Is all plasma created equal? A pilot study of the effect of interdonor variability

Targeting repair of the vascular endothelium and glycocalyx after traumatic injury with plasma and platelet resuscitation

•

Endothelial glycocalyx shedding is a key instigator of the endotheliopathy of trauma.

•

Plasma and platelet transfusions preserve vascular integrity in pre-clinical models.

•

However, platelets may be less effective than plasma in preserving the glycocalyx.

Severely injured patients with hemorrhagic shock can develop endothelial dysfunction, systemic inflammation, and coagulation disturbances collectively known as the endotheliopathy of trauma (EOT). Shedding of the endothelial glycocalyx occurs early after injury, contributes to breakdown of the vascular barrier, and plays a critical role in the pathogenesis of multiple organ dysfunction, leading to poor outcomes in trauma patients. In this review we discuss (i) the pathophysiology of endothelial glycocalyx and vascular barrier breakdown following hemorrhagic shock and trauma, and (ii) the role of plasma and platelet transfusion in maintaining the glycocalyx and vascular endothelial integrity.

Plasma pooling in combination with amotosalen/UVA pathogen inactivation to increase standardisation and safety of therapeutic plasma units

Objectives

Assessment of the impact of pooling five single‐donor plasma (SDP) units to obtain six pathogen‐reduced therapeutic plasma (PTP) units on standardisation and the retention of labile coagulation factors.

Background

SDP shows a high inter‐donor variability with potential implications for the clinical treatment outcome. Additionally, there is still an existing risk for window‐period transmissions of blood borne pathogens including newly emerging pathogens.

Methods/Materials

Five ABO‐identical SDP units were pooled, treated with the INTERTCEPT™ Blood System (Cerus Corporation, U.S.A.) and split into six PTP units which were frozen and thawed after 30 days. The variability in volume, labile coagulation factor retention and activity was assessed.

Results

The variability of volumes between the PTP units was reduced by 46% compared to SDP units. The variability in coagulation factor content between the PTP units was reduced by 63% compared to SDP units. Moderate, but significant losses of coagulation factors (except for vWF) were observed in PTPs compared to SDPs.

Conclusion

The pooling of five SDP units to obtain six PTP units significantly increases product standardisation with potential implications for safety, economics as well as transfusion‐transmitted pathogen safety, making it an interesting alternative to quarantine SDP (qSDP) and pathogen‐reduced SDP.