Nabil M. Elkassabany, Geralyn M. Meny, Rafael R. Doria, Catherine Marcucci; Green Plasma—Revisited. Anesthesiology 2008; 108:764–765 doi: https://doi.org/10.1097/ALN.0b013e3181672668

We could find no reports on green plasma in the past 40 yr in either the surgical or the anesthesia literature, which perhaps explains the lack of knowledge on the part of today’s clinicians. However, we found several articles dating back to the 1960s. At that time, green plasma was appearing in blood banks in fairly significant numbers (as many as 1% of all plasma units in large blood bank centers in England). Discoloration of plasma units by gram-negative cryophilic contaminants such as the Pseudomonas  species was still a concern at that time but was increasingly less likely in the antibiotic age and did not explain the relatively sudden increase in the number of green units. An additional etiology was therefore sought. The yellow color of plasma is due to the presence of the yellow pigments bilirubin, carotenoids, hemoglobin, and iron transferrin. A previous report had noted the green appearance of sera obtained from donors with rheumatoid arthritis and had identified a corresponding decrease in the yellow pigments of these sera, especially in patients with disease duration of more than 10 yr. However, Tovey and Lathe reported hundreds of units of strikingly green plasma subsequently identified to be from a second cohort of donors (young married women) who did not have rheumatoid arthritis and whose sera had normal levels of yellow pigments. They were unsuccessful in extracting a green pigment from the green plasma; however, they found an unexpected blue precipitate. This pigment was subsequently identified as ceruloplasmin.

Nabil M. Elkassabany, Geralyn M. Meny, Rafael R. Doria, Catherine Marcucci; Green Plasma—Revisited. Anesthesiology 2008; 108:764–765 doi: https://doi.org/10.1097/ALN.0b013e3181672668