An in vivo assessment of green plasma: The potential hemostatic superiority of a currently discarded blood product.
basic_science · Level V
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- Also identified by DOI 10.1097/TA.0000000000005071.
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Abstract
Approximately 5% of donated plasma has a green appearance, due to elevated ceruloplasmin levels from increased estrogen. These products are currently discarded based on color alone. However, studies have shown improved trauma outcomes from female donors. In an ex vivo study, we recently noted accelerated and increased clot production with green plasma. The purpose of this study was to assess whether these findings could be confirmed in an in vivo animal model of severe hemorrhage. We utilized a well-established rat model of uncontrolled hemorrhage. Following cannulation and anesthesia, 33 rats underwent midline laparotomy followed by excision of 50% of the middle hepatic lobe to induce hemorrhage. After 60 seconds, GREEN (11 rats), standard FEMALE (11), or MALE plasma (11) were infused at a fixed volume of 5 mL. Abdominal cavity blood was collected to evaluate blood loss every 15 minutes for 60 minutes. Deaths occurring before experiment termination were recorded. Rats resuscitated with GREEN plasma had improved shock index compared with FEMALE and MALE at 15 (3.7 vs. 6.2 vs. 10.2; p=0.092), 30 (3.8 vs. 8.2 vs. 6.5; p=0.039), and 60 minutes (3.9 vs. 29.9 vs. 7.1; p=0.015). Mean arterial pressures in GREEN plasma-resuscitated rats were higher at 30 (p=0.032) and 60 minutes (p=0.115). Cumulative percent blood volume lost was lower at each time point in those receiving GREEN plasma. Survival to 60 minutes was 100% among GREEN and FEMALE plasma rats but only 64% among MALE resuscitated ones (p<0.001). Our study demonstrated that green plasma has improved efficacy for reducing bleeding and restoring hemodynamic stability compared with standard plasma in a rodent model of uncontrolled hemorrhage. Combined with our recent ex vivo data noting equivalent (often superior) hemostatic potential compared with standard units, we recommend reintroducing this often-discarded AABB-approved product back into the plasma donor pool. (J Trauma Acute Care Surg 2026;00:000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Level V.