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Review
. 2018 Apr 18:5:91.
doi: 10.3389/fmed.2018.00091. eCollection 2018.

The Role of Plasma Transfusion in Massive Bleeding: Protecting the Endothelial Glycocalyx?

Stefano Barelli  1 , Lorenzo Alberio  1   2
Affiliations
Review

The Role of Plasma Transfusion in Massive Bleeding: Protecting the Endothelial Glycocalyx?

Stefano Barelli et al. Front Med (Lausanne). .

Abstract

Massive hemorrhage is a leading cause of death worldwide. During the last decade several retrospective and some prospective clinical studies have suggested a beneficial effect of early plasma-based resuscitation on survival in trauma patients. The underlying mechanisms are unknown but appear to involve the ability of plasma to preserve the endothelial glycocalyx. In this mini-review, we summarize current knowledge on glycocalyx structure and function, and present data describing the impact of hemorrhagic shock and resuscitation fluids on glycocalyx. Animal studies show that hemorrhagic shock leads to glycocalyx shedding, endothelial inflammatory changes, and vascular hyper-permeability. In these animal models, plasma administration preserves glycocalyx integrity and functions better than resuscitation with crystalloids or colloids. In addition, we briefly present data on the possible plasma components responsible for these effects. The endothelial glycocalyx is increasingly recognized as a critical component for the physiological vasculo-endothelial function, which is destroyed in hemorrhagic shock. Interventions for preserving an intact glycocalyx shall improve survival of trauma patients.

Keywords: endothelium; fresh frozen plasma; glycocalyx; massive hemorrhage; resuscitation; shock.

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References

    1. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma (2006) 60(6 Suppl):S3–11.10.1097/01.ta.0000199961.02677.19 - DOI - PubMed
    1. Seghatchian J, Samama MM. Massive transfusion: an overview of the main characteristics and potential risks associated with substances used for correction of a coagulopathy. Transfus Apher Sci (2012) 47(2):235–43.10.1016/j.transci.2012.06.001 - DOI - PubMed
    1. Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma (2007) 63(4):805–13.10.1097/TA.0b013e3181271ba3 - DOI - PubMed
    1. Savage SA, Zarzaur BL, Croce MA, Fabian TC. Redefining massive transfusion when every second counts. J Trauma Acute Care Surg (2013) 74(2):396–400.10.1097/TA.0b013e31827a3639 - DOI - PubMed
    1. Rahbar MH, del Junco DJ, Huang H, Ning J, Fox EE, Zhang X, et al. A latent class model for defining severe hemorrhage: experience from the PROMMTT study. J Trauma Acute Care Surg (2013) 75(1 Suppl 1):S82–8.10.1097/TA.0b013e31828fa3d3 - DOI - PMC - PubMed

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