues to be a logistical difficulty for military medical providers,” said Mongold. “The possibility of using freeze-dried plasma is one consideration in attempting to provide the most cutting-edge, effective care for patients. While we are focusing at this time on freeze-dried plasma for combat casualties, maybe in the future it will have a role in the civilian setting as well.”