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McRae HL, Milito C, Klapheke CA, Refaai MA. Evaluation of solvent/detergent‐treated plasma safety and efficacy in orthotopic liver transplant and thrombotic thrombocytopenic purpura patients: A single center experience. Transfusion 2021; 62:429-438. [DOI: 10.1111/trf.16777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/03/2021] [Accepted: 11/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Hannah L. McRae
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit University of Rochester Medical Center Rochester New York USA
| | - Chelsea Milito
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit University of Rochester Medical Center Rochester New York USA
| | - Catherine A. Klapheke
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit University of Rochester Medical Center Rochester New York USA
| | - Majed A. Refaai
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit University of Rochester Medical Center Rochester New York USA
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Laroche V, Blais‐Normandin I. Clinical Uses of Blood Components. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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3
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Kaplan A. Preparation, Storage, and Characteristics of Whole Blood, Blood Components, and Plasma Derivatives. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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4
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Reddy RL. Therapeutic Apheresis. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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5
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McCullough J. Pathogen Reduced Blood Products. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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6
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Wasiluk T, Rogowska A, Boczkowska-Radziwon B, Zebrowska A, Bolkun L, Piszcz J, Radziwon P. Maintaining plasma quality and safety in the state of ongoing epidemic - The role of pathogen reduction. Transfus Apher Sci 2021; 60:102953. [PMID: 33023853 PMCID: PMC7832281 DOI: 10.1016/j.transci.2020.102953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023]
Abstract
In the field of transfusion medicine, many pathogen reduction techniques (PRTs) are currently available, including those based on photochemical (PI) and photodynamic inactivation (PDI). This is particularly important in the face of emerging viral pathogens that may pose a threat to blood recipients, as in the case of the COVID-19 pandemic. However, PRTs have some limitations, primarily related to their adverse effects on coagulation factors, which should be considered before their intended use. A comprehensive search of PubMed, Wiley Online Library and Science Direct databases was conducted to identify original papers. As a result, ten studies evaluating fresh plasma and frozen-thawed plasma treated with different PI/ PDI methods and evaluating concentrations of coagulation factors and natural anticoagulants both before and after photochemical treatment were included in the review. The use of PI and PDI is associated with a significant decrease in the activity of all analysed coagulation factors, while the recovery of natural anticoagulants remains at a satisfactory level, variable for individual inactivation methods. In addition, the published evidence reviewed above does not unequivocally favour the implementation of PI/PDI either before freezing or after thawing as plasma products obtained with these two approaches seem to satisfy the existing quality criteria. Based on current evidence, if implemented responsibly and in accordance with the current guidelines, both PI and PDI can ensure satisfactory plasma quality and improve its safety.
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Affiliation(s)
- Tomasz Wasiluk
- Regional Centre for Transfusion Medicine, Bialystok, Poland.
| | - Anna Rogowska
- Regional Centre for Transfusion Medicine, Bialystok, Poland
| | | | | | - Lukasz Bolkun
- Department of Haematology, Medical University of Bialystok, Bialystok, Poland
| | - Jaroslaw Piszcz
- Department of Haematology, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Radziwon
- Regional Centre for Transfusion Medicine, Bialystok, Poland; Department of Haematology, Medical University of Bialystok, Bialystok, Poland
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7
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Arroyo JL, Martínez E, Amunárriz C, Muñoz C, Romón I, Álvarez I, García JM. Methylene blue-treated plasma, versus quarantine fresh frozen plasma, for acute thrombotic thrombocytopenic purpura treatment: Comparison between centres and critical review on longitudinal data. Transfus Apher Sci 2020; 59:102771. [PMID: 32605805 PMCID: PMC7152885 DOI: 10.1016/j.transci.2020.102771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/23/2020] [Accepted: 04/05/2020] [Indexed: 12/18/2022]
Abstract
Introduction Therapeutic plasma exchange (TPE) is the first-line treatment for acute thrombotic thrombocytopenic purpura (TTP). Methylene blue-plasma (MBP) has been used for over 20 years, but its efficacy in this setting remains controversial. Patients and methods: this is a comparative analysis of the experience of two Centres, with different plasma products, to evaluate their efficacy in TTP. One centre used quarantine plasma (QP), and MBP the other. We performed a retrospective longitudinal study, analysing the clinical files of TTP patients of a 13-year data evaluation period. Duration of treatment and transfusion parameters, medical record, laboratory testing, concomitant medication, and survival rate, were assessed for every episode. Results During the study period, 12 (55.5 %) and 10 (45.5 %) new cases were treated with QP and MBP, respectively. There were no significant differences between the mean numbers of TPE processes, days elapsed from diagnosis to TPE, and plasma volume transfused. The QP TPE episodes of treatment were significantly associated with an increased time to recovery compared with MBP episodes of treatment (p = 0.004). Conclusion MBP was as effective as QP in the treatment of TTP patients. Since recovery was more favourable when MBP was used, we consider MBP remains a suitable alternative to treat TTP patients.
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Affiliation(s)
| | - Eva Martínez
- Servicio de Transfusión, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Carmen Muñoz
- Centro Comunitario de Sangre y Tejidos de Asturias, Oviedo, Spain
| | - Iñigo Romón
- Servicio de Transfusión, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - José María García
- Servicio de Transfusión, Hospital Universitario Central de Asturias, Oviedo, Spain
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McGonigle AM, Patel EU, Waters KM, Moliterno AR, Thoman SK, Vozniak SO, Ness PM, King KE, Tobian AAR, Lokhandwala PM. Solvent detergent treated pooled plasma and reduction of allergic transfusion reactions. Transfusion 2019; 60:54-61. [PMID: 31840276 DOI: 10.1111/trf.15600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) patients have increased risk for allergic transfusion reactions (ATR) due to the number of plasma products they require. This study evaluated the efficacy of solvent detergent treated plasma (S/D treated plasma) to reduce ATRs. STUDY DESIGN AND METHODS All TTP patients who presented from April 2014 to February 2015 and experienced a moderate-severe ATR to untreated plasma with TPE were switched to S/D treated plasma (Octaplas) for their remaining procedures and included in the study. Patient records were retrospectively reviewed. RESULTS The overall ATR rate per procedure decreased from 35.0% (95% CI = 15.4%-59.2%) with untreated plasma to 1.4% ([1/73] 95% CI = 0.0%-7.4%) with S/D treated plasma. The moderate-severe ATR rate decreased from 20.0% ([4/20] 95% CI = 5.7%-43.7%) with untreated plasma to 0.0% ([0/73] 95% CI = 0.0%-4.9%) with S/D treated plasma. The overall ATR rate per plasma unit decreased from 2.6% (95%CI = 1.0%-5.1%) with untreated plasma to 0.1% (95% CI = 0.0%-0.4%) with S/D treated plasma. No patients experienced VTE while receiving untreated plasma. Four patients experienced VTE events while receiving S/D treated plasma. All patients who experienced a VTE had additional risk factors for VTE. CONCLUSION S/D plasma has promise as an effective product to reduce the risk of ATRs in TTP patients. Given the high risk of ATR in TTP patients, consideration of S/D plasma instead of untreated plasma for TPE in these patients may be warranted, especially for patients with a history of moderate to severe ATR. More extensive studies are needed to confirm these findings.
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Affiliation(s)
- Andrea M McGonigle
- Department of Pathology and Laboratory Medicine, Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Eshan U Patel
- Department of Pathology, Transfusion Medicine Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin M Waters
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alison R Moliterno
- Department of Medicine, Hematology Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sandra K Thoman
- Department of Pathology, Transfusion Medicine Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sonja O Vozniak
- Department of Pathology, Transfusion Medicine Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul M Ness
- Department of Pathology, Transfusion Medicine Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen E King
- Department of Pathology, Transfusion Medicine Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A R Tobian
- Department of Pathology, Transfusion Medicine Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Parvez M Lokhandwala
- Department of Pathology, Transfusion Medicine Division, Johns Hopkins University School of Medicine, Baltimore, Maryland
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9
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Erickson A, Waldhaus K, David T, Huang N, Rico S, Corash L, Mufti N, Benjamin RJ. Plasma treated with amotosalen and ultraviolet A light retains activity for hemostasis after 5 days post-thaw storage at 1 to 6oC. Transfusion 2017; 57:997-1006. [DOI: 10.1111/trf.13973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/29/2022]
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10
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Theusinger OM, Goslings D, Studt JD, Brand-Staufer B, Seifert B, Spahn DR, Frey BM. Quarantine versus pathogen-reduced plasma-coagulation factor content and rotational thromboelastometry coagulation. Transfusion 2016; 57:637-645. [DOI: 10.1111/trf.13935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Oliver M. Theusinger
- Institute of Anesthesiology, University and University Hospital Zurich; Zurich Switzerland
| | - David Goslings
- Regional Blood Transfusion Service, Zurich Swiss Red Cross; Zurich Switzerland
| | - Jan-Dirk Studt
- Division of Hematology; University and University Hospital Zurich; Zurich Switzerland
| | | | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology; Biostatistics, and Prevention Institute, University of Zurich; Zurich Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich; Zurich Switzerland
| | - Beat M. Frey
- Regional Blood Transfusion Service, Zurich Swiss Red Cross; Zurich Switzerland
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11
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Preparation, Storage, and Characteristics of Blood Components and Plasma Derivatives. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Therapeutic Apheresis. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Clinical Uses of Blood Components. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Cicchetti A, Berrino A, Casini M, Codella P, Facco G, Fiore A, Marano G, Marchetti M, Midolo E, Minacori R, Refolo P, Romano F, Ruggeri M, Sacchini D, Spagnolo AG, Urbina I, Vaglio S, Grazzini G, Liumbruno GM. Health Technology Assessment of pathogen reduction technologies applied to plasma for clinical use. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:287-386. [PMID: 27403740 PMCID: PMC4942318 DOI: 10.2450/2016.0065-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although existing clinical evidence shows that the transfusion of blood components is becoming increasingly safe, the risk of transmission of known and unknown pathogens, new pathogens or re-emerging pathogens still persists. Pathogen reduction technologies may offer a new approach to increase blood safety. The study is the output of collaboration between the Italian National Blood Centre and the Post-Graduate School of Health Economics and Management, Catholic University of the Sacred Heart, Rome, Italy. A large, multidisciplinary team was created and divided into six groups, each of which addressed one or more HTA domains.Plasma treated with amotosalen + UV light, riboflavin + UV light, methylene blue or a solvent/detergent process was compared to fresh-frozen plasma with regards to current use, technical features, effectiveness, safety, economic and organisational impact, and ethical, social and legal implications. The available evidence is not sufficient to state which of the techniques compared is superior in terms of efficacy, safety and cost-effectiveness. Evidence on efficacy is only available for the solvent/detergent method, which proved to be non-inferior to untreated fresh-frozen plasma in the treatment of a wide range of congenital and acquired bleeding disorders. With regards to safety, the solvent/detergent technique apparently has the most favourable risk-benefit profile. Further research is needed to provide a comprehensive overview of the cost-effectiveness profile of the different pathogen-reduction techniques. The wide heterogeneity of results and the lack of comparative evidence are reasons why more comparative studies need to be performed.
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Affiliation(s)
- Americo Cicchetti
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Alexandra Berrino
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Marina Casini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Paola Codella
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppina Facco
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Alessandra Fiore
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Marano
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Marco Marchetti
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Emanuela Midolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Roberta Minacori
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Pietro Refolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica Romano
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Matteo Ruggeri
- Postgraduate School of Health Economics and Management (Altems), Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Sacchini
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio G. Spagnolo
- Institute of Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Irene Urbina
- Health Technology Assessment Unit of “Gemelli” Teaching Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Vaglio
- Italian National Blood Centre, National Institute of Health, Rome, Italy
| | - Giuliano Grazzini
- Italian National Blood Centre, National Institute of Health, Rome, Italy
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Abstract
Thrombocytopenia is a common laboratory finding in the intensive care unit (ICU) patient. Because the causes can range from laboratory artifact to life-threatening processes such as thrombotic thrombocytopenic purpura (TTP), identifying the cause of thrombocytopenia is important. In the evaluation of the thrombocytopenia patient, one should incorporate all clinical clues such as why the patient is in the hospital, medications the patient is on, and other abnormal laboratory findings. One should ensure that the patient does not suffer from heparin-induced thrombocytopenia (HIT) or one of the thrombotic microangiopathies (TMs). HIT can present in any patient on heparin and requires specific testing and antithrombotic therapy. TMs cover a spectrum of disease ranging from TTP to pregnancy complications and can have a variety of presentations. Management of disseminated intravascular coagulation depends on the patient’s condition and complication. Other causes of ICU thrombocytopenia include sepsis, medication side effects, post-transfusion purpura, catastrophic anti phospholipid antibody disease, and immune thrombocytopenia.
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Neisser‐Svae A, Heger A. Two solvent/detergent‐treated plasma products with a different biochemical profile. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - A. Heger
- Octapharma Pharmazeutika Produktionsges.m.b.H Vienna Austria
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17
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Heger A, Janisch S, Pock K, Römisch J. Comparative biochemical studies of fresh frozen plasma and pooled solvent/detergent-treated plasma (octaplasLG ® ) with focus on protein S and its impact in different thrombin generation assay set-ups. Vox Sang 2016; 111:266-273. [PMID: 27232115 DOI: 10.1111/vox.12420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 04/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The solvent/detergent treatment enables effective and robust inactivation of all lipid-enveloped viruses, but also inactivates partly sensitive plasma proteins such as protein S. The aim of this study was to investigate the thrombin generation capacity of octaplasLG® , in particular focusing on the function of protein S in thrombin generation assay and the impact of assay settings. MATERIALS AND METHODS Sixteen octaplasLG® batches and 32 units of single donor fresh frozen plasma (FFP) were investigated. For protein S, both functional activity and free antigen levels were measured. Thrombin generation assay was performed using two fluorogenic tests with different triggers. Finally, rotational thromboelastometry was performed. RESULTS Mean protein S levels were lower in octaplasLG® , but a wider range of values was found for FFP. Clotting parameters and thrombin generation capacities overlapped between the two plasma groups as demonstrated using both thrombin generation assays and different triggers. Spiking studies with protein S-depleted plasma, human purified protein S or antibodies against protein S confirmed a correlation between protein S and thrombin generation capacity under specific assay conditions, especially in an assay with low tissue factor concentration. CONCLUSION Correlation between protein S and thrombin generation capacity was demonstrated in the TGA. Due to higher variability in protein S content in the FFP group, overlapping haemostatic potentials of the two plasma groups were found.
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Affiliation(s)
- A Heger
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria.
| | - S Janisch
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
| | - K Pock
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
| | - J Römisch
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
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van Beers JJBC, van Egmond LT, Wetzels RJH, Verhezen PWM, Beckers EAM, van Oerle R, Spronk HMH, Straat RJMHE, Henskens YMC. Increased coagulation and fibrinolytic potential of solvent-detergent plasma: a comparative study between Omniplasma and fresh frozen plasma. Vox Sang 2016; 111:33-42. [DOI: 10.1111/vox.12395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- J. J. B. C. van Beers
- Central Diagnostic Laboratory; Cluster for Hemostasis and Transfusion; Maastricht University Medical Center; Maastricht the Netherlands
| | - L. T. van Egmond
- Central Diagnostic Laboratory; Cluster for Hemostasis and Transfusion; Maastricht University Medical Center; Maastricht the Netherlands
| | - R. J. H. Wetzels
- Central Diagnostic Laboratory; Cluster for Hemostasis and Transfusion; Maastricht University Medical Center; Maastricht the Netherlands
| | - P. W. M. Verhezen
- Central Diagnostic Laboratory; Cluster for Hemostasis and Transfusion; Maastricht University Medical Center; Maastricht the Netherlands
| | - E. A. M. Beckers
- Department of Internal Medicine; Subdivision Hematology; Maastricht University Medical Center; Maastricht the Netherlands
| | - R. van Oerle
- Central Diagnostic Laboratory; Cluster for Hemostasis and Transfusion; Maastricht University Medical Center; Maastricht the Netherlands
- Laboratory for Clinical Thrombosis and Haemostasis; Department of Internal Medicine; Cardiovascular Research Institute Maastricht; Maastricht University Medical Center; Maastricht the Netherlands
| | - H. M. H. Spronk
- Laboratory for Clinical Thrombosis and Haemostasis; Department of Internal Medicine; Cardiovascular Research Institute Maastricht; Maastricht University Medical Center; Maastricht the Netherlands
| | - R. J. M. H. E. Straat
- Central Diagnostic Laboratory; Cluster for Hemostasis and Transfusion; Maastricht University Medical Center; Maastricht the Netherlands
| | - Y. M. C. Henskens
- Central Diagnostic Laboratory; Cluster for Hemostasis and Transfusion; Maastricht University Medical Center; Maastricht the Netherlands
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Abstract
The solvent/detergent treatment is an established virus inactivation technology that has been industrially applied for manufacturing plasma derived medicinal products for almost 30 years. Solvent/detergent plasma is a pharmaceutical product with standardised content of clotting factors, devoid of antibodies implicated in transfusion-related acute lung injury pathogenesis, and with a very high level of decontamination from transfusion-transmissible infectious agents. Many clinical studies have confirmed its safety and efficacy in the setting of congenital as well as acquired bleeding disorders. This narrative review will focus on the pharmaceutical characteristics of solvent/detergent plasma and the clinical experience with this blood product.
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20
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Liumbruno GM, Marano G, Grazzini G, Capuzzo E, Franchini M. Solvent/detergent-treated plasma: a tale of 30 years of experience. Expert Rev Hematol 2015; 8:367-74. [DOI: 10.1586/17474086.2015.1016906] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The last 20 years have seen many advances in transfusion therapy and safety. Blood products are biological products engendering complex interactions with the immune system. Prestorage leukoreduction results in a reduced risk of febrile reactions, CMV transmission, and immune modulation, proving to be safer for patients than non-leuko reduced products. Simple patient identification issues and clerical error continue to be the primary causes of ABO-incompatible transfusions. Rigorous donor screening as well as serologic and nucleic acid testing for transfusion transmitted infection have brought the blood supply to a very safe level, although transmission of these agents continues to be a problem in underdeveloped countries. Emerging infectious diseases, beyond current laboratory detection capabilities, combined with global travel, pose unknown imminent risks everywhere. We also briefly discuss the current risks of transfusion-transmitted infections. We review currently available hemostatic blood products, their compositions, and their clinical indications; we mention product modifications currently in development; and we touch upon the hemostatic properties and drawbacks of whole blood, which is currently gaining popularity as an alternative to split blood products. We conclude with an in-depth overview of the risks associated with transfusion, including incompatibility, hemolytic transfusion reactions, transfusion-associated circulatory overload (TACO), and transfusion-related acute lung injury (TRALI).
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Affiliation(s)
| | - Patrick Schoettker
- Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland
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Camous L, Veyradier A, Darmon M, Galicier L, Mariotte E, Canet E, Parquet N, Azoulay É. Macrovascular thrombosis in critically ill patients with thrombotic micro-angiopathies. Intern Emerg Med 2014; 9:267-72. [PMID: 23054401 DOI: 10.1007/s11739-012-0851-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 09/14/2012] [Indexed: 12/24/2022]
Abstract
The purpose of this study is to assess the incidence and describe the clinical and pathological features of macrovascular thrombosis during the course of thrombotic micro-angiopathy (TMA) in a 6 year retrospective study of all adults with TMA, admitted to a teaching-hospital ICU. Of the 55 patients identified, all had anaemia and thrombocytopenia and 45 (82 %) had renal or neurological impairment. All patients received plasmapheresis, steroids, and strict blood pressure control. Macrovascular venous or arterial thromboses were diagnosed in 28 (51 %) patients; among them, 7 had cerebral artery thrombosis and 21 (including 13 with central venous catheters) had deep vein thrombosis. Median time from plasmapheresis initiation to thrombosis was 7 (4-10) days. Clinical findings were suggestive of deep venous thrombosis in 7 of the 21 patients (33 %) and only one of the 7 patients with stroke had corresponding clinical signs. By multivariate analysis, factors independently associated with macrovascular thrombosis were undetectable ADAMTS13 activity (odds ratio 7.33, 95 % confidence interval 1.3-41.3), cardiac involvement with TMA (odds ratio, 3.46; 95 % confidence interval, 1.1-13.9) and TMA flare (odds ratio 9.03; 95 % confidence interval 1.03-79.4). In conclusion, half of the patients with TMA experience macrovascular thrombosis. Patients with TTP-related ADAMTS13 deficiency and those with cardiac manifestations of TMA are at higher risk for arterial or deep venous thrombosis.
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Affiliation(s)
- Laurent Camous
- Medical ICU, Clinical Immunology and Hemapheresis Departments, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010, Paris, France
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Wang Z, Du X, Li C, Ma L, Sun P, Cao H, Lin F, Ye S, Xiao X. Coagulation factors and inhibitors in thawed plasma stored at 1–6°C for 5days in China. Transfus Apher Sci 2014; 50:274-80. [DOI: 10.1016/j.transci.2014.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/02/2014] [Indexed: 12/24/2022]
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Advances in military, field, and austere transfusion medicine in the last decade. Transfus Apher Sci 2013; 49:380-6. [PMID: 23856530 DOI: 10.1016/j.transci.2013.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 11/23/2022]
Abstract
Two decades of war in south-west Asia has demonstrated the essential role of primary resuscitation with blood products in the care of critically injured soldiers. This idea has been widely adopted and is being critically tested in civilian trauma centers. The need for red cells, plasma and platelets to be immediately available in remote locations creates a logistic burden that will best be eased by innovative new blood products such as longer-stored liquid RBCs, freeze-dried plasma, small-volume frozen platelets, and coagulation factor concentrates such as fibrinogen concentrates and prothrombin complex concentrates. Such products have long shelf-lives, low logistic burdens of weight, fragility, or needs for processing prior to use. Developing and fielding a full family of such products will improve field medical care and make products available in the evacuation chain. It also will allow treatment in other austere environments such as the hundreds of small hospitals in the US which serve as Levels 3 and 4 trauma centers but do not currently have thawed plasma or platelets available. Such small trauma centers currently care for half of all the trauma patients in the country. Proving the new generation of blood products work, will help assure their widest availability in emergencies.
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Vitale MA, Vanbeek C, Spivack JH, Cheng B, Geller JA. Pharmacologic reversal of warfarin-associated coagulopathy in geriatric patients with hip fractures: a retrospective study of thromboembolic events, postoperative complications, and time to surgery. Geriatr Orthop Surg Rehabil 2013; 2:128-34. [PMID: 23569682 DOI: 10.1177/2151458511417434] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Patients with acute hip fractures who are on maintenance warfarin for anticoagulation present a significant challenge and their management remains controversial. The purpose of this study was to assess thromboembolic and systemic complications associated with pharmacological reversal of warfarin-associated coagulopathy in a population of geriatric patients with hip fractures. METHODS This retrospective cohort study identified patients with operative hip fractures on oral warfarin therapy who had an international normalized ratio (INR) >1.50 on admission (N = 93) approximately over a 13-year span. The control group consisted of patients whose warfarin was held upon admission without further intervention preoperatively (n = 23). The treatment group consisted of patients who underwent pharmacologic reversal of elevated INR with vitamin K and/or fresh frozen plasma (FFP) in addition to holding warfarin (n = 70). Primary outcomes included thromboembolic and other complications as well as mortality within 3 months of presentation. Time to surgery was a secondary outcome. RESULTS The 3-month mortality rate was 4% in the pharmacological intervention group and 17% in the watch-and-wait group; this difference trended toward statistical significance (P = .06). There were no significant differences in the likelihoods of other thromboembolic or nonthromboembolic complications between groups. While the difference in mean time to surgery was not significantly different overall between groups, this difference was significant in a subgroup of patients with higher baseline INRs (n = 46, INR >2.17), with a mean difference of 4.0 fewer days until surgery in the pharmacological intervention group (P < .01). CONCLUSIONS Pharmacological reversal of warfarin-associated coagulopathy with a combination of vitamin K and FFP appears to be a safe way to optimize patients for operative fixation of hip fractures and is associated with a shorter delay to surgery in patients with more elevated INRs preoperatively. LEVEL OF EVIDENCE retrospective cohort study (level III).
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Affiliation(s)
- Mark A Vitale
- Center for Hip and Knee Replacement, Department of Orthopaedic Surgery, New York Presbyterian Medical Center, Columbia University, New York, NY, USA
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Preparation, Storage, and Characteristics of Blood Components and Plasma Derivatives. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Clinical Uses of Blood Components. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Therapeutic Apheresis. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hacquard M, Lecompte T, Belcour B, Geschier C, Jacquot C, Jacquot E, Schneider T. Evaluation of the hemostatic potential including thrombin generation of three different therapeutic pathogen-reduced plasmas. Vox Sang 2011; 102:354-61. [PMID: 22092160 DOI: 10.1111/j.1423-0410.2011.01562.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Several pathogen inactivation methods currently applied to therapeutic plasma may result in products with different hemostatic properties. This study aims at evaluating and comparing the hemostatic potential of different therapeutic plasma preparations currently available in France. MATERIALS AND METHODS We studied three types of pathogen-reduced plasma for transfusion (MB/light, Amotosalen/UVA, industrial S/D plasma). Quarantine, non-pathogen-reduced plasma, was used as a control. This study compared more specifically the content in FVIII, fibrinogen (clottable and antigen assays) and ADAMTS-13 and evaluated the intrinsic hemostatic properties using a thrombin generation test [Calibrated Automated Thrombogram (CAT)] at high and low concentrations of tissue factor to assess the maximum quantity of thrombin generated or the contribution of FVIII and FIX in the amplification phase of thrombin generation, respectively. RESULTS The median FVIII concentration was >70 IU/dl for each preparation. Endogenous thrombin potential values were significantly different among the methods of plasma preparation (P<0·001) but were all in the range of the values measured in donors' plasma. Control by the thrombomodulin-activated protein C system was preserved in all preparations (>50% inhibition of endogenous thrombin potential). Fibrinogen concentrations were all within normal range but fibrinogen levels were lower in the plasmas treated with photochemical methods. ADAMTS-13 levels were preserved. CONCLUSION The hemostatic potential appears well preserved in all therapeutic plasmas tested but there are some differences between preparations, the clinical relevance of which remains to be elucidated.
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Affiliation(s)
- M Hacquard
- EFS Lorraine Champagne, Vandoeuvre les Nancy, France.
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Ettinger A, Miklauz MM, Hendrix BK, Bihm DJ, Maldonado-Codina G, Goodrich RP. Protein stability of previously frozen plasma, riboflavin and UV light-treated, refrozen and stored for up to 2years at −30°C. Transfus Apher Sci 2011; 44:25-31. [DOI: 10.1016/j.transci.2010.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
INTRODUCTION Current methods for pathogen inactivation of plasma involve four major processes using solvent-detergent (SD), methylene blue (MB), amotosalen and riboflavin as additives. Three of these methods involve the use of visible or ultraviolet light. METHODS A comparison of the four methods was made using publications in Medline, Pubmed, Embase and Biosis to obtain data on the logistics of use, the quality of the plasma proteins and the effectiveness of pathogen inactivation. RESULTS Three of the methods, MB, amotosalen and riboflavin, are designed for use in a blood bank; the SD method is generally applied at a centralized manufacturing centre and involves large plasma pools. All methods result in a reduction in protein values with the per cent retention of FVIII activity in the range of 67-78% and fibrinogen of 65-84%. Protein S and alpha(2)-antiplasmin are lower following solvent-detergent treatment. Alterations in fibrinogen structure have been reported with methylene blue. DISCUSSION Three of the methods are designed for small volume use in a blood bank. All four methods have some effect on the coagulant proteins; however, the final concentrations are within regulated limits. While there is variability in the effectiveness against pathogens, direct comparison is difficult because of the methodologies used. Nonetheless, all are effective in inactivating HIV and other lipid-enveloped pathogens. Clinical studies on the effectiveness of these products are surprisingly sparse, and no randomized clinical trials have yet been performed with amotosalen or riboflavin plasmas.
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Affiliation(s)
- G Rock
- University of Ottawa, Ottawa, Ontario, Canada.
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Sørensen B, Bevan D. A critical evaluation of cryoprecipitate for replacement of fibrinogen. Br J Haematol 2010; 149:834-43. [DOI: 10.1111/j.1365-2141.2010.08208.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bihm DJ, Ettinger A, Buytaert-Hoefen KA, Hendrix BK, Maldonado-Codina G, Rock G, Giclas PC, Goodrich RP. Characterization of plasma protein activity in riboflavin and UV light-treated fresh frozen plasma during 2 years of storage at â30°C. Vox Sang 2010; 98:108-15. [DOI: 10.1111/j.1423-0410.2009.01238.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Recommendations for the transfusion of plasma and platelets. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2009; 7:132-50. [PMID: 19503635 PMCID: PMC2689068 DOI: 10.2450/2009.0005-09] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Giancarlo Liumbruno
- UU.OO.CC. di Immunoematologia e Medicina Trasfusionale e Patologia Clinica, Ospedale San Giovanni Calibita Fatebenefratelli, Roma, Italy.
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Liumbruno GM, Sodini ML, Grazzini G. Recommendations from the Tuscan Transfusion System on the appropriate use of solvent/detergent-inactivated fresh-frozen plasma. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2008; 6:25-36. [PMID: 18661921 PMCID: PMC2626856 DOI: 10.2450/2008.0027-07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Revised: 06/04/2007] [Accepted: 12/05/2007] [Indexed: 01/14/2023]
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Webert KE, Cserti CM, Hannon J, Lin Y, Pavenski K, Pendergrast JM, Blajchman MA. Proceedings of a Consensus Conference: pathogen inactivation-making decisions about new technologies. Transfus Med Rev 2008; 22:1-34. [PMID: 18063190 PMCID: PMC7127103 DOI: 10.1016/j.tmrv.2007.09.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Significant progress has been made in reducing the risk of pathogen transmission to transfusion recipients. Nonetheless, there remains a continuing risk of transmission of viruses, bacteria, protozoa, and prions to recipients. These include many of the viruses for which specific screening tests exist as well as pathogens for which testing is currently not being done, including various species of bacteria, babesiosis, variant Creutzfeld-Jacob disease, hepatitis A virus, human herpes virus 8, chikungunya virus, Chagas disease, and malaria. Pathogen inactivation (PI) technologies potentially provide an additional way to protect the blood supply from emerging agents and also provide additional protection against both known and as-yet-unidentified agents. However, the impact of PI on product quality and recipient safety remains to be determined. The purpose of this consensus conference was to bring together international experts in an effort to consider the following issues with respect to PI: implementation criteria; licensing requirements; blood service and clinical issues; risk management issues; cost-benefit impact; and research requirements. These proceedings are provided to make available to the transfusion medicine community the considerable amount of important information presented at this consensus conference.
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Affiliation(s)
- Kathryn E Webert
- Medical, Scientific, and Research Affairs, Canadian Blood Services, Hamilton, Edmonton and Toronto, Canada.
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Scully M, Longair I, Flynn M, Berryman J, Machin SJ. Cryosupernatant and solvent detergent fresh-frozen plasma (Octaplas) usage at a single centre in acute thrombotic thrombocytopenic purpura. Vox Sang 2007; 93:154-8. [PMID: 17683359 DOI: 10.1111/j.1423-0410.2007.00940.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is an acute, life-threatening disorder and plasma exchange (PEX) remains the mainstay of treatment. METHODS We reviewed 50 acute TTP episodes to establish the efficacy and safety of cryosupernatant (CPP) and Octaplas. RESULTS Twelve episodes used CPP only and 15 episodes started with CPP and changed to Octaplas. Once Octaplas had been used, it was continued on further admissions. Cryosupernatant was used exclusively in 24% and Octaplas exclusively in 42% of all episodes. The number of citrate reactions and allergic (plasma) reactions were halved in those receiving only Octaplas compared with cryosupernatant. There were 22 line infections and in approximately 70% of cases the infection was associated with a reduction in platelet count. In all 50 episodes, the only documented thrombosis was a superficial non-central vein. In episodes receiving only cryosupernatant or Octaplas, there was no significant difference in the median number of PEX to remission, 7.0 (interquartile range, IQR 5-8.8) and 8.0 (IQR 6.5-22), respectively. Baseline viral screen in all episodes was negative after discharge following an acute episode. CONCLUSION There was no difference in number of PEX to remission with cryosupernatant and solvent/detergent fresh-frozen plasma (Octaplas). However, allergic/urticarial and citrate reactions were more common with cryosupernatant. There was no documented viral transmission with either product.
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Affiliation(s)
- M Scully
- Haemostasis Research Unit, Department of Haematology, University College London, 51 Chenies Mews, London, UK.
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Pereira A. Medidas de seguridad viral del plasma destinado a transfusión y su aplicación en España. Med Clin (Barc) 2007; 129:458-68. [DOI: 10.1157/13111004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Osselaer JC, Debry C, Goffaux M, Pineau J, Calomme G, Dubuc E, Chatelain B, Vandendaele MC, Hsu J, Rheinschmidt M, Lin L. Coagulation function in fresh-frozen plasma prepared with two photochemical treatment methods: methylene blue and amotosalen. Transfusion 2007; 48:108-17. [PMID: 17900283 DOI: 10.1111/j.1537-2995.2007.01488.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pathogen inactivation of plasma intended for transfusion is now the standard of care in Belgium. Two methods for treatment of single plasma units are available: amotosalen plus ultraviolet A light and methylene blue plus visible light. This study compared the quality and stability of plasma treated with these two methods. STUDY DESIGN AND METHODS Plasma units made from a pool of two ABO-matched fresh apheresis units were photochemically treated with either amotosalen (PCT-FFP) or methylene blue (MB-FFP). A total of 12 paired samples were evaluated. Plasma coagulation function was assessed at three time points: immediately after treatment, after 30 days of frozen storage, and an additional 24 hours at 4 degrees C after thawing. Comparison between PCT-FFP and MB-FFP was assessed with the paired t test and a p value of less than 0.05 indicated statistical significance. RESULTS Based on statistical analysis, mean levels of factor (F)II, FXII, FXIII, von Willebrand antigen, ADAMTS-13, D-dimers, and protein C were equivalent between PCT-FFP and MB-FFP for all three time points. PCT-FFP exhibited shorter mean prothrombin time, activated partial thromboplastin time (two time points), and thrombin time and higher mean levels of fibrinogen, FXI, and protein S than MB-FFP. Retention of FV, FVII, FVIII, FX, or von Willebrand factor:ristocetin cofactor in PCT-FFP was either equivalent to or higher than MB-FFP. MB-FFP contained higher mean levels of plasminogen, antithrombin, and plasmin inhibitor than PCT-FFP. Retention of F IX in MB-FFP was higher than PCT-FFP only after the 4 degrees C storage after thawing. CONCLUSION There is adequate preservation of therapeutic coagulation factor activities in both PCT-FFP and MB-FFP. The overall coagulation factor levels and stability of PCT-FFP were better preserved than MB-FFP.
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Affiliation(s)
- Jean-Claude Osselaer
- Blood Transfusion Center and Laboratory of Hematology, Cliniques Universitaires de Mont Godinne, Université Catholique de Louvain, Yvoir, Belgium.
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Velik-Salchner C, Haas T, Innerhofer P, Streif W, Nussbaumer W, Klingler A, Klima G, Martinowitz U, Fries D. The effect of fibrinogen concentrate on thrombocytopenia. J Thromb Haemost 2007; 5:1019-25. [PMID: 17461931 DOI: 10.1111/j.1538-7836.2007.02481.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The hypothesis that the administration of fibrinogen concentrate enables restoration of impaired clot formation and increased bleeding in severe thrombocytopenia was tested. METHODS Thirty pigs were anesthetized, instrumented for blood sampling (routine coagulation tests, modified thrombelastography ROTEM, hemodynamic monitoring and platelet apheresis to a target below 30 x 10(9) L(-1) after splenectomy. Thereafter 10 each of the animals randomly received two apheresis platelet concentrates, 250 mg kg(-1) fibrinogen concentrate or normal saline solution. A standardized liver injury was subsequently inflicted to induce uncontrolled hemorrhage. RESULTS Median (Q1, Q3) clot firmness increased significantly more in thrombocytopenic pigs after fibrinogen administration (42 mm (41, 43) to 60 mm (57, 63)) than following platelet transfusion (40 mm (37, 45) to 52 mm (48, 55), P = 0.0004) or placebo (45 mm (41, 48) to 45 mm (43, 46), P = 0.0002). Median blood loss velocity after liver injury was significantly less with fibrinogen (33 mL min(-1), P = 0.005) than with platelets (62 mL min(-1), P = 0.037) or saline (84 mL min(-1), P = 0.005), and median survival time after liver injury was 55 min in the fibrinogen, 26 min in the platelet (P = 0.035) and 19 min in the saline group (P = < 0.0001). CONCLUSIONS These data show for the first time that impaired clot formation during thrombocytopenia improves with administration of fibrinogen concentrate, which results in a slowdown of blood loss and prolonged survival.
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Affiliation(s)
- C Velik-Salchner
- Department of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria
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Burnouf T, Goubran HA, Radosevich M, Sayed MA, Gorgy G, El-Ekiaby M. A process for solvent/detergent treatment of plasma for transfusion at blood centers that use a disposable-bag system. Transfusion 2007; 46:2100-8. [PMID: 17176321 DOI: 10.1111/j.1537-2995.2006.01035.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Solvent/detergent (S/D) inactivates enveloped viruses in plasma. The current technology requires a plasma fractionation facility and is applied to large plasma pools, which increases the cost and risks of exposure to S/D-resistant pathogens and lowers the content of protein S and alpha2-antiplasmin. Two S/D treatment procedures for single donations or minipools of plasma have been developed with a single-use bag system. STUDY DESIGN AND METHODS Frozen plasma samples were thawed and treated in disposable bags with either 2 percent tri(n-butyl)phosphate (TnBP) at 37 degrees C or 1 percent TnBP and 1 percent Triton X-45 at 31 degrees C for 4 hours. Plasma samples were extracted three times with 7.5 percent sterile castor oil to remove TnBP and Triton X-45. The TnBP-treated plasma samples were further subjected to a clarifying centrifugation (3800 x g, 30 min). Final plasma samples were dispensed into individual bags and frozen at -30 degrees C. Plasma quality was assessed at each step of the procedures. RESULTS Both processes yielded greater than 90 percent mean recovery of coagulation factors (clottable fibrinogen, von Willebrand factor, and factors VIII, V, VII, IX, X, and XI), anticoagulants (protein C, protein S), protease inhibitors (antithrombin, alpha2-antiplasmin), total protein, albumin, and immunoglobulins. Global coagulation tests of the treated plasma samples were normal. Final TnBP and Triton X-45 content was less than 10 and 50 ppm, respectively. CONCLUSION S/D treatment of plasma can be performed in a closed-bag system under conditions that maintain plasma protein quality. The technology is simple, presents advantages over the industrial large-scale S/D plasma process, and could be performed in blood centers.
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Mintz PD, Neff A, MacKenzie M, Goodnough LT, Hillyer C, Kessler C, McCrae K, Menitove JE, Skikne BS, Damon L, Lopez-Plaza I, Rouault C, Crookston KP, Benjamin RJ, George J, Lin JS, Corash L, Conlan MG. A randomized, controlled Phase III trial of therapeutic plasma exchange with fresh-frozen plasma (FFP) prepared with amotosalen and ultraviolet A light compared to untreated FFP in thrombotic thrombocytopenic purpura. Transfusion 2006; 46:1693-704. [PMID: 17002625 DOI: 10.1111/j.1537-2995.2006.00959.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Photochemical treatment of fresh-frozen plasma (FFP) with amotosalen and ultraviolet (UV) A light (PCT FFP) results in inactivation of a broad spectrum of pathogens while retaining coagulation factor activity, antithrombotic proteins, and von Willebrand factor-cleaving protease (VWF-CP) activity. STUDY DESIGN AND METHODS A randomized, controlled, double-blind Phase III trial was conducted with PCT FFP or control FFP for therapeutic plasma exchange (TPE) in patients with thrombotic thrombocytopenic purpura (TTP). Owing to the rarity of this diagnosis, the trial was not powered to demonstrate small differences between treatment groups. Patients were treated with study FFP for a maximum of 35 days until remission was achieved (for a maximum of 30 daily study TPEs with no remission) plus an additional 5 days after remission. RESULTS Among the 35 patients treated, the primary endpoint, remission within 30 days, was achieved by 14 of 17 (82%) PCT patients and 16 of 18 (89%) control patients (p = 0.658) The 90 percent confidence interval for treatment difference in remission rate for test - control was (-0.291 to 0.163). Time to remission, relapse rates, time to relapse, total volume and number of FFP units exchanged, and number of study TPEs were not significantly different between groups. Improvement in VWF-CP and inhibitors was similar for both groups. The overall safety profile of PCT FFP was similar to control FFP. No antibodies to amotosalen neoantigens were detected. CONCLUSION The comparable results between treatment groups observed from this small trial suggest that TPE with PCT FFP was safe and effective for treatment of TTP.
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Affiliation(s)
- Paul D Mintz
- University of Virginia Health System, Charlottesville, Virginia, USA
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Salge-Bartels U, Breitner-Ruddock S, Hunfeld A, Seitz R, Heiden M. Are quality differences responsible for different adverse reactions reported for SD-plasma from USA and Europe? Transfus Med 2006; 16:266-75. [PMID: 16879155 DOI: 10.1111/j.1365-3148.2006.00672.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Thromboembolic adverse reactions reported after transfusion of SD-plasma in the United States (US) prompted us to perform a comparative study with SD-plasma from the US and the European (EU) market. In SD-plasma from US, residual tri-N-butyl phosphate was found, and citrate concentrations were lower than in EU-plasma. Except for substantial losses of FV, FVIII and antiplasmin found for all SD-plasmas, clotting factor activities were mainly retained. However, for SD-plasma from US, markedly elevated concentrations of lipoprotein (a) [Lp(a)], fibrin monomer and a particularly high degree of complement activation (C3a des-Arg) were observed. Furthermore, pronounced differences were found for protein S. Although SD-plasma pools from US contained nearly normal concentrations of free and bound protein S antigen, protein S activities were almost completely absent. In contrast to this, SD-plasma from EU showed a moderate loss of both protein S activity and free antigen. Antitrypsin inhibitor activities were much more diminished in SD-plasma from US than from EU. In view of a possible thrombogenicity of SD-plasma from US, the loss of protein S and elevated Lp(a) concentrations could be of significance. The very high levels of C3a des-Arg in US plasma could possibly have an additional effect, through priming platelet activation after transfusion.
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McLeod BC. Therapeutic apheresis: use of human serum albumin, fresh frozen plasma and cryosupernatant plasma in therapeutic plasma exchange. Best Pract Res Clin Haematol 2006; 19:157-67. [PMID: 16377548 DOI: 10.1016/j.beha.2005.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
In therapeutic plasma exchange, patient plasma is removed and a colloid replacement solution is infused in its stead. A solution of 4-5% human serum albumin in saline is the recommended replacement solution in most instances, even though it leads to transient mild deficiencies of most plasma proteins. Albumin solutions are pasteurized to inactivate viruses, carry a very low risk of febrile and allergic reactions, and are convenient to store and administer. Fresh frozen plasma, which must be type specific and needs to be ordered in advance and thawed before use, carries a higher risk of reactions; however, it replaces all plasma constituents and is appropriate for patients with thrombotic thrombocytopenic purpura or a pre-existing coagulopathy. Neither cryosupernatant plasma, which is relatively depleted of the proteins in cryoprecipitate, nor pooled plasma that has been virally inactivated with organic solvents and detergents has been shown to be superior to fresh frozen plasma for any indication.
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Affiliation(s)
- Bruce C McLeod
- Blood Center, Rush Medical College, Rush University Medical Center, 1753 West Congress Parkway, Chicago, IL 60612, USA.
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