Impact of Platelets and Fresh Frozen Plasma in Contrast to Red Cell Concentrate on Unstimulated and Stimulated Cytokine Release in anIn VitroModel of Transfusion

A 25-year old male was admitted for an episode of right sided headache and subsequent generalized seizure. On admission his temperature was 37.6°. He had generalized petechiae and conjunctival hemorrhages. Organomegaly and lymphadenopathy were absent. There was mild left sided weakness. The Hgb. was 6.9 g/dl., reticulocyte count 10%, WBC 11,500/mm3, and platelet count 10,000/mm3. There were numerous schistocytes on the peripheral smear; bone marrow revealed panhyperplasia. Coagulation studies were normal. The BUN was 30, and the creatinine 1.7 mg/dl. Plasma was positive for Hgb. CT scan was negative for gross intracranial bleeding. The diagnosis of T.T.P. was made. On admission, the patient received 10 units of platelets and 2 units of packed red blood cells. He did not require further red cell or platelet transfusions during the rest of his hospital course. He was then started on infusions of fresh-frozen plasma. He then received one unit every 3 hours for 6 days, one unit every 6 hours for 2 days, then one unit every 12 hours for 2 days and finally 1 unit daily for 5 days. The response was immediate. After the infusions were started, the hematologic parameters steadily improved. The patient’s hematuria rapidly improved. Further CNS symptoms did not appear. The patient’s Hgb. was 12 g/dl, and reticulocyte count was 2.5% by the 9th day. His platelet count was normal by the 4th day. The patient was discharged on the 15th day. Infusions of plasma were discontinued at the time of discharge. The patient required plasma therapy 4 weeks later for recurrent thrombocytopenia (50,000/mm3). The patient has remained normal for 9 months since therapy and further plasma has not been required. Primary plasma therapy for T.T.P. as sole treatment should be further studied.

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Prothrombin Complex Concentrate Versus Fresh Frozen Plasma for Vitamin K Antagonist Reversal in Acutely Bleeding Patients: A Retrospective Study

Blood ◽

10.1182/blood.v128.22.3830.3830 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3830-3830

Author(s):

Martin H. Ellis ◽

Orly Avnery ◽

Leticia Aizenberg ◽

Muhamad Mahamid

Keyword(s):

Hospital Admission ◽

Fresh Frozen Plasma ◽

Vitamin K Antagonist ◽

Red Cell ◽

Major Hemorrhage ◽

Urgent Surgery ◽

Fresh Frozen ◽

Clinical Benefits ◽

Red Cell Transfusion ◽

Frozen Plasma

Abstract Introduction Vitamin K antagonist (VKA) drugs require immediate reversal in VKA-treated patients with major bleeding or requiring urgent surgery. 4-factor prothrombin complex concentrates (PCCs)are approved for urgent VKA reversalbecause they reverse the international normalized ratio (INR) more rapidly than fresh frozen plasma (FFP). Studies comparing the clinical benefits of PCC and FFP have focused on VKA reversal prior to urgent surgery. Few data comparing laboratory and clinical outcomes of patients receiving PCC or FFP for major hemorrhage have been published, and these pertain to intracranial hemorrhage (ICH) only. Given the complexity of performing randomized studies in this setting, observational studies are relevant to inform on this issue. AIMS To compare the effects of PCC versus FFP on patient outcomes in VKA-associated major hemorrhage. The primary outcomes were the rate of INR reversal and blood product utilization. The secondary outcome was duration of intensive care and total hospital admission. Methods We performed a retrospective, single-center study of consecutive unselected patients receiving a 4-factor PCC for VKA reversal because of hemorrhage between January 2012 and April 2015 compared to consecutive unselected patients treated with FFP for the same indication from January 2010-December 2011, a period prior to introduction of PCC at the Meir Medical Center. Patients were identified by review of clinical and blood bank electronic medical records. We analyzed patient demographics, indication for VKA, underlying illnesses, aspirin use, site and severity of hemorrhage, INR pre- and post reversal, rate of INR reversal, transfusion requirements and duration of hospitalization, treatment. Results 56 patients received PCC and were compared to 56 patients treated with FFP. In the PCC group 17 patients had ICH and 25 had gastrointestinal hemorrhage compared to 17 and 31 patients respectively in the FFP group. Patients were adjusted for age, sex, presence of renal failure, active cancer, aspirin use, site of hemorrhage, pre-treatment INR and hemoglobin concentration and hemorrhagic shock at presentation. Outcomes: Median time to INR of ≤1.3 was 0.5 (range 0.5-1.5) vs 15.5 (range 5-96) hours for PCC vs FFP respectively, P<0.001). Packed red cell transfusion did not differ between the groups: median =1(range 0-13) in the PCC group and median= 2(range=2-10) in the FFP group (P=0.3), but more FFP was transfused in the FFP vs PCC group median =0(range 0-8) in the PCC group and median= 4(range=2-8) in the FFP group (P<0.001). Duration of hospital admission was longer in the FFP (median=7 days, range 1-93) vs PCC patients (median =6 days, range=1-35) (P=0.04). Conclusion This is the first observational study comparing PCC and FFP for VKA-related hemorrhage to our knowledge and the first study of PCC versus FFP for extracranial VKA-related hemorrhage. PCC was more effective than FFP in for reversal of the INR and was associated with less overall FFP use but not packed red cell transfusion. Similarly hospital admission duration was shorter among the PCC patients. Larger studies are required to determine whether PCC confers other clinical benefits over FFP for VKA reversal in acutely bleeding patients. Disclosures Ellis: Boehringer Ingelheim: Speakers Bureau; Bayer: Speakers Bureau; Pfizer: Speakers Bureau.

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Red Cell, Plasma and Albumin Transfusion Decision Triggers

Anaesthesia and Intensive Care ◽

10.1177/0310057x9302100204 ◽

1993 ◽

Vol 21 (2) ◽

pp. 156-162 ◽

Cited By ~ 25

Author(s):

M. D. Nicholls ◽

G. Whyte

Keyword(s):

Decision Making ◽

Blood Loss ◽

Fresh Frozen Plasma ◽

Red Cell ◽

Coagulation Test ◽

Cell Plasma ◽

Fresh Frozen ◽

Red Cell Transfusion ◽

Specialist Groups ◽

Frozen Plasma

Hypothetical clinical cases were used to investigate transfusion-related decision-making. Three red cell, three fresh frozen plasma (FFP) and three albumin transfusion decision cases were administered by questionnaire to 228 medical staff. The transfusion decision triggers were identified and comparisons made between resident and specialist groups and between Melbourne and Sydney participants. Factors important in red cell transfusion decisions included haemoglobin, symptoms of anaemia, presence of co-morbidities or surgery, gender, period of hospitalisation and the degree of documented blood loss. FFP administration was influenced by an abnormal coagulation test, the presence of co-morbidities and by the number of red cell units transfused. The administration of albumin, concentrated or 5% SPPS, was influenced by the period of hospitalisation and clinical circumstances such as a falling urine output postoperatively, and by the presence of hypotensive complications. Different transfusion responses were noted: resident staff transfused red cells and FFP earlier than specialists; Sydney specialists were more conservative of red cell transfusion; Melbourne specialists more conservative of FFP administration and surgeons were four times more likely to transfuse patients than physicians or anesthetists at certain haemoglobin values.

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Latar Belakang Penyakit pada Penggunaan Transfusi Komponen Darah pada Anak

Sari Pediatri ◽

10.14238/sp13.3.2011.159-64 ◽

2016 ◽

Vol 13 (3) ◽

pp. 159

Author(s):

Yetty Movieta Nency ◽

Dana Sumanti

Keyword(s):

Whole Blood ◽

Fresh Frozen Plasma ◽

Red Cell ◽

Fresh Frozen ◽

Frozen Plasma

Latar belakang.Aplikasi transfusi darah dalam klinis sehari-hari dapat sebagai terapi pengganti maupun suportif. Sesuai pertimbangan risiko dan manfaat tranfusi komponen darah seperti thrombocyt concentrate(TC) packed red cell(PRC), fresh frozen plasma(FFP), platelete rich plasma (PRP), dan cryoprecipitate/kriopresipitat lebih direkomendasikan daripada whole blood(WB). Tujuan.Mengetahui hubungan antara latar belakang penyakit dengan penggunaan transfusi komponen darah.Metode.Penelitian retrospekstif dilakukan di Ruang Anak Rumah Sakit Dr Kariadi Semarang. Data diperoleh dari register bank darah rumah sakit tahun 2008-2010. Latar belakang penyakit ditentukan dengan mengidentifikasi diagnosis pada setiap kasus transfusi. Komponen darah yang diteliti PRC, TC, FFP, PRP, dan kriopresipitat. Utilisasi dengan menghitung total jumlah komponen darah yang dipakai per diagnosis penyakit, dan rerata pemakaian produk darah per jumlah kasus terindikasi transfusi per tahun. Analisis uji statistik hubungan dengan menggunakan Chi square.Hasil.Terdapat peningkatan rerata utilisasi darah 5678 unit darah per tahun. Terdapat peningkatan penggunaan selama 3 tahun terakhir, secara berurutan adalah 3751, 6496, dan 6787 unit darah (p<0.001). Komponen darah yang paling banyak digunakan berturut-turut adalah TC 3228 unit, PRC 1682 unit, FFP 295 unit, PRP 224 unit, dan cryo133 unit. Pasien leukemia merupakan pengguna komponen darah terbanyak dengan rerata pemakaian per tahun 2098 unit, diikuti oleh sepsis 893 unit, dan thalassemia 568 unit. Rasio kebutuhan PRC terbanyak untuk kasus penyakit jantung (2,23) diikuti penyakit ginjal (2,25) dan thalassemia (1,7). Untuk penggunaan TC, terbanyak berturut-turut adalah ITP (14,70 unit), anemia aplastik (9,8 unit), dan leukemia (6 unit). Terdapat hubungan antara diagnosis penyakit dengan penggunaan transfusi komponen PRC, TC, dan plasma (p<0,001).Kesimpulan.Terdapat hubungan antara latar belakang penyakit penyebab dengan penggunaan transfusi komponen darah. Leukemia, sepsis, dan thalassemia adalah latar belakang penyakit yang paling banyak menggunakan transfusi komponen darah. Berturut turut komponen darah yang banyak digunakan adalah konsentrat trombosit, komponen sel darah merah, serta plasma darah segar.

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The effect of storing whole blood at 22°C for up to 24 hours with and without rapid cooling on the quality of red cell concentrates and fresh-frozen plasma

Transfusion ◽

10.1111/j.1537-2995.2008.01842.x ◽

2008 ◽

Vol 48 (11) ◽

pp. 2338-2347 ◽

Cited By ~ 46

Author(s):

Claire Wilsher ◽

Margaret Garwood ◽

Janet Sutherland ◽

Craig Turner ◽

Rebecca Cardigan

Keyword(s):

Whole Blood ◽

Fresh Frozen Plasma ◽

Red Cell ◽

Rapid Cooling ◽

Fresh Frozen ◽

Frozen Plasma

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Das Smith-Lemli-Opitz-Syndrom

Kinder- und Jugendmedizin ◽

10.1055/s-0037-1617867 ◽

2005 ◽

Vol 5 (04) ◽

pp. 178-182

Author(s):

Wieland Kiess ◽

Manuela Schulz ◽

Sabine Liebermann ◽

Roland Pfäffle ◽

Peter Bührdel ◽

...

Keyword(s):

Fresh Frozen Plasma ◽

Therapeutische Möglichkeiten ◽

Fresh Frozen ◽

Frozen Plasma

ZusammenfassungDas Smith-Lemli-Opitz-Syndrom wird durch einen Defekt des letzten Schrittes der Cholesterolbiosynthese, den Mangel an 7-Dehydrocholesterolreduktase, verursacht. Die Akkumulation der Metaboliten 7-Dehydrocholesterol und 8-Dehydrocholesterol, die die wichtigsten biochemischen Marker für die Diagnose der Erkrankung darstellen, sowie der Mangel an Cholesterol können zu multiplen kongenitalen Anomalien führen. Die Ursache des Enzymmangels sind Mutationen innerhalb des DHCR7-Gens, welches auf Chromosom 11q13 lokalisiert ist. Therapeutische Möglichkeiten bestehen in der Gabe von Cholesterol und im Notfall Fresh Frozen Plasma (FFP); der therapeutische Nutzen von Statinen befindet sich zurzeit in der klinischen Erprobung.

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The Recovery of Factor VIII from Fresh-Frozen, Indated and Outdated Human Plasma

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648010 ◽

1976 ◽

Vol 36 (01) ◽

pp. 071-077 ◽

Cited By ~ 2

Author(s):

Daniel E. Whitman ◽

Mary Ellen Switzer ◽

Patrick A. McKee

Keyword(s):

Factor Viii ◽

Polyacrylamide Gel Electrophoresis ◽

Sodium Dodecyl ◽

The United States ◽

Fresh Frozen Plasma ◽

Red Cross ◽

Random Samples ◽

Fresh Frozen ◽

Factor Viii Concentrates ◽

Frozen Plasma

SummaryThe availability of factor VIII concentrates is frequently a limitation in the management of classical hemophilia. Such concentrates are prepared from fresh or fresh-frozen plasma. A significant volume of plasma in the United States becomes “indated”, i. e., in contact with red blood cells for 24 hours at 4°, and is therefore not used to prepare factor VIII concentrates. To evaluate this possible resource, partially purified factor VIII was prepared from random samples of fresh-frozen, indated and outdated plasma. The yield of factor VIII protein and procoagulant activity from indated plasma was about the same as that from fresh-frozen plasma. The yield from outdated plasma was substantially less. After further purification, factor VIII from the three sources gave a single subunit band when reduced and analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis. These results indicate that the approximately 287,000 liters of indated plasma processed annually by the American National Red Cross (ANRC) could be used to prepare factor VIII concentrates of good quality. This resource alone could quadruple the supply of factor VIII available for therapy.

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Haemophilia in a Female

Thrombosis and Haemostasis ◽

10.1055/s-0038-1653669 ◽

1971 ◽

Vol 26 (02) ◽

pp. 205-210

Author(s):

J. A McBride ◽

J Hunter ◽

Elizabeth Pearse ◽

Yvette Sultan ◽

J. P Caen

Keyword(s):

Fresh Frozen Plasma ◽

Plasma Fibrinogen ◽

Fresh Frozen ◽

Frozen Plasma

SummaryA case of haemophilia in a female is described together with the response of the patient’s level of antihaemophilic factor in the plasma following transfusion of fresh frozen plasma, fibrinogen and cryoprecipitate.

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Severe Inherited “Homozygous” Protein C Deficiency in a Newborn Infant

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661136 ◽

1984 ◽

Vol 52 (01) ◽

pp. 053-056 ◽

Cited By ~ 77

Author(s):

A Estellés ◽

I Garcia-Plaza ◽

A Dasí ◽

J Aznar ◽

M Duart ◽

...

Keyword(s):

Newborn Infant ◽

Protein C ◽

Skin Lesions ◽

Fresh Frozen Plasma ◽

Clinical Syndrome ◽

Assay Method ◽

Enzyme Linked Immunosorbent Assay ◽

Protein C Deficiency ◽

Fresh Frozen ◽

Frozen Plasma

SummaryA relapsing clinical syndrome of skin lesions and disseminated intravascular coagulation (DIC) that showed remission with the infusion of fresh frozen plasma is described in a newborn infant with homozygous deficiency of protein C antigen.This patient presented since birth a recurrent clinical picture of DIC and ecchymotic skin lesions that resembled typical ecchymosis except for the fact that they showed immediate improvement with the administration of fresh frozen plasma. Using an enzyme linked immunosorbent assay method, the determination of protein C antigen levels in the patient, without ingestion of coumarin drugs, showed very low values (<1%).No other deficiencies in the vitamin-K-dependent factors or in anti thrombin III, antiplasmin, and plasminogen were found. Seven relatives of the infant had heterozygous deficiency in protein C antigen (values between 40-55%), without clinical history of venous thrombosis. The pedigree analysis of this family suggests an autosomal recessive pattern of inheritance for the clinical phenotype, although an autosomal dominant pattern has been postulated until now in other reported families.We conclude that our patient has a homozygous deficiency in protein C and this homozygous state may be compatible with survival beyond the neonatal period.

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