1
|
Preparation and Storage of Cryoprecipitate Derived from Amotosalen and UVA-Treated Apheresis Plasma and Assessment of In Vitro Quality Parameters. Pathogens 2022; 11:pathogens11070805. [PMID: 35890049 PMCID: PMC9317929 DOI: 10.3390/pathogens11070805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 11/22/2022] Open
Abstract
Cryoprecipitate is a plasma-derived blood product, enriched for fibrinogen, factor VIII, factor XIII, and von Willebrand factor. Due to infectious risk, the use of cryoprecipitate in Central Europe diminished over the last decades. However, after the introduction of various pathogen-reduction technologies for plasma, cryoprecipitate production in blood centers is a feasible alternative to pharmaceutical fibrinogen concentrate with a high safety profile. In our study, we evaluated the feasibility of the production of twenty-four cryoprecipitate units from pools of two units of apheresis plasma pathogen reduced using amotosalen and ultraviolet light A (UVA) (INTERCEPT® Blood System). The aim was to assess the compliance of the pathogen-reduced cryoprecipitate with the European Directorate for the Quality of Medicines (EDQM) guidelines and the stability of coagulation factors after frozen (≤−25 °C) storage and five-day liquid storage at ambient temperature post-thawing. All pathogen-reduced cryoprecipitate units fulfilled the European requirements for fibrinogen, factor VIII and von Willebrand factor content post-preparation. After five days of liquid storage, content of these factors exceeded the minimum values in the European requirements and the content of other factors was sufficient. Our method of production of cryoprecipitate using pathogen-reduced apheresis plasma in a jumbo bag is feasible and efficient.
Collapse
|
2
|
Lotens A, Prudent M, Rapaille A. Antioxidants in single methylene-blue-treated plasma units cannot be used to predict pathogen inactivation treatment success. Vox Sang 2022; 117:937-942. [PMID: 35445418 DOI: 10.1111/vox.13273] [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: 10/05/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Measurement of antioxidant power (AOP) can be useful to validate the execution of the pathogen inactivation (PI) treatment of plasma units. The aim of this study was to evaluate the Theraflex technology for plasma units routinely used in Belgium. MATERIALS AND METHODS AOP was tested on plasma units treated by Theraflex with various non-complete treatment scenarios. AOP was quantified electrochemically using disposable devices and was expressed as equivalent ascorbic acid concentration. RESULTS During a complete PI treatment, AOP rose from 195 ± 32 to 230 ± 42 μmol/L eq. ascorbic acid after addition of methylene blue (MB), and decreased to 192 ± 30 μmol/L eq. ascorbic acid after illumination and finally to 177 ± 27 μmol/L eq. ascorbic acid after final filtration. Without MB, the final filtration had no effect on the plasma AOP (197 ± 22 μmol/L eq. ascorbic acid before filtration and 194 ± 22 μmol/L eq. ascorbic acid after filtration). With no MB and no illumination, there was no significant difference between the plasma AOP at the beginning (188 ± 23 μmol/L eq. ascorbic acid) and at the end of the process (179 ± 21 μmol/L eq. ascorbic acid). CONCLUSION AOP measurement may not indicate the effectiveness of the PI treatment.
Collapse
Affiliation(s)
- Anaïs Lotens
- Blood Service, Belgian Red Cross, Namur, Belgium
| | - Michel Prudent
- Laboratoire de Recherche sur les Produits Sanguins, Recherche et Développement Produits, Transfusion Interrégionale CRS, Epalinges, Switzerland.,Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland
| | | |
Collapse
|
3
|
Cantó PA, Ruiz JS, Madrid PL, Vicente IN, Lucas CM, Martínez AM, Boix SB, Martínez AJC, Comos JDLR, Seguí IG, Alcaina PS. ABO GROUP-BASED STRATEGY FOR INVENTORY MANAGEMENT OF METHYLENE BLUE-TREATED THAWED PLASMA IN A BLOOD BANK. Transfus Apher Sci 2022; 61:103438. [DOI: 10.1016/j.transci.2022.103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
|
4
|
Wu T, Wang X, Ren K, Huang X, Liu J. The Alterations in Methylene Blue/Light-Treated Frozen Plasma Proteins Revealed by Proteomics. Transfus Med Hemother 2021; 48:298-305. [PMID: 34803573 DOI: 10.1159/000515119] [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: 10/28/2020] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study was to investigate the modified proteins in methylene blue/light-treated frozen plasma (MB-FP) compared with fresh frozen plasma (FFP) in order to gain a better application of MB/light-treated plasma in clinic transfusion. Methods MB-FP and FFP were collected from Changchun central blood station, and a trichloroacetic acid/acetone precipitation method was used to remove albumin for the enrichment of lower abundance proteins. The plasma protein in MB-FP and FFP were separated using two-dimensional gel electrophoresis (2-DE) and the differentially expressed protein spots were analyzed using mass spectrometry. Finally, the differentially expressed proteins were tested using Western blot and enzyme-linked immunosorbent assay (ELISA). Results Approximately 14 differentially expressed protein spots were detected in the MB-FP, and FFP was chosen as the control. After 2-DE comparison analysis and mass spectrometry, 8 significantly differentially expressed protein spots were identified, corresponding to 6 different proteins, including complement C1r subcomponent (C1R), inter-alpha-trypsin inhibitor heavy chain H4 (ITI-H4), keratin, type II cytoskeletal 1 (KRT1), hemopexin (HPX), fibrinogen gamma chain (FGG), and transthyretin (TTR). Western blot showed no significant difference in the expression level of KRT1 between MB-FP and FFP (p > 0.05). Both Western blot and ELISA indicated that the level of HPX was significantly higher in FFP than in MB-FP (p < 0.05). Conclusion This comparative proteomics study revealed that some significantly modified proteins occur in MB-FP, such as C1R, ITI-H4, KRT1, HPX, FGG, and TTR. Our findings provide more theoretical data for using MB-FP in transfusion medicine. However, the relevance of the data for the transfusion of methylene blue/light-treated plasma remains unclear. The exact modification of these proteins and the effects of these modified proteins on their functions and their effects in clinical plasma infusion need to be further studied.
Collapse
Affiliation(s)
- Tiange Wu
- Blood Transfusion Department, The Second Hospital of Jilin University, Changchun, China
| | - Xiaoning Wang
- Blood Transfusion Department, The First Hospital of Jilin University, Changchun, China
| | - Kai Ren
- Blood Transfusion Department, The Second Hospital of Jilin University, Changchun, China
| | - Xiaochen Huang
- Anesthesiology, Changchun University of Chinese Medicine, Changchun, China
| | - Jiankai Liu
- Department of Biochemistry, College of Basic Medical Sciences, Jilin University, Changchun, China
| |
Collapse
|
5
|
Rapaille A, Lotens A, de Valensart N, Najdovski T, Green L. Evaluation of the hemostatic capacity of methylene blue-treated liquid (not frozen) plasma stored up 14 days at 2° to 6°C. Transfusion 2021; 61:2450-2457. [PMID: 33913163 DOI: 10.1111/trf.16427] [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: 11/18/2020] [Revised: 03/22/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early plasma transfusion for management of bleeding, particularly trauma, is associated with better outcomes. Improving the availability/safety of plasma transfusion for patients is essential for transfusion services. The aim of this study is to evaluate the hemostatic capacity of methylene-blue (MB) liquid (not frozen) plasma over time. MATERIALS AND METHODS Twenty whole blood-derived plasma units collected from male donors were separated and processed within 18 h of collection. Individual plasmas were treated with MB and stored in liquid status at 2-6°C for 14 days. A range of coagulation assays, including thrombin generation, rotational thromboelastometry (ROTEM), and Thrombodynamics were tested at different time-points, together with bacterial growth. RESULTS Apart from Factor (F)XII, other coagulation factors (fibrinogen, FV, FVIII, FXI) reduced significantly after MB treatment, with levels remaining stable except for FVIII afterward. By day 14, most clotting factors were >0.7 IU/ml, apart from FVIII. There was a disproportionate decrease in Protein S (PS) activity compared to free PS antigen and by day 14 its value was ~50%. There was no significant difference in maximum clot formation (ROTEM) and clot-density (Thrombodynamics) over time. Endogenous thrombin potential (Thrombin-Generation), clot-size, and velocity index (Thrombodynamics) decreased significantly over time consistent with clotting factor reduction. There was no bacterial growth. CONCLUSIONS MB-treated liquid plasma stored at 2-6°C can be used for up to 14 days: the long shelf-life, the liquid status, and the MB treatment will improve its availability for management of bleeding as well as providing a safe component from pathogens.
Collapse
Affiliation(s)
| | - Anaïs Lotens
- Service du Sang, Belgian Red Cross, Suarlée, Belgium
| | | | | | - Laura Green
- NHS Blood and Transplant and Barts Health NHS Trust, Queen Mary University of London, London, UK
| |
Collapse
|
6
|
Pathogen reduction of blood components during outbreaks of infectious diseases in the European Union: an expert opinion from the European Centre for Disease Prevention and Control consultation meeting. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:433-448. [PMID: 31846608 DOI: 10.2450/2019.0288-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022]
Abstract
Pathogen reduction (PR) of selected blood components is a technology that has been adopted in practice in various ways. Although they offer great advantages in improving the safety of the blood supply, these technologies have limitations which hinder their broader use, e.g. increased costs. In this context, the European Centre for Disease Prevention and Control (ECDC), in co-operation with the Italian National Blood Centre, organised an expert consultation meeting to discuss the potential role of pathogen reduction technologies (PRT) as a blood safety intervention during outbreaks of infectious diseases for which (in most cases) laboratory screening of blood donations is not available. The meeting brought together 26 experts and representatives of national competent authorities for blood from thirteen European Union and European Economic Area (EU/EEA) Member States (MS), Switzerland, the World Health Organization, the European Directorate for the Quality of Medicines and Health Care of the Council of Europe, the US Food and Drug Administration, and the ECDC. During the meeting, the current use of PRTs in the EU/EEA MS and Switzerland was verified, with particular reference to emerging infectious diseases (see Appendix). In this article, we also present expert discussions and a common view on the potential use of PRT as a part of both preparedness and response to threats posed to blood safety by outbreaks of infectious disease.
Collapse
|
7
|
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
| |
Collapse
|
8
|
Hess JR, Pagano MB, Barbeau JD, Johannson PI. Will pathogen reduction of blood components harm more people than it helps in developed countries? Transfusion 2017; 56:1236-41. [PMID: 27167359 DOI: 10.1111/trf.13512] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/24/2015] [Accepted: 12/31/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Blood-borne infectious diseases are a major impediment to the provision of safe blood. Pathogen reduction (PR) technologies have been approved for the treatment of plasma and platelet (PLT) concentrates to reduce infectious complications and graft-versus-host disease but product potency is adversely affected STUDY DESIGN AND METHODS We reviewed published data describing PR technology for estimates of treated blood component physical and functional loss. These physical and functional losses were summed and projected onto measured effects of plasma and PLT dose in trauma resuscitation. The net benefits estimated as reduced infectious disease deaths were compared to net losses estimated as increased deaths from uncontrolled hemorrhage. RESULTS Transfusion-transmitted infectious diseases caused five or fewer acute deaths each year from 2009 through 2014 in the United States according to the Food and Drug Administration. In-hospital deaths from uncontrolled hemorrhage after trauma number more than 10,000 yearly and are reduced by 4% to 15% with concentrated blood product resuscitation. The loss of 20% of plasma potency and 30% of PLT potency to PR is likely to be associated with 400 extra trauma deaths each year. Trauma represents a small fraction, perhaps 15%, of all massively transfused individuals. CONCLUSIONS Resuscitation of massive hemorrhage may be limited by blood component potency as shown in our literature review and analysis. The safety-versus-potency trade involved with current blood plasma and PLT PR technology is likely to result in a net loss of life. Hemorrhagic risk from reduced blood product potency for patients with trauma and other indications for massive transfusion is an important consideration in risk-based decision making for implementing PR.
Collapse
Affiliation(s)
- John R Hess
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Monica B Pagano
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington
| | - James D Barbeau
- Department of Pathology, Brown University School of Medicine, Providence, Rhode Island
| | - Pär I Johannson
- Department of Transfusion Medicine, Rigshospitalet, Copenhagen, Denmark.,Department of Surgery, University of Texas Health Medical School, Houston, Texas
| |
Collapse
|
9
|
Cancelas JA, Slichter SJ, Rugg N, Pratt PG, Nestheide S, Corson J, Pellham E, Huntington M, Goodrich RP. Red blood cells derived from whole blood treated with riboflavin and ultraviolet light maintain adequate survival in vivo after 21 days of storage. Transfusion 2017; 57:1218-1225. [PMID: 28369971 DOI: 10.1111/trf.14084] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pathogen reduction (PR) of whole blood (WB) may increase blood safety when applied before component separation. This study evaluates the in vivo performance of red blood cells (RBCs) derived from WB treated with the riboflavin and ultraviolet (UV) light PR (Mirasol) system. STUDY DESIGN AND METHODS This was a prospective, two-center, single-blind, randomized, two-period, crossover clinical trial designed to evaluate autologous 51 Cr/99m Tc-radiolabeled recovery and survival of RBCs derived from Mirasol-treated WB compared to untreated WB. RBCs were stored in AS-3 for 21 days at 1 to 6°C. In vitro RBC variables were characterized. Frequency and severity of treatment-emergent adverse event (TEAE) and neoantigenicity were determined. RESULTS Twenty-four healthy adult volunteers (n = 12 per site) were evaluated. The Mirasol 24-hr RBC recoveries were 82.5 ± 3.9% with one-sided 95% lower confidence limit of 80.9%, meeting US Food and Drug Administration acceptance criteria, albeit at lower level than controls (91.7 ± 6.8%, p < 0.001). Mean RBC survival and T50 were reduced in the Mirasol group (61 and 23 days, respectively) versus controls (82 and 36 days, respectively; p < 0.001) with a mean area under the curve survival of treated RBCs of 83% of untreated controls. End-of-storage hemolysis in the Mirasol group was 0.22 ± 0.1% (control, 0.15 ± 0.1%; p < 0.001). No neoantigenicity or differences in TEAEs were found. CONCLUSION RBCs derived from Mirasol WB and stored for up to 21 days in AS-3 maintained acceptable cell quality and recovery, albeit modestly reduced compared with untreated RBCs. Mirasol WB may represent a valid single WB PR platform that allows manufacture of RBC for storage for up to 21 days.
Collapse
Affiliation(s)
- Jose A Cancelas
- Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio
| | - Sherrill J Slichter
- Bloodworks Northwest, Seattle, Washington.,University of Washington, Seattle, Washington
| | - Neeta Rugg
- Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio
| | - P Gayle Pratt
- Hoxworth Blood Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Raymond P Goodrich
- Infectious Disease Research Center, Colorado State University, Fort Collins, Colorado
| |
Collapse
|