Preservation of coagulation factors V and VIII during collection and subsequent storage of bank blood in ACD-A and CPD solutions

Evaluation of Coagulation Factors Activity in Different Types of Plasma Preparations

Fresh frozen plasma (FFP) is a crucial substitute therapy in management of bleeding; producing plasma from whole blood stored within 24 h offers operational flexibility and leukocyte filtration significantly reduce transfusion reactions, it is necessary to consider the impact of these plasma preparations on clotting factors activity. Total of 75 plasma samples collected from 25 blood donors distributed as 3 groups; FFP (Group A), leukocyte filtrated FFP (Group B) and plasma frozen within 24 h i.e. PF24 (Group C), for all samples prothrombin time (PT), INR, (APTT), Factors V, VII, VIII, IX levels and Fibrinogen were done, also comparing coagulation factors levels in FFP in different blood groups. There were significant difference between three groups in (PT), INR and (APTT): (P = 0.00). Concerning Factor VII: significant difference (P = 0.03) between the three groups, FFP had a significantly higher level of FVII compared to filtrated FFP (98.92 vs. 82.52%; P = 0.02), while no significant difference between FFP and PF24 was detected (P = 0.76). Factor VIII: had significant difference (P = 0.00) between the three groups, FFP and Filtrated FFP had no significant difference regarding level of FVIII (P = 0.72), but FFP had significantly higher level of FVIII compared to PF24 (P < 0.05). Concerning Fibrinogen level: no significant difference between FFP and filtrated FFP (P = 0.99), while FFP had a higher level versus PF24 (P < 0.05). On the Contrary, no significant difference between three groups in Factor V: (P = 0.22) and Factor IX: (P = 0.12). ABO blood group effect on studied parameters in FFP: FVIII was statistically higher in Non-O blood group (P = 0.03), other factors had no statistical differences (P > 0.05). The leukocyte filtration of FFP did not affect the majority of coagulation factors activities, although FVII level was reduced, it stills enough for surgical hemostasis. The PF24 resulted in reduced FVIII and fibrinogen levels but no significant changes in FV, FVII or FIX, thus, can be used for FFP indications except that specifically requiring replacement of FVIII and/or fibrinogen as Hemophilia or DIC. No significant difference in coagulation factors of FFP between O and non-O blood groups except FVIII that was reduced in O blood group.

The involvement of cation leaks in the storage lesion of red blood cells

Stored blood components are a critical life-saving tool provided to patients by health services worldwide. Red cells may be stored for up to 42 days, allowing for efficient blood bank inventory management, but with prolonged storage comes an unwanted side-effect known as the "storage lesion", which has been implicated in poorer patient outcomes. This lesion is comprised of a number of processes that are inter-dependent. Metabolic changes include a reduction in glycolysis and ATP production after the first week of storage. This leads to an accumulation of lactate and drop in pH. Longer term damage may be done by the consequent reduction in anti-oxidant enzymes, which contributes to protein and lipid oxidation via reactive oxygen species. The oxidative damage to the cytoskeleton and membrane is involved in increased vesiculation and loss of cation gradients across the membrane. The irreversible damage caused by extensive membrane loss via vesiculation alongside dehydration is likely to result in immediate splenic sequestration of these dense, spherocytic cells. Although often overlooked in the literature, the loss of the cation gradient in stored cells will be considered in more depth in this review as well as the possible effects it may have on other elements of the storage lesion. It has now become clear that blood donors can exhibit quite large variations in the properties of their red cells, including microvesicle production and the rate of cation leak. The implications for the quality of stored red cells from such donors is discussed.

The quality of fresh-frozen plasma produced from whole blood stored at 4°C overnight

BACKGROUND

The aim of this study was to assess whether the quality of FFP produced from whole blood stored at 4 degrees C overnight is adequate for its intended purpose.

STUDY DESIGN AND METHODS

Fresh-frozen plasma (FFP) separated from whole blood (n = 60) leukodepleted (LD) after storage at 4 degrees C overnight (18-24 hr from donation, Day 1 FFP) was compared with that LD within 8 hours of donation (Day 0 FFP, the current standard method).

RESULTS

In more than 95 percent of Day 1 FFP units, levels of factor (F) II, FV, FVII, FVIII, F IX, FX, FXI, and FXII were greater than 0.50 U per mL except for von Willebrand factor (VWF) antigen and FVIII, where 92 and 87 percent of units, respectively, contained greater than 0.50 IU per mL. Compared with historical data on FFP stored for 8 hours, fibrinogen, FV, FVIII, and FXI were reduced by 12, 15, 23, and 7 percent, respectively, but other factors were not significantly reduced. Levels of VWF-cleaving protease activity were not different between FFP prepared from paired units of blood (n = 3) held for 8 or 24 hours, but were below the reference range in an additional 2 of 6 units held for 24 hours. The activities of protein S, protein C, antithrombin III, and alpha(2)-antiplasmin were reduced by less than 10 percent in Day 1 FFP (n = 20), but with final levels above the lower limit of the normal range in greater than 95 percent of units. Activated FXII antigen was not significantly raised in plasma stored for 18 to 24 hours, but levels of prothrombin fragment 1 + 2 were slightly increased (0.88 ng/mL, 18-24 hr; 0.65 ng/mL, < 8 hr).

CONCLUSION

These data suggest that there is good retention of relevant coagulation factor activity in plasma produced from whole blood stored at 4 degrees C for 18 to 24 hours and that this would be an acceptable product for most patients requiring FFP.

Hereditary blood coagulation factor-VII deficiency: a comparison of the defect in beagles from several sources

1. Hereditary blood coagulation factor-VII deficiency has previously been identified in Beagles from a number of sources in Britain and North America. 2. A study is now reported in which the nature of the defect is compared in plasma samples from these sources. 3. When prothrombin times and Russell's Viper venom clotting times were determined on mixtures of samples, no cross-correction of the defective coagulation activity was detected. 4. Antibody neutralization assays of factor-VII related antigen and assays of factor-VII procoagulant activity revealed essentially similar levels in all samples. 5. Thus no significant genetic variants of the defect were identified.

Small-pool high-yield factor VIII production

Hemophilia care depends on several factors for the production of purified FVIII: plasma procurement, plasma logistics, production method, and efficacy. The latter two are restrictive factors, both for the supply and the safety of FVIII preparations. Conventional production methodology unavoidably recovers only 10 to 20% of usable protein, therefore requiring large pools of source plasma. Related to pool size is the transmission of diseases, which poses unnecessary risks for patients. The development of new technologies to better recover FVIII allows reduction of the pool size: crush-thaw, controlled pore-glass chromatography, and heparin double-cold precipitation techniques. This review will reflect on current production methods, pool size concept, small-pool approaches in FVIII production, and future developments.

The stability of coagulation factors in stored blood

The complete coagulation profile of citrate phosphate dextrose (CPD) stored blood has been studied during 21 days storage at 4 degrees C. Ten donations were studied at zero, one, seven, 14 and 21 days. One donation contained small clots and was studied separately. Activities of factors I, II, IX, XII or XIII did not deteriorate significantly. Slight, but clinically unimportant deterioration occurred in factors VII, X and XI. There was marked deterioration in activities of factor V, and factor VIII, the levels decreasing from 1.0u/ml at day zero to 0.51 to 0.30 respectively at day 21. The donation which contained small clots had more marked decreases in factors V and VIII from the first day. The general stability of coagulation factors suggests that even massive blood replacement is unlikely to result in clinically significant coagulation defects.

Factor VIII (AHG) levels in 1016 regular blood donors. The effects of age, sex, and ABO blood groups

Factor VIII (AHG) activity was assayed in the plasma specimens from 1016 regular and controlled blood donors. Age and ABO blood groups had highly significant effects on factor VIII concentrations, whereas the effect of sex was not significant. The median in the donors of blood group O rose from 87% at the age of 20 to 119% at the age of 60 years, and the median in blood groups A and B+AB of corresponding ages rose from 108 to 147%. An interaction effect of age and blood groups was present only at the 5% level of significance. The present data and the previous findings of others suggest the existence of an association between high factor VIII levels and thrombotic states.

Clinical and experimental studies on adenine, various nucleosides and their analogs in hematology

In red blood cells as well as in platelets there appears to be a decrease in adenine nucleotides during storage under blood bank conditions. This can be decreased by use of anticoagulant preservatives with higher phosphate content than the standard ACD solution, through the addition of adenine and inosine. Maintenance of higher ATP levels appears to be related to longer circulating life span after transfusion into patients in the case of red blood cells but not platelets. Inosine and more alkaline preservative medium also contribute to the maintenance of 2,3-DPG levels in red blood cells, and with it to the maintenance of normal hemoglobin dissociation curves and thus oxygen-carrying capacity. Certain nucleoside analogs may contribute to the preservation of platelets and of whole blood by their platelet-aggregation inhibitory activity. Platelet-aggregation inhibitors may also be useful in preventing thromboembolic episodes with potentially greater safety than anticoagulants.