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OUP accepted manuscript. Lab Med 2022; 53:439-445. [DOI: 10.1093/labmed/lmac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bahreini S, Javadzadeh Shahshahani H, Nasizadeh S, Ahmadinejad M. The activity of labile coagulation factors and fibrinogen in thawed plasma during a 5 day storage period in the hospital blood bank refrigerator. Transfus Med 2021; 31:494-498. [PMID: 34605106 DOI: 10.1111/tme.12823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fresh frozen plasma (FFP) is used to treat coagulation disorders. Even though the activity of labile coagulation factors gradually decreases once thawed, it can be used up to 24 h after thawing, if stored properly. In this study, the level of coagulation factor activity was evaluated in thawed plasma during a 5 day storage period. MATERIALS AND METHODS This cross-sectional study was performed on 40 FFP units prepared in Yazd Blood Center. Samples were thawed in a waterbath for 20-30 min at 30-37°C and then stored in the hospital blood bank refrigerator. The level of fibrinogen concentration, as a stable factor and, coagulation factors V and VIII, as labile factors, were measured in the plasma immediately following the thawing process as well as 24 and 120 h after the process. Data analysis was performed using SPSS software 20. RESULTS The fibrinogen level remained stable for up to 24 h after thawing; after 120 h there was a 1.66% decrease with the mean level of 334.0 ± 53.3 mg/dl. The mean activity of factors V and VIII levels decreased by 12.3%, and 26% respectively over 120 h after thawing when compared to that after 24 h. A 120 h after thawing Factor V activity was above 70% in 87.5% of thawed plasmas and its mean activity was 81.6 ± 11.8. Factor VIII activity was above 70% in only 35% of thawed plasmas with the mean activity of 64.4 ± 17.2. CONCLUSION Thawed plasma can be used for up to 5 days in all therapeutic applications of FFP since it still has the essential hemostatic effects. However, in situations where higher levels of FVIII are needed, Thawed Plasma is not a suitable alternative. In such cases FFP, FVIII concentrate or cryoprecipitated antihemophilic factor should be used.
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Affiliation(s)
- Sahar Bahreini
- Faculty of Medicine, Ali ibn Abitaleb, Islamic Azad University, Yazd, Iran
| | | | - Soheila Nasizadeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Minoo Ahmadinejad
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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Draman R, Yousuf R, Abdul Aziz S, Ding CH, Zainol S, Leong CF. A Preliminary Study on Coagulation Parameters and Sterility of Thawed Refrozen Fresh Frozen Plasma. Indian J Hematol Blood Transfus 2020; 36:112-116. [PMID: 32174694 PMCID: PMC7042476 DOI: 10.1007/s12288-019-01171-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
Abstract
Thawed fresh frozen plasma (FFP) if not used within 6 h, may have to be discarded due to the risk of contamination and uncertainty about its quality. The main objective of this study was to evaluate the levels of coagulation Factor II (FII), Factor VIII (FVIII), fibrinogen and bacterial growth in thawed refrozen FFP. Thirty FFP samples were collected from healthy donors. FFP were thawed in water bath at 37 °C for 20-25 min. Approximately 10 mL of plasma from each FFP unit was tested for FII, FVIII, fibrinogen and sterility. The thawed FFP units were then kept at 4 °C for 6 h before being refrozen and stored at - 20 °C. Two weeks later, the refrozen FFP were thawed again and representative samples were analysed as before. There was a significant decline in the mean FVIII level, from 155.77% to 85.6% at second thaw. The mean FII level increased significantly from 74.9% to 82%, whereas the mean fibrinogen level fell from 3.34g/L to 3.28 g/L, but the decline was not statistically significant. There was no bacterial contamination in all samples at both time points. Refrozen plasma may be considered as an alternative to the storage of thawed unused FFP provided they are kept in a controlled environment to reduce wastage. These thawed refrozen FFP can be used later in bleeding cases like other FFP as the levels of FVIII are still within the standard haematology range (0.5-2 IU/mL) and above the minimal level of 30% coagulation factors required for adequate haemostasis.
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Affiliation(s)
- Rahayu Draman
- Department of Pathology, Hospital Pekan, Pekan, Pahang Darul Makmur Malaysia
| | - Rabeya Yousuf
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Suria Abdul Aziz
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Chuan Hun Ding
- Department of Medical Microbiology and Immunology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Suzana Zainol
- Department of Pathology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Chooi Fun Leong
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Zhao Y, Feng G, Feng L. Effects of pre-analytical storage time, temperature, and freeze-thaw times on coagulation factors activities in citrate-anticoagulated plasma. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:456. [PMID: 30603644 DOI: 10.21037/atm.2018.11.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Coagulation factor assays are very important for diagnosing, treating, and monitoring inherited and acquired factor deficiencies. Appropriate pre-analytical storage conditions of citrate-anticoagulated plasma are essential for detection of coagulation factor activity. We aimed to investigate the effects of storage temperature and time on coagulation factor (F) II, FV, FVII, FX, FXI, and FXII activity up to 24 h and the effects of freeze-thaw times at -80 °C on factor activity. Methods Twenty-two blood samples were analyzed after storage for 0 (baseline), 2, 4, 6, 8, 12, and 24 h at 25 and 4 °C. Mean percent changes, numbers of samples with >10% changes, percent change trend plots, and difference plots were evaluated to determine clinically relevant differences. Results The acceptable storage times for FII coagulation activity (FII:C), FV:C, FVII:C, FX:C, FXI:C, and FXII:C were 24, 8, 8, 24, 12, and 12 h at 4 °C and 24, 4, 8, 8, 12, and 12 h at 25 °C, respectively. The acceptable freeze-thaw times for FII:C, FV:C, FVII:C, FX:C, FXI:C, and FXII:C were 2, 2, 3, 3, 2, and 1, respectively. Conclusions When factor activity cannot be determined within these acceptable timeframes, we recommend that plasma samples should be frozen and thawed at appropriate times for analysis.
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Affiliation(s)
- Ying Zhao
- Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Guofang Feng
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Limin Feng
- Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
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Klanderman RB, Bosboom JJ, Migdady Y, Veelo DP, Geerts BF, Murphy MF, Vlaar APJ. Transfusion-associated circulatory overload-a systematic review of diagnostic biomarkers. Transfusion 2018; 59:795-805. [PMID: 30488959 PMCID: PMC7379706 DOI: 10.1111/trf.15068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/12/2018] [Accepted: 10/14/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Transfusion‐associated circulatory overload (TACO) is the leading cause of transfusion‐related major morbidity and mortality. Diagnosing TACO is difficult because there are no pathognomonic signs and symptoms. TACO biomarkers may aid in diagnosis, decrease time to treatment, and differentiate from other causes of posttransfusion dyspnea such a transfusion‐related acute lung injury. STUDY DESIGN AND METHODS A systematic review of literature was performed in EMBASE, PubMed, the TRIP Database, and the Cochrane Library, from inception to June 2018. All articles discussing diagnostic markers for TACO were included. Non‐English articles or conference abstracts were excluded. RESULTS Twenty articles discussing biomarkers for TACO were included. The majority investigated B‐type natriuretic peptide (BNP) and the N‐terminal prohormone cleavage fragment of BNP (NT‐proBNP), markers of hydrostatic pressure that can be determined within 1 hour. The data indicate that a post/pretransfusion NT‐proBNP ratio > 1.5 can aid in the diagnosis of TACO. Posttransfusion levels of BNP less than 300 or NT‐proBNP less than 2000 pg/mL, drawn within 24 hours of the reaction, make TACO unlikely. Cut‐off levels that exclude TACO are currently unclear. In critically ill patients, the specificity of natriuretic peptides for circulatory overload is poor. Other biomarkers, such as cytokine profiles, cannot discriminate between TACO and transfusion‐related acute lung injury. CONCLUSION Currently, BNP and NT‐proBNP are the primary diagnostic biomarkers researched for TACO. An NT‐proBNP ratio greater than 1.5 is supportive of TACO, and low levels of BNP or NT‐proBNP can exclude TACO. However, they are unreliable in critically ill patients. Other biomarkers, including cytokines and pulmonary edema fluid‐to‐serum protein ratio have not yet been sufficiently investigated for clinical use.
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Affiliation(s)
- Robert B Klanderman
- Department of Intensive Care Medicine, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
| | - Joachim J Bosboom
- Department of Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
| | - Yazan Migdady
- Department of Pathology, Stanford University School of Medicine, Stanford, California
| | - Denise P Veelo
- Department of Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
| | - Bart F Geerts
- Department of Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
| | - Michael F Murphy
- NHS Blood & Transplant, Oxford University Hospitals and University of Oxford, Oxford, United Kingdom
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers-AMC, Amsterdam, The Netherlands
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Zhu L, Sun L, Fan F, Zhang D, Li C, Wang D. Stability of plasma proteins and factors in Chinese universal pooled plasma. J Int Med Res 2018; 47:2637-2646. [PMID: 30293471 PMCID: PMC6567730 DOI: 10.1177/0300060518798999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective This study aimed to determine the precision dose of Chinese universal pooled plasma (CUPP) developed by our laboratory, and the stability of plasma proteins and factors. Methods A total of 100 single fresh-frozen plasma (FFP) units were selected to test plasma proteins, including total protein, albumin, fibrinogen, factor V, factor VIII, antithrombin-III, and protein C. Different pooling protocols with 20, 40, 60, 80, and 100 units were used to optimize the number of pooled units. The pooled plasma was then used to further evaluate the optimal storage conditions and duration at 22°C, 4°C, and −20°C. Results There were considerable differences in plasma protein levels among single units of FFP. After different pooling protocols, the mean value of plasma proteins did not significantly change. However, with a larger number of pooled samples, plasma proteins were more stable with a smaller standard deviation. Acceptable storage for CUPP was achieved with storage for 1 day at 22°C, 4 days at 4°C, and 3 months at −20°C. Conclusion A uniform level of plasma proteins and factors in CUPP appears to support establishment of a precise dose of plasma.
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Affiliation(s)
- Liguo Zhu
- 1 Department of Blood Transfusion, Chinese PLA General Hospital, Beijing, China
| | - Liping Sun
- 1 Department of Blood Transfusion, Chinese PLA General Hospital, Beijing, China
| | - Fengyan Fan
- 1 Department of Blood Transfusion, Chinese PLA General Hospital, Beijing, China
| | - Dongqing Zhang
- 1 Department of Blood Transfusion, Chinese PLA General Hospital, Beijing, China
| | - Changqing Li
- 2 Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, China
| | - Deqing Wang
- 1 Department of Blood Transfusion, Chinese PLA General Hospital, Beijing, China
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Coagulation Factor Activities Changes Over 5 Days in Thawed Fresh Frozen Plasma Stored at Different Initial Storage Temperatures. Indian J Hematol Blood Transfus 2017; 34:510-516. [PMID: 30127563 DOI: 10.1007/s12288-017-0879-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022] Open
Abstract
Thawed plasma is fresh frozen plasma (FFP) that has been stored for 5 days at 1-6 °C. Duration of storage and different storage temperatures might affect the coagulation factor activity in thawed FFP. This study measured the changes of coagulation factor activities over 5 days in thawed FFP and stored at two different initial storage temperatures. Thirty-six units of FFP, which consisted of nine units each from blood groups A, B, AB, and O, were thawed at 37 °C. Each unit was divided into two separate groups (Group A and Group B) based on initial storage temperature. The first group was stored at 2-6 °C for 5 days (Group A). The second group was stored at 20-24 °C for initial 6 h followed by 2-6 °C for 5 days (Group B). Prothrombin time (PT), activated partial thromboplastin time (APTT), coagulation factor activities of fibrinogen, factor (F) II, FV, FVII, FVIII, FIX, FX, and von Willebrand factor antigen (vWF Ag) were assessed at baseline after thawing, at 6 h, and on days 1, 3, and 5 of storage for both groups. All coagulation factors mean activities in both storage groups decreased significantly over 5 days of storage. The mean FVIII activity at day 5 of storage was 36.9% in Group A and 39.8% in Group B. The other coagulation factors mean activities were > 50% on day 5 of storage in both groups. The coagulation factor activities of thawed FFP stored for 5 consecutive days were reduced in the two storage groups but most of the activities were still above 30%. This study suggests that thawed FFP stored for 5 days has the potential to ameliorate coagulation factor deficiencies in affected patients.
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Effects of preanalytical frozen storage time and temperature on screening coagulation tests and factors VIII and IX activity. Sci Rep 2017; 7:12179. [PMID: 28939816 PMCID: PMC5610264 DOI: 10.1038/s41598-017-11777-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/30/2017] [Indexed: 01/05/2023] Open
Abstract
Preanalytical quality control of blood samples is critical for tests of coagulation function and coagulation factor activity. Preanalytical storage time and temperature are the main variables. We investigated the effects of preanalytical frozen storage time and temperature on activated partial thromboplastin time (APTT), fibrinogen (Fbg), prothrombin time (PT)/international normalized ratio (INR), thrombin time (TT), factor VIII activity (FVIII:C), and factor IX activity (FIX:C) in frozen plasma. Samples (n = 144) were randomly and equally divided into four groups (storage at −80 °C or −20 °C) and analysed by CS5100 or CA7000 coagulation analysers. Baseline values and results after storage for 15 days, 1 month, 3 months, 6 months, and 1 year were measured after thawing. Mean percent changes and scatter plots were used to determine clinically relevant differences. The stabilities of coagulation tests and coagulation factor activities measured by the CS5100 system were consistent with those measured by the CA7000 system. At −80 °C, assessment samples of PT/INR, Fbg, and TT can be safely stored for 1 year, APTT for 6 months, and FVIII:C and FIX:C for 1 month. At −20 °C, samples of Fbg and TT can be stored for 1 year, PT/INR and FIX:C for 1 month, and APTT and FVIII:C for 15 days.
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Huebner BR, Moore EE, Moore HB, Sauaia A, Stettler G, Dzieciatkowska M, Hansen K, Banerjee A, Silliman CC. Freeze-dried plasma enhances clot formation and inhibits fibrinolysis in the presence of tissue plasminogen activator similar to pooled liquid plasma. Transfusion 2017; 57:2007-2015. [PMID: 28500652 DOI: 10.1111/trf.14149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Systemic hyperfibrinolysis is an integral part of trauma-induced coagulopathy associated with uncontrolled bleeding. Recent data suggest that plasma-first resuscitation attenuates hyperfibrinolysis; however, the availability, transport, storage, and administration of plasma in austere environments remain challenging and have limited its use. Freeze-dried plasma (FDP) is a potential alternative due to ease of storage, longer shelf life, and efficient reconstitution. FDP potentially enhances clot formation and resists breakdown better than normal saline (NS) and albumin and similar to liquid plasma. STUDY DESIGN AND METHODS Healthy volunteers underwent citrated blood draw followed by 50% dilution with NS, albumin, pooled plasma (PP), or pooled freeze-dried plasma (pFDP). Citrated native and tissue plasminogen activator (t-PA)-challenge (75 ng/mL) thrombelastography were done. Proteins in PP, pFDP, and albumin were analyzed by mass spectroscopy. RESULTS pFDP and PP had superior clot-formation rates (angle) and clot strength (maximum amplitude) compared with NS and albumin in t-PA-challenge thrombelastographies (angle: pFDP, 67.9 degrees; PP, 67.8 degrees; NS, 40.6 degrees; albumin, 35.8 degrees; maximum amplitude: pFDP, 62.4 mm; PP, 63.5 mm; NS, 44.8 mm; albumin, 41.1 mm). NS and albumin dilution increased susceptibility to t-PA-induced hyperfibrinolysis compared with pFDP and PP (NS, 62.4%; albumin, 62.6%; PP, 8.5%; pFDP, 6.7%). pFDP was similar to PP in the attenuation of t-PA-induced fibrinolysis. Most proteins (97%) were conserved during the freeze-dry process, with higher levels in 12% of pFDP proteins compared with PP. CONCLUSION pFDP enhances clot formation and attenuates hyperfibrinolysis better than NS and albumin and is a potential alternative to plasma resuscitation in the treatment of hemorrhagic shock.
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Affiliation(s)
| | - Ernest E Moore
- Department of Surgery, University of Colorado, Aurora, Colorado.,Department of Surgery, Denver Health Medical Center, Aurora, Colorado
| | - Hunter B Moore
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Angela Sauaia
- Department of Surgery, University of Colorado, Aurora, Colorado.,Department of Surgery, Denver Health Medical Center, Aurora, Colorado
| | | | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado, Aurora, Colorado
| | - Kirk Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado, Aurora, Colorado
| | | | - Christopher C Silliman
- Department of Pediatrics, University of Colorado, Aurora, Colorado.,Bonfils Blood Center, Denver, Colorado
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Philip J, Sarkar RS, Pathak A. The effect of repeated freezing and thawing on levels of vitamin K-dependent coagulation factors and fibrinogen in fresh frozen plasma. Asian J Transfus Sci 2013; 7:11-5. [PMID: 23559757 PMCID: PMC3613653 DOI: 10.4103/0973-6247.106715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Fresh frozen plasma (FFP) is considered adequate for transfusion immediately after thawing or for up to 24 hours if kept at 1–6°C, and is currently used very often to replace deficient clotting factors. If factor levels in refrozen FFP are within normal limits, then this component can possibly be transfused, thus avoiding wastage of FFP. Aim: To study the fate of vitamin K-dependent coagulation factors (F II, F VII, F IX, F X) and fibrinogen activity levels in repeatedly (twice) frozen and thawed FFP. Materials and Methods: Two hundred FFP units comprising 50 units of each major blood group (A, B, AB, and O) were thawed at 37°C and 10–20 mL of FFP transferred to transfer bags with the help of a sterile connecting device (SCD). The FFP samples were taken into tubes (first sampling), and then the transfer bags were kept for 24 hours at 4°C. After 24 hours, repeat samples were taken in tubes from the transfer bag (second sampling), and then the bags were re-stored at < -18°C. One week later, the above procedure was repeated. Activity of coagulation factors and fibrinogen levels were measured by the automated coagulation analyzer. Results: The levels of F II, F VII, F IX, F X, and fibrinogen of all the 200 FFP units, at all four time points, were above the lower normal value, but well within the normal range. Conclusion: The levels of F II, F VII, F IX, F X, and fibrinogen remain stable and adequate for transfusion in twice-thawed-and-refrozen FFP. This component can be safely used for transfusion as a source of vitamin K-dependent clotting factors and fibrinogen.
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Affiliation(s)
- Joseph Philip
- Department of Transfusion Medicine, AFMC, Pune, Maharashtra, India
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van den Besselaar AMHP, Witteveen E, van der Meer FJM. Long-term stability of frozen pooled plasmas stored at -70°C, -40°C, and -20°C for prothrombin time and International Normalized Ratio (INR) assessment. Thromb Res 2013; 131:349-51. [PMID: 23411127 DOI: 10.1016/j.thromres.2013.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frozen pooled plasmas may be used for quality assessment and local calibration of prothrombin time (PT) and International Normalized Ratio (INR) measurement systems. The purpose of the present study is to estimate the long-term stability of frozen pooled plasmas stored for at least three years. METHODS Six pooled plamas with different INR levels were stored at -70°C, -40°C, and -20°C for various time periods up to 1453days. PT of stored samples were measured with two thromboplastin reagents on a single automated coagulation instrument. INR was calculated from PT and plotted against plasma storage time. Linear regression lines of INR on storage time were used to estimate the percentage increase of INR. RESULTS INR of plasma stored at -40°C or -20°C increased significantly with time. INR of plasma stored at -70°C did not change significantly in 11 out of 12 cases. The INR change of pooled plasmas stored at -70°C for 3years varied between 0.07% and 2.03%. CONCLUSION Long-term storage of plasmas at -40°C or -20°C should be avoided. Pooled plasmas stored at -70°C can be used for quality assessment and local calibration for at least 3years.
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Clotting factor activity in thawed Octaplas® LG during storage at 2–6°C for 6days from a quality assurance point of view. Transfus Apher Sci 2012; 46:129-36. [DOI: 10.1016/j.transci.2012.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 12/21/2011] [Accepted: 01/23/2012] [Indexed: 11/23/2022]
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13
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Cardigan R, Themessl A, Garwood M. Short-term deviations in temperature during storage of plasma at -40°C do not affect its quality. Transfusion 2011; 51:1541-5. [PMID: 21736574 DOI: 10.1111/j.1537-2995.2010.03028.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little data are available on the suitability of frozen plasma for transfusion when stored outside its normal temperature, which is the focus of investigation in this study. STUDY DESIGN AND METHODS Plasma was pooled and split to create 10 identical units on each of 24 occasions (12 Group A and O). Plasma was frozen and stored at -40°C for 2 weeks and then one of each of the 10 identical units was subjected to one of the following deviations in storage temperature: -18°C for 1 week, 1 month, or 2 months; -10°C for 1 week, 1 month, or 2 months; 4°C for 4, 24, or 72 hours; or stored at -40°C (control) before returning all units to -40°C. RESULTS Factor VIII was only significantly reduced when plasma was stored at 4°C for 24 hours or more or -10°C for 1 week. For all other arms of the study, the majority of units of plasma (>75%) remained above 0.70 IU/mL and more than 95% were above the lower limit of normal (0.50 IU/mL). The prothrombin time ratio only increased after storage at -10°C for 1 month or more, and the activated partial thromboplastin time ratio after storage at 4°C for 24 hours. None of the deviations in storage resulted in a decrease in fibrinogen activity. CONCLUSION These data suggest that plasma that has been stored at -40°C and exposed to storage temperatures and times of up to 4 hours at 4°C, 1 week at -10°C or 2 months at -18°C meets EU guidelines and is suitable for transfusion.
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Yaxley PE, Beal MW, Jutkowitz LA, Hauptman JG, Brooks MB, Hale AS, Parr A. Comparative stability of canine and feline hemostatic proteins in freeze-thaw-cycled fresh frozen plasma. J Vet Emerg Crit Care (San Antonio) 2010; 20:472-8. [DOI: 10.1111/j.1476-4431.2010.00563.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Miller I, Gianazza E, Gemeiner M. Any use in proteomics for low-tech approaches? Detecting fibrinogen chains of different animal species in two-dimensional electrophoresis patterns. J Chromatogr B Analyt Technol Biomed Life Sci 2010; 878:2314-8. [DOI: 10.1016/j.jchromb.2010.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 06/30/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
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16
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Yang R, Zhang X, Wei W, Hong M, Yang Y, Hu Y. Relationship between acquired deficiency of vitamin K-dependent clotting factors and hemorrhage. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2010; 30:312-7. [PMID: 20556573 DOI: 10.1007/s11596-010-0348-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Indexed: 02/01/2023]
Abstract
This study examined the changes of activities of vitamin K-dependent clotting factors (VKDCF) under various pathological conditions and explored the relationship between acquired deficiency of VKDCFs and hemorrhage. Clinical data of 35 patients who were diagnosed as having acquired deficiency of VKDCF were retrospectively analyzed. Coagulation factors involved in the intrinsic and extrinsic pathways were detected in these patients and 41 control subjects. The results showed that the average activities of VKDCFs were decreased in the patients in comparison to the control subjects and significantly increased after treatment of these patients with vitamin K and blood products. Multivariate regression analysis indicated that decreased activity of VKDCF was not an independent risk factor for bleeding disorders owing to deficiency or metabolic disturbance of vitamin K. It was concluded that acquired deficiency of VKDCF occurs under a variety of pathologic conditions and is closely associated with hemorrhagic events. Administration of vitamin K and transfusion of blood products containing high concentrations of VKDCFs helps alleviate the hemorrhagic diseases.
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Affiliation(s)
- Rui Yang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Scott E, Puca K, Heraly J, Gottschall J, Friedman K. Evaluation and comparison of coagulation factor activity in fresh-frozen plasma and 24-hour plasma at thaw and after 120 hours of 1 to 6°C storage. Transfusion 2009; 49:1584-91. [DOI: 10.1111/j.1537-2995.2009.02198.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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von Heymann C, Keller MK, Spies C, Schuster M, Meinck K, Sander M, Wernecke KD, Kiesewetter H, Pruss A. Activity of clotting factors in fresh-frozen plasma during storage at 4°C over 6 days. Transfusion 2009; 49:913-20. [DOI: 10.1111/j.1537-2995.2008.02063.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Grazzini G, Rossi G, Rafanelli D, Gambelli D, Farina C, Mori F, Zucchelli P, Marchiori G, Breda A, Liumbruno GM. Quality control of recovered plasma for fractionation: an extensive Italian study. Transfusion 2008; 48:1459-68. [PMID: 18435675 DOI: 10.1111/j.1537-2995.2008.01709.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study was aimed at obtaining significant information on the quality of whole-blood plasma (WBP) delivered to a private pharmaceutical company by the blood transfusion centers (BTCs) of 10 Italian regions. STUDY DESIGN AND METHODS A statistical sampling plan of plasma units took into account the contribution each selected blood transfusion center, belonging to the 10 regions, made to the plasma pool annually delivered to the pharmaceutical company. A total of 1787 plasma units were selected for coagulation Factor VIII (FVIII:C) and Factor VIII antigen (FVIII:Ag) analysis. RESULTS The FVIII:C mean value was 0.99 IU per mL; it was significantly lower in O units (0.86 IU/mL) than in non-O units (1.08 IU/mL). The mean value of FVIII:Ag was 0.90 IU per mL; it was significantly lower in O units (0.78 IU/mL) than in non-O units (0.99 IU/mL). In units with a FVIII:C level of less than 0.70 IU per mL, the FVIII:Ag mean value (0.62 IU/mL) was higher in comparison to the FVIII:C mean value (0.57 IU/mL). Instead, in the units with a FVIII:C level of at least 0.70 IU per mL, the mean level of FVIII:C (1.08 IU/mL) was higher than that of FVIII:Ag (0.96 IU/mL). CONCLUSIONS The mean value of FVIII:C (0.99 IU/mL) in whole-blood plasma produced by the 10 Italian regions is higher than that reported in other studies. A total of 83.1 percent of units have a FVIII:C level of at least 0.70 IU per mL. The mean level of FVIII:Ag is lower than that of FVIII:C. FVIII:Ag is higher in those units with a FVIII:C level of less than 0.70 IU per mL, while it gradually decreases as FVIII:C exceeds 0.70 IU per mL, thus showing a greater resistance to handling of plasma in the production steps mostly affecting FVIII:C stability.
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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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21
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Lamboo M, Poland DCW, Eikenboom JCJ, Harvey MS, Groot E, Brand A, de Vries RRP. Coagulation parameters of thawed fresh-frozen plasma during storage at different temperatures. Transfus Med 2007; 17:182-6. [PMID: 17561859 DOI: 10.1111/j.1365-3148.2007.00729.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: 11/30/2022]
Abstract
Once thawed, fresh-frozen plasma (FFP) should be used, according to guidelines, within 24 h. In hospital practice, this may be associated with wastage. This study has been performed to investigate the coagulation levels of thawed quarantine FFP as used in the Netherlands. Five units of quarantine FFP, obtained by plasmapheresis, were thawed and by sterile docking divided into satellite bags (SB). SB 2-4 were stored at room temperature (RT) for, respectively, 1, 3 and 6 h and SB 5-9 at 4 degrees C for 6, 12 and 24 h and 1 and 2 weeks. At each time point, activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, factor V (FV), factor VIII (FVIII) and ADAMTS13 activity were measured. During storage at RT for up to 6 h, no major differences were found in the levels of FV, PT, fibrinogen and ADAMTS13 activity. FVIII activity showed a decrease of 16% and the APTT was prolonged by 6%. During storage at 4 degrees C for 2 weeks, FV and FVIII were reduced by 35 and 45%, respectively. The APTT and PT were prolonged by 17 and 15%, respectively. Fibrinogen was decreased by 8%. No change in ADAMTS13 activity was found. FFP stored at RT for 6 h or at 4 degrees C for 2 weeks can provide sufficient support for adequate haemostasis except for patients with a known deficiency for FVIII and can be used for plasmapheresis in patients with thrombotic thrombocytopenic purpura (TTP).
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Affiliation(s)
- M Lamboo
- Departments of Internal Medicine, and Immunohematology/Bloodtransfusion, Leiden University Medical Center, Leiden, The Netherlands.
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von Heymann C, Pruss A, Sander M, Finkeldey A, Ziemer S, Kalus U, Kiesewetter H, Salama A, Spies C. Thawing Procedures and the Time Course of Clotting Factor Activity in Fresh-Frozen Plasma: A Controlled Laboratory Investigation. Anesth Analg 2006; 103:969-74. [PMID: 17000814 DOI: 10.1213/01.ane.0000240416.56803.5b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In this study, we evaluated the effects of the thawing process of 2 commercially available devices on the activity of clotting factors, inhibitors and activation markers of the hemostatic system in fresh-frozen plasma (FFP). In an experimental procedure, FFP was thawed under running warm water at 42 degrees C. METHODS Plasma of 20 healthy donors was sampled, separated, and distributed in 3 plasma bags. Within 2 h after sampling plasma bags was frozen at a temperature of -30 degrees C to -40 degrees C and stored for at least 8 wk. After sampling (baseline) as well as immediately and 1, 2, 4, and 6 h after thawing, the activity of FV, FVII, FVIII, fibrinogen, fibrin monomers (FM), d-dimers (DD), alpha2-antiplasmin (alpha2-AP), and protein S (PS) was determined from each plasma bag. RESULTS From 1 h to 6 h after thawing, no significant differences in the activity of the investigated coagulation markers dependent on the thawing procedure were found. However, immediately after thawing and independent of the thawing procedure, the activity of FVII was significantly decreased (P < 0.01), whereas FM were significantly increased (P = 0.001). CONCLUSION The thawing procedures studied exhibited no significant influence on activity and stability of the investigated markers of coagulation over the study period. The decreased activity of FVII and the clinical significance of the increase in FM require further research.
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Affiliation(s)
- Christian von Heymann
- Department of Anesthesiology and Intensive Care Medicine, Charité-University Hospital Berlin, Charité Campus Mitte, Berlin, Germany.
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Lelkens CCM, Koning JG, de Kort B, Floot IBG, Noorman F. Experiences with frozen blood products in the Netherlands military. Transfus Apher Sci 2006; 34:289-98. [PMID: 16815757 DOI: 10.1016/j.transci.2005.11.008] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 11/25/2005] [Indexed: 11/28/2022]
Abstract
For peacekeeping and peace enforcing missions abroad the Netherlands Armed Forces decided to use universal donor frozen blood products in addition to liquid products. This article describes our experiences with the frozen blood inventory, with special attention to quality control. It is shown that all thawed (washed) blood products are in compliance with international regulations and guidelines. By means of the -80 degrees C frozen stock of red cells, plasma and platelets readily available after thaw (and wash), we can now safely reduce shipments and abandon the backup 'walking' blood bank, without compromising the availability of blood products in theatre.
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Affiliation(s)
- C C M Lelkens
- Military Blood Bank, Plesmanlaan 1C, 2333 BZ, Leiden, The Netherlands.
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Sidhu RS, Le T, Brimhall B, Thompson H. Study of coagulation factor activities in apheresed thawed fresh frozen plasma at 1–6°C for five days. J Clin Apher 2006; 21:224-6. [PMID: 16607628 DOI: 10.1002/jca.20095] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The concern for the loss of activities of coagulation factors in thawed fresh frozen plasma kept at 1-6 degrees C for long periods has prevented transfusion services from using thawed plasma beyond 24 hours of storage. There is no mention of the method of collection of the plasma and/or the study of the bacterial growth in the studies reported in the literature. The present project was undertaken to investigate coagulation factor activities and bacterial growth in apheresed fresh plasma. Twenty apheresed plasma units from different blood groups were used. After the 24-hour expiration time of the thawed plasma kept at 1-6 degrees C, aliquots were taken at day 1, day 3, and day 5 of expiration time and were immediately frozen at -70 degrees C. Samples were assayed for activities of coagulation factors II, V, VII, VIII, X, XI, and fibrinogen (Fib). Our study reveals no statistically significant change in activities of coagulation factors II, VII, X, XI, and fibrinogen from day 1 to day 5 storage of plasma at 1-6 degrees C; however, there is a mean decrease of 8.8 and 14.3% in activities of factors V and VIII, respectively. All culture samples taken on day 5 storage were negative at 7 days. In conclusion, our results do not show a significant change in the activity of most coagulation factors in the thawed apheresis plasma stored at 1-6 degrees C over a 5-day period. Hence, it is feasible to transfuse the plasma beyond the 24-hour period without compromising the clinical outcome of patients with coagulopathy.
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Affiliation(s)
- Rameshwar S Sidhu
- Department of Pathology, University of Colorado Health Sciences Center, and the Children's Hospital, Denver, Colorado 80262, USA.
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de Alarcon P, Benjamin R, Dugdale M, Kessler C, Shopnick R, Smith P, Abshire T, Hambleton J, Matthew P, Ortiz I, Cohen A, Konkle BA, Streiff M, Lee M, Wages D, Corash L. Fresh frozen plasma prepared with amotosalen HCl (S-59) photochemical pathogen inactivation: transfusion of patients with congenital coagulation factor deficiencies. Transfusion 2005; 45:1362-72. [PMID: 16078927 DOI: 10.1111/j.1537-2995.2005.00216.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Photochemical treatment (PCT) with amotosalen HCl (S-59) was developed to inactivate pathogens and white blood cells in plasma (PCT-FFP) used for transfusion support. STUDY DESIGN AND METHODS An open-label, multicenter trial was conducted in patients with congenital coagulation factor deficiencies (factors [F]I, FII, FV, FVII, FX, FXI, and FXIII and protein C) to measure the kinetics of specific coagulation factors, hemostatic efficacy, and safety of PCT-FFP. Posttransfusion prothrombin time (PT), partial thromboplastin time (PTT), and clinical hemostasis were evaluated before and after PCT-FFP transfusions. RESULTS Thirty-four patients received 107 transfusions of PCT-FFP for kinetic studies or therapeutic indications (mean dose, 12.8 +/- 8.5 mL/kg). Incremental factor recoveries ranged from 0.9 to 2.4 IU per dL per IU per kg (FII, FV, FVII, FX, FXI, and protein C). Mean pretransfusion PT (20.7 +/- 22.2 sec) corrected after PCT-FFP (13.8 +/- 2.4 sec, p < 0.001). Mean pretransfusion PTT (51.2 +/- 29.3 sec) corrected after PCT-FFP (32.0 +/- 5.1 sec, p < 0.001). Thirteen patients required 77 transfusions for therapeutic indications. PCT-FFP provided effective hemostasis and was well tolerated. CONCLUSIONS Replacement coagulation factors in PCT-FFP exhibited kinetics and therapeutic efficacy consistent with conventional FFP.
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Affiliation(s)
- Pedro de Alarcon
- Department of Pediatric Hematology, University of Virginia, Charlottesville, Virginia, USA
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