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Apelseth TO, Raza S, Callum J, Ipe T, Blackwood B, Akhtar A, Hess JR, Marks DC, Brown B, Delaney M, Wendel S, Stanworth SJ. A review and analysis of outcomes in randomized clinical trials of plasma transfusion in patients with bleeding or for the prevention of bleeding: The BEST collaborative study. Transfusion 2024. [PMID: 38623793 DOI: 10.1111/trf.17835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Previous systematic reviews have revealed an inconsistency of outcome definitions as a major barrier in providing evidence-based guidance for the use of plasma transfusion to prevent or treat bleeding. We reviewed and analyzed outcomes in randomized controlled trials (RCTs) to provide a methodology for describing and classifying outcomes. STUDY DESIGN AND METHODS RCTs involving transfusion of plasma published after 2000 were identified from a prior review (Yang 2012) and combined with an updated systematic literature search of multiple databases (July 1, 2011 to January 17, 2023). Inclusion of publications, data extraction, and risk of bias assessments were performed in duplicate. (PROSPERO registration number is: CRD42020158581). RESULTS In total, 5579 citations were identified in the new systematic search and 22 were included. Six additional trials were identified from the previous review, resulting in a total of 28 trials: 23 therapeutic and five prophylactic studies. An increasing number of studies in the setting of major bleeding such as in cardiovascular surgery and trauma were identified. Eighty-seven outcomes were reported with a mean of 11 (min-max. 4-32) per study. There was substantial variation in outcomes used with a preponderance of surrogate measures for clinical effect such as laboratory parameters and blood usage. CONCLUSION There is an expanding literature on plasma transfusion to inform guidelines. However, considerable heterogeneity of reported outcomes constrains comparisons. A core outcome set should be developed for plasma transfusion studies. Standardization of outcomes will motivate better study design, facilitate comparison, and improve clinical relevance for future trials of plasma transfusion.
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Affiliation(s)
- Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
- Norwegian Armed Forces Joint Medical Services, Oslo, Norway
| | - Sheharyar Raza
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Jeannie Callum
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen's University, Kingston, Canada
| | - Tina Ipe
- Our Blood Institute, Oklahoma City, Oklahoma, USA
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | | | - John R Hess
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Denese C Marks
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Bethany Brown
- American Red Cross, Medical and Scientific Office, Washington, DC, USA
| | | | | | - Simon J Stanworth
- NHSBT, Oxford University Hospitals NHS Trust; Blood Transfusion Research Unit (BTRU), University of Oxford, Oxford, UK
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Delaney M, Karam O, Lieberman L, Steffen K, Muszynski JA, Goel R, Bateman ST, Parker RI, Nellis ME, Remy KE. What Laboratory Tests and Physiologic Triggers Should Guide the Decision to Administer a Platelet or Plasma Transfusion in Critically Ill Children and What Product Attributes Are Optimal to Guide Specific Product Selection? From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding. Pediatr Crit Care Med 2022; 23:e1-e13. [PMID: 34989701 PMCID: PMC8769352 DOI: 10.1097/pcc.0000000000002854] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To present consensus statements and supporting literature for plasma and platelet product variables and related laboratory testing for transfusions in general critically ill children from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding. DESIGN Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children. SETTING Not applicable. PATIENTS Critically ill pediatric patients at risk of bleeding and receiving plasma and/or platelet transfusions. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A panel of 10 experts developed evidence-based and, when evidence was insufficient, expert-based statements for laboratory testing and blood product attributes for platelet and plasma transfusions. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative - Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed five expert consensus statements and two recommendations in answer to two questions: what laboratory tests and physiologic triggers should guide the decision to administer a platelet or plasma transfusion in critically ill children; and what product attributes are optimal to guide specific product selection? CONCLUSIONS The Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding program provides some guidance and expert consensus for the laboratory and blood product attributes used for decision-making for plasma and platelet transfusions in critically ill pediatric patients.
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Affiliation(s)
- Meghan Delaney
- Division of Pathology & Laboratory Medicine, Children’s National Hospital; Department of Pathology & Pediatrics, The George Washington University Health Sciences, Washington, DC
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Children’s Hospital of Richmond at VCU, Richmond, VA
| | - Lani Lieberman
- Department of Clinical Pathology, University Health Network Hospitals. Department of Laboratory Medicine & Pathobiology; University of Toronto, Toronto, Canada
| | - Katherine Steffen
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stanford University, Palo Alto, CA
| | - Jennifer A. Muszynski
- Department of Pediatrics, Division of Critical Care Medicine, Nationwide Children’s Hospital and the Ohio State University College of Medicine, Columbus, OH
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD
| | - Scot T. Bateman
- Division of Pediatric Critical Care, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA
| | - Robert I. Parker
- Emeritus, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY
| | - Marianne E. Nellis
- Pediatric Critical Care Medicine, NY Presbyterian Hospital-Weill Cornell Medicine, New York, NY
| | - Kenneth E. Remy
- Department of Pediatrics, Division of Critical Care Medicine, Washington University in St. Louis School of Medicine, St. Louis, MO
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Racine-Brzostek SE, Canver MC, DeSimone RA, Zdravkova M, Lo DT, Crowley KM, Hsu YMS, Vasovic LV, Hill SS, Cushing MM. Thawed solvent/detergent-treated plasma demonstrates comparable clinical efficacy to thawed plasma. Transfusion 2020; 60:1940-1949. [PMID: 32720432 DOI: 10.1111/trf.15948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/31/2020] [Accepted: 05/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thawed Plasma (TP), plasma thawed and refrigerated for up to 5 days, is a commonly transfused plasma product. This pilot study was conducted to determine whether Thawed Solvent/Detergent-treated Plasma stored refrigerated for up to 5-days post-thaw (T-S/D) was as efficacious as TP. STUDY DESIGN AND METHODS This single institution retrospective cohort analysis evaluated the efficacy of T-S/D in reversing coagulopathies in comparison to TP. Utilizing the institution's electronic medical records, transfusion data were collected in adult patients who received either TP or T-S/D. The primary outcome was the incidence of subsequent transfusions within 24 hours after first dose of either type of plasma. Secondary outcomes included the number of blood products transfused within 24 hours of first-dose plasma, correction of pre-transfusion coagulation laboratory values, volume transfused, and clinical outcomes. RESULTS TP was received by 301 patients and 137 received T-S/D during the first 32 months post-implementation of T-S/D. There was no difference in incidence of subsequent transfusions or number of blood products given. The median pre-INR of both the TP and T-S/D cohorts was 1.9, with a similar decrease in INR of 0.2 and 0.3 (p = 0.36), respectively, post plasma transfusion. There was no difference in correction of PT/aPTT, mortality, transfusion reactions, readmission rates, length of stay, or inpatient deep venous thrombosis. The median volume of T-S/D plasma transfused for the first dose was 126 mL less than TP (p = .0001). CONCLUSION T-S/D was as efficacious as TP for the treatment of coagulopathies and the reversal of coagulation laboratory values.
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Affiliation(s)
- Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,New York Blood Center, New York, New York, USA
| | - Matthew C Canver
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Milena Zdravkova
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Dian T Lo
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Kathleen M Crowley
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Yen-Michael S Hsu
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Shanna Sykes Hill
- Department of Anesthesiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
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Atreya C, Glynn S, Busch M, Kleinman S, Snyder E, Rutter S, AuBuchon J, Flegel W, Reeve D, Devine D, Cohn C, Custer B, Goodrich R, Benjamin RJ, Razatos A, Cancelas J, Wagner S, Maclean M, Gelderman M, Cap A, Ness P. Proceedings of the Food and Drug Administration public workshop on pathogen reduction technologies for blood safety 2018 (Commentary, p. 3026). Transfusion 2019; 59:3002-3025. [PMID: 31144334 PMCID: PMC6726584 DOI: 10.1111/trf.15344] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Chintamani Atreya
- US Food and Drug Administration, Center for Biologics Evaluation and ResearchOffice of Blood Research and ReviewSilver SpringMaryland
| | - Simone Glynn
- National Heart Lung and Blood InstituteBethesdaMarylandUSA
| | | | | | - Edward Snyder
- Blood BankYale‐New Haven HospitalNew HavenConnecticut
| | - Sara Rutter
- Department of Pathology and Laboratory MedicineYale School of MedicineNew HavenConnecticut
| | - James AuBuchon
- Department of PathologyDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Willy Flegel
- Department of Transfusion MedicineNIH Clinical CenterBethesdaMaryland
| | - David Reeve
- Blood ComponentsAmerican Red CrossRockvilleMaryland
| | - Dana Devine
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Claudia Cohn
- Department of Lab Medicine and PathologyUniversity of Minnesota Medical CenterMinneapolisMinnesota
| | - Brian Custer
- Vitalant Research InstituteSan FranciscoCalifornia
| | - Raymond Goodrich
- Department of Microbiology, Immunology and PathologyColorado State UniversityFort CollinsColorado
| | | | | | - Jose Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati HealthCincinnatiOhio
| | | | - Michelle Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST)University of StrathclydeGlasgowScotland
| | - Monique Gelderman
- Department of HematologyCenter for Biologics Evaluation and Research, US Food and Drug AdministrationSilver SpringMaryland
| | - Andrew Cap
- U.S. Army Institute of Surgical ResearchSan AntonioTexas
| | - Paul Ness
- Blood BankJohns Hopkins HospitalBaltimoreMaryland
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Cushing MM, Pagano MB, Jacobson J, Schwartz J, Grossman BJ, Kleinman S, Han MA, Cohn CS. Pathogen reduced plasma products: a clinical practice scientific review from the AABB. Transfusion 2019; 59:2974-2988. [DOI: 10.1111/trf.15435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Melissa M. Cushing
- Department of Pathology and Laboratory MedicineWeill Cornell Medicine New York New York
| | - Monica B. Pagano
- Department of Laboratory MedicineUniversity of Washington Medical Center Seattle Washington
| | | | - Joseph Schwartz
- Department of Pathology & Cell BiologyColumbia University Vagelos College of Physicians and Surgeons New York New York
| | - Brenda J. Grossman
- Department of Pathology & ImmunologyWashington University School of Medicine in St. Louis St. Louis Missouri
| | - Steven Kleinman
- Department of Pathology & Laboratory MedicineThe University of British Columbia Vancouver British Columbia
| | - Mi Ah Han
- Department of Preventive MedicineCollege of Medicine Chosun University Gwangju Republic of Korea
| | - Claudia S. Cohn
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota
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Smith NK, Kim S, Hill B, Goldberg A, DeMaria S, Zerillo J. Transfusion-Related Acute Lung Injury (TRALI) and Transfusion-Associated Circulatory Overload (TACO) in Liver Transplantation: A Case Report and Focused Review. Semin Cardiothorac Vasc Anesth 2017; 22:180-190. [DOI: 10.1177/1089253217736298] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Liver transplantation (LT) is a complex procedure in a patient with multi-organ system dysfunction and coagulation defects. The surgical procedure involves dissection, major vessel manipulation, and pathophysiologic effects of graft storage and reperfusion. As a result, LT frequently involves significant hemorrhage. Subsequent massive transfusion carries high risk of transfusion-associated complications. Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion associated mortality. In this case report and focused review, we present data that suggest that patients undergoing liver transplantation may be at higher risk for TRALI and TACO than the general population. Anesthesiologists can play a role in decreasing these risks by increasing recognition and reporting of TRALI and TACO, using point of care testing with thromboelastography to guide and decrease transfusion, and considering alternatives to traditional blood products like solvent/detergent plasma.
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Affiliation(s)
- Natalie K. Smith
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Sang Kim
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Bryan Hill
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Andrew Goldberg
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Samuel DeMaria
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Jeron Zerillo
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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7
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Garraud O. La délivrance des plasmas. Les plasmas d’aujourd’hui et de demain. Transfus Clin Biol 2016; 23:240-244. [DOI: 10.1016/j.tracli.2016.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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8
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Assessment of haemostasis in patients with cirrhosis: Relevance of the ROTEM tests?: A prospective, cross-sectional study. Eur J Anaesthesiol 2016; 33:126-33. [PMID: 26258657 DOI: 10.1097/eja.0000000000000322] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In patients with cirrhosis, decreased rotational thromboelastometry (ROTEM) parameters suggest hypocoagulability secondary to liver dysfunction. However, observed normal or increased thrombin generation suggests preserved haemostasis and/or a procoagulant state. The correlated levels of both coagulation factors and inhibitors also support preserved haemostasis. OBJECTIVE The objective of this study is to investigate the correlation between three specific approaches of haemostasis (ROTEM, thrombin generation and coagulation factors/inhibitors) on the same plasma sample from patients with cirrhosis. DESIGN A prospective, observational study. SETTING Single university hospital. PARTICIPANTS Forty patients with cirrhosis. INTERVENTION Measurement of the following factors: model for end-stage liver disease (MELD) scores; ROTEM maximum clot firmness (ROTEM-MCF) in EXTEM, INTEM, FIBTEM assays; fibrinogen; factors V and VIII; von Willebrand factor; protein C; protein S; antithrombin; and the thrombin generation test (TGT) enabling the calculation of endogenous thrombin potential without and with thrombomodulin, and the ratio of endogenous thrombin potential with-to-without thrombomodulin (regarded as an index of hypercoagulability). RESULTS ROTEM-MCF values were distributed within the normal and hypocoagulation ranges; were correlated to variations in factor V, fibrinogen, protein C and S and antithrombin; and were inversely correlated to MELD scores (ρ > 0.5; P < 0.05). Levels of von Willebrand factor were above normal and were not correlated with any other factor levels. After addition of thrombomodulin, endogenous thrombin potential values were distributed within or above normal values. Factor V variation was correlated to the ratio of endogenous thrombin potential with-to-without thrombomodulin. CONCLUSION ROTEM indicated hypocoagulability correlated to liver dysfunction. In contrast, the TGT indicated a preserved or even increased coagulation profile (which was supported by the correlation between coagulant factors and inhibitors) and a potential for hypercoagulability inversely correlated to the degree of liver dysfunction. ROTEM may not be appropriate for haemostasis assessment in patients with liver cirrhosis and could lead to the unnecessary transfusion of fresh frozen plasma. TRIAL REGISTRATION S.C. 3024 - ID RCB: 2012-A01728-35.
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9
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Hall DP, Estcourt LJ, Doree C, Hopewell S, Trivella M, Walsh TS. Plasma transfusions prior to insertion of central lines for people with abnormal coagulation. Cochrane Database Syst Rev 2016; 9:CD011756. [PMID: 27647489 PMCID: PMC5215106 DOI: 10.1002/14651858.cd011756.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The insertion of central venous catheters (CVCs) may be associated with peri- and post-procedural bleeding. People who require a central line often have disorders of coagulation as a result of their underlying illness, co-morbidities or the effects of treatment. Clinical practice in some institutions is to mitigate the risk of bleeding in these patients by prophylactically transfusing fresh frozen plasma (FFP) in order to correct clotting factor deficiencies prior to central line insertion. However, FFP transfusion is not without risk, and it remains unclear whether this intervention is associated with reduced rates of bleeding or other clinically-meaningful outcomes. OBJECTIVES To assess the effect of different prophylactic plasma transfusion regimens prior to central line insertion in people with abnormal coagulation. SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 3), PubMed (e-publications only), Ovid MEDLINE (from 1946), Ovid Embase (from 1974), the Transfusion Evidence Library (from 1950) and ongoing trial databases to 1 March 2016. SELECTION CRITERIA We included RCTs involving transfusions of plasma to prevent bleeding in people of any age with abnormal coagulation requiring insertion of a central venous catheter, published in English. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We identified four trials eligible for inclusion, of which three are ongoing. We did not exclude any studies because they were not published in English.The included study randomised 81 adults in intensive care whose INR (International Normalised Ratio) was greater than or equal to 1.5 to no FFP or to a single dose of 12 mL/kg FFP prior to undergoing central venous catheterisation (58 participants) or other invasive procedure (23 participants). It is the subgroup of 58 adults undergoing CVC insertion that were included in this review, the study authors provided unpublished data for this review's outcomes.The quality of the evidence was low or very low across different outcomes according to the GRADE methodology. The included study was at high risk of bias due to lack of blinding of participants and personnel and imbalance in the number of participants who had liver disease between study arms.There was insufficient evidence to determine a difference in major procedure-related bleeding within 24 hours (one RCT; 58 participants; no events in either study arm, very low-quality evidence). We are very uncertain whether FFP reduces minor procedure-related bleeding within 24 hours of the study (one RCT; 58 participants, RR 0.67, 95% CI 0.12 to 3.70, very low-quality evidence).No studies were found that looked at: all-cause mortality; the proportion of participants receiving plasma or red cell transfusions; serious adverse reactions (transfusion or line-related complications); number of days in hospital; change in INR; or quality of life.The three ongoing studies are still recruiting participants (expected recruitment: up to 355 participants in total). and are due to be completed by February 2018. AUTHORS' CONCLUSIONS There is only very limited evidence from one RCT to inform the decision whether or not to administer prophylactic plasma prior to central venous catheterisation for people with abnormal coagulation. It is not possible from the current RCT evidence to recommend whether or not prophylactic plasma transfusion is beneficial or harmful in this situation. The three ongoing RCTs will not be able to answer this review's questions, because they are small studies and do not address all of the comparisons included in this review (355 participants in total). To detect an increase in the proportion of participants who had major bleeding from 1 in 100 to 2 in 100 would require a study containing at least 4634 participants (80% power, 5% significance).
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Affiliation(s)
- David P Hall
- NHS LothianCritical Care and AnaestheticsRoyal Infirmary of EdinburghEdinburghUKEH16 4SA
| | - Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordOxfordshireUKOX3 7LD
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Timothy S Walsh
- Edinburgh Royal InfirmaryLittle France CrescentEdinburghUKEH16 2SA
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10
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Corash L, Benjamin RJ. The role of hemovigilance and postmarketing studies when introducing innovation into transfusion medicine practice: the amotosalen-ultraviolet A pathogen reduction treatment model. Transfusion 2016; 56 Suppl 1:S29-38. [PMID: 27001358 DOI: 10.1111/trf.13530] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Innovations in transfusion medicine require randomized controlled clinical trials (RCTs) to demonstrate safety and efficacy before approval; however, these studies are costly and limited in scope and may be underpowered to detect rare adverse events (AEs). Regulatory agencies, such as the Food and Drug Administration, require postmarketing surveillance, hemovigilance (HV), and controlled Phase IV studies to monitor performance and confirm safety. STUDY DESIGN AND METHODS The INTERCEPT Blood System (IBS) is an illustrative model for implementation of a transformative technology for which sponsored active HV, regulatory authority HV, and Phase IV studies were used to extend preapproval efficacy and safety information. RESULTS After CE mark registration in Europe, 13,644 patients received 76,346 IBS components prepared largely without gamma irradiation or bacterial screening in sponsored active HV studies documenting no increased incidence of AEs compared to historical controls and no increased component utilization. National HV systems in France and Switzerland specifically demonstrated no transfusion-associated graft-versus-host disease or increased incidence of transfusion-associated acute lung injury, after transfusion of 317,669 IBS platelet (PLT) components, and significant reduction of transfusion-transmitted bacterial infection as well as acute transfusion reactions. Cumulatively, these studies provide new information about safety and efficacy of IBS PLT and plasma components not obtainable from RCTs. CONCLUSION Although inherently different from RCTs, properly designed postmarketing studies are informative regarding the safety and efficacy of innovative transfusion technologies in large patient populations under conditions of routine use.
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11
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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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Tinmouth A. Assessing the Rationale and Effectiveness of Frozen Plasma Transfusions. Hematol Oncol Clin North Am 2016; 30:561-72. [DOI: 10.1016/j.hoc.2016.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Is solvent/detergent plasma better than standard fresh-frozen plasma? A systematic review and an expert consensus document. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 14:277-286. [PMID: 27136429 DOI: 10.2450/2016.0168-15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/28/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Only a few studies have compared solvent/detergent plasma (SD-plasma) to standard fresh-frozen plasma (FFP) in terms of efficacy and safety. MATERIALS AND METHODS A systematic review was performed in order to develop a consensus document on the use of SD-plasma. Moreover, a pharmacoeconomic study was performed in order to assess whether the use of SD-plasma can be cost-effective with respect to the use of FFP. A multidisciplinary panel used the systematic review and the GRADE methodology to develop evidence-based recommendations on this topic. RESULTS Based on moderate to very low quality evidence, the panel developed the following consensus statements: (i) the panel suggested that SD-plasma is safer than FFP; (ii) the panel could not express for or against a greater efficacy of SD-plasma as compared to FFP; (iii) the panel suggested that in patients undergoing liver transplantation SD-plasma can be preferred over FFP; (iv) the panel suggested that SD-plasma can be preferred over FFP in patients with thrombotic thrombocytopenic purpura undergoing plasma-exchange procedures; (v) the panel could not recommend for or against preferring SD-plasma over FFP in critical care patients; and (vi) the panel suggested that the use of SD-plasma can be cost-effective with respect to the use of FFP. DISCUSSION Data from additional randomised studies are needed to establish more definitive guidelines on the use of SD-plasma.
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Komorowski AL, Li WF, Millan CA, Huang TS, Yong CC, Lin TS, Lin TL, Jawan B, Wang CC, Chen CL. Temporary abdominal closure and delayed biliary reconstruction due to massive bleeding in patients undergoing liver transplantation: an old trick in a new indication. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:118-24. [PMID: 26692574 PMCID: PMC4764012 DOI: 10.1002/jhbp.311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/17/2015] [Indexed: 12/27/2022]
Abstract
Background Massive bleeding during liver transplantation (LT) is difficult to manage surgical event. Perihepatic packing (PP) and temporary abdominal closure (TAC) with delayed biliary reconstruction (DBR) can be applied in these circumstances. Method A prospective database of LT in a major transplant center was analyzed to identify patients with massive uncontrollable bleeding during LT that was resolved by PP, TAC, and DBR. Results From January 2009 to July 2013, 20 (3.6%) of 547 patients who underwent LT underwent DBR. Mean intraoperative blood loss was 20,500 ml at the first operation. The DBR was performed with a mean of 55.2 h (16–110) after LT. Biliary reconstruction included duct‐to‐duct (n = 9) and hepatico‐jejunostomy (n = 11). Complications occurred in eight patients and included portal vein thrombosis, cholangitis, severe bacteremia, pneumonia. There was one in‐hospital death. In the follow‐up of 18 to 33 months we have seen one patient died 9 months after transplantation. The remaining 18 patients are alive and well. Conclusions In case of massive uncontrollable bleeding and bowel edema during LT, the combined procedures of PP, TAC, and DBR offer an alternatively surgical option to solve the tough situation.
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Affiliation(s)
- Andrzej L Komorowski
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.,Department of Surgical Oncology, Maria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Kraków, Poland
| | - Wei-Feng Li
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Carlos A Millan
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Tun-Sung Huang
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.,Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chee-Chien Yong
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Tsan-Shiun Lin
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Ting-Lung Lin
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
| | - Bruno Jawan
- Liver Transplantation Program and Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Chi Wang
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan. .,Department of Surgery, Chang Gung Memorial Hospital Chiayi, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chao-Long Chen
- Liver Transplantation Program and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan
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Cinqualbre J, Kientz D, Remy E, Huang N, Corash L, Cazenave JP. Comparative effectiveness of plasma prepared with amotosalen-UVA pathogen inactivation and conventional plasma for support of liver transplantation. Transfusion 2015; 55:1710-20. [PMID: 25857325 DOI: 10.1111/trf.13100] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 11/26/2014] [Accepted: 12/07/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Liver transplant may require large-volume plasma transfusion with increased risk of transfusion-transmitted infection (TTI). Pathogen inactivation of plasma with amotosalen-UVA offers the potential to mitigate TTI risk. STUDY DESIGN AND METHODS A retrospective cohort design was used to compare the therapeutic efficacy and key safety outcomes for liver transplants supported with quarantine plasma (Q-FFP [reference]) or amotosalen-UVA plasma (IBS plasma [test]). The outcomes evaluated were volume of plasma, the numbers of red blood cell (RBC) components, and the total dose of platelets (PLTs) transfused during and 7 days after transplant. The safety outcomes were acute hepatic artery thrombosis (HAT) and mortality. RESULTS Transplantation and transfusion records for 212 Q-FFP transplants and 215 IBS plasma transplants were reviewed. Not all transplants required plasma; 161 received Q-FFP and 174 received IBS plasma. Among the transplants that required plasma, there were significant differences in median values between cohorts for delay to transplantation (p=0.002), model end-stage liver disease score (p<0.001), pretransplant hematocrit (p=0.006), and graft cold perfusion time (p=0.033). The median volumes of plasma transfused were not different for test and reference (2.160 L vs. 1.969 L, p=0.292). Transplants in the test cohort required a mean of 3.7% more RBC components (p=0.767) and on average a 16.5% increase in total PLT dose (p=0.518). No significant differences were observed for the frequency of acute HAT or mortality. CONCLUSION In this retrospective study, IBS plasma provided therapeutic support of liver transplant not different from Q-FFP.
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Affiliation(s)
- Jacques Cinqualbre
- Pôle des Pathologies Digestives-Hépatiques-Transplantations, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Okoye OT, Reddy H, Wong MD, Doane S, Resnick S, Karamanos E, Skiada D, Goodrich R, Inaba K. Large animal evaluation of riboflavin and ultraviolet light-treated whole blood transfusion in a diffuse, nonsurgical bleeding porcine model. Transfusion 2015; 55:532-43. [PMID: 25582335 DOI: 10.1111/trf.12894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/31/2014] [Accepted: 08/11/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Mirasol system has been demonstrated to effectively inactivate white blood cells (WBCs) and reduce pathogens in whole blood in vitro. The purpose of this study was to compare the safety and efficacy of Mirasol-treated fresh whole blood (FWB) to untreated FWB in an in vivo model of surgical bleeding. STUDY DESIGN AND METHODS A total of 18 anesthetized pigs (40 kg) underwent a 35% total blood volume bleed, cooling to 33°C, and a standardized liver injury. Animals were then randomly assigned to resuscitation with either Mirasol-treated or untreated FWB, and intraoperative blood loss was measured. After abdominal closure, the animals were observed for 14 days, after which the animals were euthanized and tissues were obtained for histopathologic examination. Mortality, tissue near-infrared spectroscopy, red blood cell (RBC) variables, platelets (PLTs), WBCs, and coagulation indices were analyzed. RESULTS Total intraoperative blood loss was similar in test and control arms (8.3 ± 3.2 mL/kg vs. 7.7 ± 3.9 mL/kg, p = 0.720). All animals survived to Day 14. Trended values over time did not show significant differences-tissue oxygenation (p = 0.605), hemoglobin (p = 0.461), PLTs (p = 0.807), WBCs (p = 0.435), prothrombin time (p = 0.655), activated partial thromboplastin time (p = 0.416), thromboelastography (TEG)-reaction time (p = 0.265), or TEG-clot formation time (p = 0.081). Histopathology did not show significant differences between arms. CONCLUSIONS Mirasol-treated FWB did not impact survival, blood loss, tissue oxygen delivery, RBC indices, or coagulation variables in a standardized liver injury model. These data suggest that Mirasol-treated FWB is both safe and efficacious in vivo.
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Affiliation(s)
- Obi T Okoye
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California
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Haugaa H, Taraldsrud E, Nyrerød HC, Tønnessen TI, Foss A, Solheim BG. Low incidence of hyperfibrinolysis and thromboembolism in 195 primary liver transplantations transfused with solvent/detergent-treated plasma. Clin Med Res 2014; 12:27-32. [PMID: 24415744 PMCID: PMC4453305 DOI: 10.3121/cmr.2013.1168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Liver transplantation regularly requires transfusion of red blood cells (RBCs), plasma, and platelets. Compared to fresh frozen plasma (FFP) from single blood donors, solvent/detergent-treated plasma (SD-plasma) pooled from several hundred blood donors has advantages with respect to pathogen reduction, standardized content of plasma proteins, and significantly reduced risk of transfusion related lung injury and allergic/immunologic adverse reactions. However, SD-plasma has been suspected to increase the incidence of hyperfibrinolysis and thromboembolic events. STUDY DESIGN AND METHODS We investigated the transfusion practices, hyperfibrinolysis parameters, and thrombosis outcomes in 195 consecutive adult primary liver transplants in our center using SD-plasma (Octaplas) as the exclusive source of plasma. RESULTS Perioperatively, median (interquartile range) 4 (1 to 9) RBC-units, 10 (4 to 18) plasma-bags, and 0 (0 to 2) platelet-units were transfused. Hyperfibrinolysis defined as LY30 ≤ 7.5% was detected in 12/138 thrombelastography-monitored patients (9%). These patients received significantly more RBCs, plasma, and platelets than did patients without hyperfibrinolysis. Thrombotic graft complications were observed in three patients (2%). Pulmonary embolism was not observed in any patient. CONCLUSION SD-plasma is a safe plasma product for liver transplant recipients, and the incidences of hyperfibrinolysis and thromboembolic events are not significantly different from those seen in centers using FFP.
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Affiliation(s)
- Håkon Haugaa
- Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway Faculty of Medicine, University of Oslo, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway
| | - Eli Taraldsrud
- Dept. of Immunology, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway
| | - Hans Christian Nyrerød
- Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway
| | - Tor Inge Tønnessen
- Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway Faculty of Medicine, University of Oslo, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway
| | - Aksel Foss
- Faculty of Medicine, University of Oslo, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway Section for Transplant Surgery, Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway
| | - Bjarte G Solheim
- Faculty of Medicine, University of Oslo, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway Dept. of Immunology, Oslo University Hospital, Rikshospitalet, Box 4950 Nydalen, 0424 Oslo, Norway
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Affiliation(s)
- D. C. Marks
- Research and Development; Australian Red Cross Blood Service; Sydney New South Wales Australia
| | - H. M. Faddy
- Research and Development; Australian Red Cross Blood Service; Brisbane Queensland Australia
| | - L. Johnson
- Research and Development; Australian Red Cross Blood Service; Sydney New South Wales Australia
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Kirchner C, Dirkmann D, Treckmann JW, Paul A, Hartmann M, Saner FH, Görlinger K. Coagulation management with factor concentrates in liver transplantation: a single-center experience. Transfusion 2014; 54:2760-8. [PMID: 24827116 DOI: 10.1111/trf.12707] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/27/2014] [Accepted: 02/04/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Allogeneic blood products transfusion during liver transplantation (LT) can be associated with increased morbidity and mortality. Data on thromboelastometry (ROTEM)-guided coagulation management with coagulation factor concentrates (CFCs)-fibrinogen concentrate and/or prothrombin complex concentrate (PCC)-are sparse. We aimed to retrospectively evaluate the safety events observed with this approach in our clinic. STUDY DESIGN AND METHODS LT patients from January 2009 to December 2010 (n = 266) were identified by chart review. A ROTEM-based algorithm with CFC guided the hemostatic therapy. Doppler ultrasound was used to evaluate thrombosis in the hepatic artery, portal vein, and hepatic veins. Stroke, myocardial ischemia, pulmonary embolism, and transfusion variables were recorded. Patients receiving CFC were included in the CFC group (n = 156); those not receiving CFC were included in the non-CFC group (n = 110). Safety events were compared between these two groups. RESULTS Allogeneic transfusion(s) in the 266 patients was low, with medians of 2 (interquartile range [IQR], 0-5), 0 (IQR 0-0), and 0 (IQR 0-1) units for red blood cells (RBCs), fresh-frozen plasma (FFP), and platelets (PLTs), respectively. Ninety-seven of 266 LTs (36.5%) were performed without RBCs transfusion, 227 (85.3%) without FFP, and 190 (71.4%) without PLTs. There were no significant differences in thrombotic, thromboembolic, and ischemic adverse events occurrence between the CFC group and the non-CFC group (11/156 patients vs. 5/110; p = 0.31). CONCLUSION In LT, ROTEM-guided treatment with fibrinogen concentrate and/or PCC did not appear to increase the occurrence of thrombosis and ischemic events compared to patients who did not receive these concentrates.
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Affiliation(s)
- Carmen Kirchner
- Department of General, Visceral and Transplant Surgery, University Hospital Essen, Essen, Germany
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Garraud O, Chavarin P, Boussoulade F, Morata P, Rochette-Eribon S, Acquart S, Fabrigli P, Argaud C, Bost V, Cognasse F. [The different types of therapeutic plasma are equivalent?]. Transfus Clin Biol 2014; 21:31-6. [PMID: 24560485 DOI: 10.1016/j.tracli.2014.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 01/09/2014] [Indexed: 11/16/2022]
Abstract
In France, three varieties of therapeutic plasma are being processed, distributed and delivered, currently; however, many more varieties are in use worldwide, which go by the property of labile blood component or plasma derived medicines. For one type of component (one given name), several devices and bags and so on are used to concur to its process, which makes that one type of therapeutic plasma may significantly differ from one production setting to one other. This may affect (more or less) the component properties as well as the possibly reported adverse events. This review aims thus, firstly at stressing on the difficulty in comparing data obtained in different contexts, and secondly at making the point on future directions to process therapeutic plasma.
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Affiliation(s)
- O Garraud
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France; Faculté de médecine, université de Lyon, 42023 Saint-Étienne, France.
| | - P Chavarin
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France
| | - F Boussoulade
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France
| | - P Morata
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France
| | - S Rochette-Eribon
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France
| | - S Acquart
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France
| | - P Fabrigli
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France
| | - C Argaud
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France
| | - V Bost
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France; Faculté de médecine, université de Lyon, 42023 Saint-Étienne, France
| | - F Cognasse
- Établissement français du sang Auvergne-Loire, 42023 Saint-Étienne, France; Faculté de médecine, université de Lyon, 42023 Saint-Étienne, France
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Alvarez I, Reichenberg S, di Nicola S. Plasma transfusion volume and liver transplantation safety. Transfusion 2013; 53:2353-4. [PMID: 24099342 DOI: 10.1111/trf.12321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Feys HB, Van Aelst B, Devreese K, Devloo R, Coene J, Vandekerckhove P, Compernolle V. Oxygen removal during pathogen inactivation with riboflavin and UV light preserves protein function in plasma for transfusion. Vox Sang 2013; 106:307-15. [PMID: 24460692 DOI: 10.1111/vox.12106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/25/2013] [Accepted: 10/01/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Photochemical pathogen inactivation technologies (PCT) for individual transfusion products act by inhibition of replication through irreversibly damaging nucleic acids. Concern on the collateral impact of PCT on the blood component's integrity has caused reluctance to introduce this technology in routine practice. This work aims to uncover the mechanism of damage to plasma constituents by riboflavin pathogen reduction technology (RF-PRT). METHODS Activity and antigen of plasma components were determined following RF-PRT in the presence or absence of dissolved molecular oxygen. RESULTS Employing ADAMTS13 as a sentinel molecule in plasma, our data show that its activity and antigen are reduced by 23 ± 8% and 29 ± 9% (n = 24), respectively, which corroborates with a mean decrease of 25% observed for other coagulation factors. Western blotting of ADAMTS13 shows decreased molecular integrity, with no obvious indication of additional proteolysis nor is riboflavin able to directly inhibit the enzyme. However, physical removal of dissolved oxygen prior to RF-PRT protects ADAMTS13 as well as FVIII and fibrinogen from damage, indicating a direct role for reactive oxygen species. Redox dye measurements indicate that superoxide anions are specifically generated during RF-PRT. Protein carbonyl content as a marker of disseminated irreversible biomolecular damage was significantly increased (3·1 ± 0·8 vs. 1·6 ± 0·5 nmol/mg protein) following RF-PRT, but not in the absence of dissolved molecular oxygen (1·8 ± 0·4 nmol/mg). CONCLUSIONS RF-PRT of single plasma units generates reactive oxygen species that adversely affect biomolecular integrity of relevant plasma constituents, a side-effect, which can be bypassed by applying hypoxic conditions during the pathogen inactivation process.
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Affiliation(s)
- H B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
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Lozano M, Cid J, Müller TH. Plasma Treated with Methylene Blue and Light: Clinical Efficacy and Safety Profile. Transfus Med Rev 2013; 27:235-40. [DOI: 10.1016/j.tmrv.2013.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 12/29/2022]
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