Multiple Levels of Degradation Diminish Hemostatic Potential of Thawed Plasma
- 1 January 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Trauma and Acute Care Surgery
- Vol. 70 (1), 71-80
- https://doi.org/10.1097/ta.0b013e318207abec
Abstract
Background: Severe bleeding after injury requires transfusion of blood products, including fresh frozen plasma (FFP). Many centers are keeping thawed plasma (TP) ready for massively transfused patients. According to the American Association of Blood Banks Standards, TP is approved for transfusion up to 5 days after thawing, when stored at 1°C to 6°C. However, there are no clinical data analyzing the effects of the approved 5-day storage on plasma. We hypothesize that the hemostatic potential (HP) of freshly thawed (FFP-0) was superior to plasma stored for 5 days (FFP-5). Methods: FFP from 30 single donors were thawed at 37°C and kept at 1°C to 6°C for 5 days. HP was evaluated at day 0 and 5 by measuring kinetics of thrombin generation (TG), kinetics of clot formation by thromboelastography, clotting factors and inhibitors, and cell-derived microparticles (MPs) by flow cytometry. Results: When comparing FFP-5 to FFP-0, FFP-5 exhibited only 40% of the potential of FFP-0 for TG (6.2 nM/min vs. 14.3 nM/min, p < 0.0001), a slower clotting response via thromboelastography (reaction time: 4.3 minutes vs. 3.2 minutes, p < 0.0001) and a longer delay in reaching maximum thrombus generation (5.7 minutes vs. 4.6 minutes, p < 0.01). Diminished HP was accompanied by a significant decline in multiple coagulation proteins, including FV, VII, VIII, von Willebrand factor, and free Protein S, by up to 30%, and a decrease of 50% in MP counts. Conclusion: The HP and clot forming ability of TP significantly declined with storage. Hence, freshly TP may have a greater ability to restore hemostasis and correct coagulopathy compared with FFP-5. The clinical consequences for transfused patients deserve further exploration.Keywords
This publication has 28 references indexed in Scilit:
- Protective Effects of Fresh Frozen Plasma on Vascular Endothelial Permeability, Coagulation, and Resuscitation After Hemorrhagic Shock Are Time Dependent and Diminish Between Days 0 and 5 After ThawThe Journal of Trauma and Acute Care Surgery, 2010
- Clinical review: Fresh frozen plasma in massive bleedings - more questions than answersCritical Care, 2010
- INCREASE IN ACTIVATED PROTEIN C MEDIATES ACUTE TRAUMATIC COAGULOPATHY IN MICEShock, 2009
- Resuscitation and transfusion principles for traumatic hemorrhagic shockBlood Reviews, 2009
- Duration of red blood cell storage is associated with increased incidence of deep vein thrombosis and in hospital mortality in patients with traumatic injuriesCritical Care, 2009
- Increased Plasma and Platelet to Red Blood Cell Ratios Improves Outcome in 466 Massively Transfused Civilian Trauma PatientsAnnals of Surgery, 2008
- The dynamics of clot formation in fresh‐frozen plasmaVox Sanguinis, 2008
- Thrombin generation in acute coronary syndrome and stable coronary artery disease: dependence on plasma factor compositionJournal of Thrombosis and Haemostasis, 2008
- Thrombin generation assays are superior to traditional tests in assessing anticoagulation reversal in vitroThrombosis and Haemostasis, 2008
- Acute Traumatic Coagulopathy: Initiated by HypoperfusionAnnals of Surgery, 2007