Impacts of leukocyte filtration and irradiation on coagulation factors in fresh frozen plasma

Prolonged (post-thaw) shelf life of -80°C frozen AB apheresis plasma

BACKGROUND

Early plasma transfusion is important in the treatment of patients with major hemorrhage. Prolonged shelf life of AB type frozen −80°C and cold‐stored (4°C) deep frozen plasma (DFP) will improve strategic stock management, minimize need for resupply, and make pre‐hospital implementation more feasible.

METHODS AND MATERIALS

Plasma products type AB of different age and origin (−30°C Fresh Frozen [(FFP], −80°C DFP [short (±1 year) and long (±7 year)] stored) were thawed (Day 0), stored at 4°C, and sampled on Days 7 and 14. Additionally, samples of plasma containing blood products (Octaplas LG®, whole blood and platelets) were compared for coagulation factor activity, phospholipid clotting time (PPL), and kaolin TEG during 4°C or 22°C storage.

RESULTS

Coagulation profiles of FFP, short‐ and long‐stored −80°C DFP were not significantly different after thaw. Cold storage did not affect fibrinogen, Protein C, and Antithrombin III activities whereas factor V, VII, VIII, and Protein S decreased in all blood products. After 14 days DFP still meets the guidelines for clinical use, except for Protein S (0.4 IU/mL). With exception of Octaplas LG®, phospholipid activity and TEG coagulation were similar between plasma containing blood components during storage.

CONCLUSION

AB DFP quality was unaffected by almost 7 years of frozen storage. Quality of thawed 14‐day stored AB DFP met, with exception of Protein S, all minimal guidelines which implies that its quality is sufficient for use in the (pre)‐hospital (military) environment for treatment of major hemorrhage.

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.