Decreased Helper-Suppressor Cell Ratios Following Treatment with Blood Products: Factor VIII and IX Concentrates and Fresh Frozen Plasma

To the Editor.— I enjoyed reading the paper by Aronis et al,1 and would like to bring to your attention that we have also recently observed leukemia in two patients with hemophilia A and B, 10 and 1½ years of age, respectively.2 Because commercial factor VIII and IX were not used and only blood, fresh frozen plasma, and plasma were given on a few occasions, it was less likely that AIDS-like immune changes were responsible for the leukemia in our patients.

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The Recovery of Factor VIII from Fresh-Frozen, Indated and Outdated Human Plasma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this possible resource, partially purified factor VIII was prepared from random samples of fresh-frozen, indated and outdated plasma.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 The yield from outdated plasma was substantially less.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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Outcome of Major Hemorrhage at a Major Cardiothoracic Center in Patients with Activated Major Hemorrhage Protocol versus Nonactivated Protocol

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0040-1718869 ◽

2021 ◽

Vol 47 (01) ◽

pp. 074-083

Author(s):

Kathryn W. Chang ◽

Steve Owen ◽

Michaela Gaspar ◽

Mike Laffan ◽

Deepa R. J. Arachchillage

Keyword(s):

Fresh Frozen Plasma ◽

Electronic Records ◽

Blood Products ◽

Major Hemorrhage ◽

Fresh Frozen ◽

Dilutional Coagulopathy ◽

Baseline Characteristics ◽

The Impact ◽

Frozen Plasma ◽

Baseline Hemoglobin

AbstractThis study aimed to determine the impact of major hemorrhage (MH) protocol (MHP) activation on blood administration and patient outcome at a UK major cardiothoracic center. MH was defined in patients (> 16 years) as those who received > 5 units of red blood cells (RBCs) in < 4 hours, or > 10 units in 24 hours. Data were collected retrospectively from patient electronic records and hospital transfusion databases recording issue of blood products from January 2016 to December 2018. Of 134 patients with MH, 24 had activated MHP and 110 did not have activated MHP. Groups were similar for age, sex, baseline hemoglobin, platelet count, coagulation screen, and renal function with no difference in the baseline clinical characteristics. The total number of red cell units (median and [IQR]) transfused was no different in the patients with activated (7.5 [5–11.75]) versus nonactivated (9 [6–12]) MHP (p = 0.35). Patients in the nonactivated MHP group received significantly higher number of platelet units (median: 3 vs. 2, p = 0.014), plasma (median: 4.5 vs. 1.5, p = 0.0007), and cryoprecipitate (median: 2 vs. 1, p = 0.008). However, activation of MHP was associated with higher mortality at 24 hours compared with patients with nonactivation of MHP (33.3 vs. 10.9%, p = 0.005) and 30 days (58.3 vs. 30.9%, p = 0.01). The total RBC and platelet (but not fresh frozen plasma [FFP]) units received were higher in deceased patients than in survivors. Increased mortality was associated with a higher RBC:FFP ratio. Only 26% of patients received tranexamic acid and these patients had higher mortality at 30 days but not at 24 hours. Deceased patients at 30 days had higher levels of fibrinogen than those who survived (median: 2.4 vs. 1.8, p = 0.01). Patients with activated MHP had significantly higher mortality at both 24 hours and 30 days despite lack of difference in the baseline characteristics of the patients with activated MHP versus nonactivated MHP groups. The increased mortality associated with a higher RBC:FFP ratio suggests dilutional coagulopathy may contribute to mortality, but higher fibrinogen at baseline was not protective.

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Effects of implementing rotational thromboelastometry in cardiac surgery: A retrospective cohort study

Journal of Perioperative Practice ◽

10.1177/1750458920950662 ◽

2021 ◽

pp. 175045892095066

Author(s):

Minna Kallioinen ◽

Mika Valtonen ◽

Marko Peltoniemi ◽

Ville-Veikko Hynninen ◽

Tuukka Saarikoski ◽

...

Keyword(s):

Cardiac Surgery ◽

Prothrombin Complex Concentrate ◽

Fresh Frozen Plasma ◽

Blood Products ◽

Rotational Thromboelastometry ◽

Number Of Patients ◽

Fresh Frozen ◽

The Mean ◽

To Receive ◽

Frozen Plasma

Since 2013, rotational thromboelastometry has been available in our hospital to assess coagulopathy. The aim of the study was to retrospectively evaluate the effect of thromboelastometry testing in cardiac surgery patients. Altogether 177 patients from 2012 and 177 patients from 2014 were included. In 2014, the thromboelastometry testing was performed on 56 patients. The mean blood drainage volume decreased and the number of patients receiving platelets decreased between 2012 and 2014. In addition, the use of fresh frozen plasma units decreased, and the use of prothrombin complex concentrate increased in 2014. When studied separately, the patients with a thromboelastometry testing received platelets, fresh frozen plasma, fibrinogen and prothrombin complex concentrate more often, but smaller amounts of red blood cells. In conclusion, after implementing the thromboelastometry testing to the practice, the blood products were given more cautiously overall. The use of thromboelastometry testing was associated with increased possibility to receive coagulation product transfusions. However, it appears that thromboelastometry testing was mostly used to assist in management of major bleeding.

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DIFFERENCES IN CHANGES OF HEMOGLOBIN BETWEEN 6-12 HOURS AND 12-14 HOURS AFTER TRANSFUSION

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v24i2.1306 ◽

2018 ◽

Vol 24 (2) ◽

pp. 108

Author(s):

Rosita Linda ◽

Devita Ninda

Keyword(s):

Blood Transfusion ◽

Secondary Data ◽

Hemoglobin Concentration ◽

Fresh Frozen Plasma ◽

Blood Components ◽

Blood Products ◽

Fresh Frozen ◽

Frozen Plasma ◽

Hemoglobin Measurement ◽

Baseline Hemoglobin

Each year more than 41,000 blood donations are needed every day and 30 million blood components are transfused. Blood products that can be transfused include Packed Red Cells (PRC), Whole Blood (WB), Thrombocyte Concentrate (TC), Fresh Frozen Plasma (FFP). Monitoring Hemoglobin (Hb) after transfusion is essential for assessing the success of a transfusion. The time factor after transfusion for Hemoglobin (Hb) examination needs to be established, analyze to judge the success of a blood transfusion which is performed. The aim of this study was to analyze the differences in changes of hemoglobin between 6-12 hours, and 12-24 hours after-transfusion. This study was retrospective observational using secondary data. The subjects were patients who received PRC, and WBC transfusion. At 6-12, and 12-24 hours after-transfusion, hemoglobin, RBC, and hematocrit were measured. Then the data were analyzed by unpaired t-test. The collected data included the results of the Hb pre-transfusion, 6-12, and 12-24 hours after-transfusion. The subjects of this study were 98 people. The administration of transfusion increased by 10-30% in hemoglobin concentration at 6-12 hours after-transfusion. While at 12-24 hours after-transfusion, hemoglobin after-transfusion increased 15-37% from the baseline. Hemoglobin values were not different at any of the defined after-transfusion times (p = 0.76 (p>0.05)). Hemoglobin values were not different at 6-12 hours, and 12-24 hours after-transfusion. Keywords: Hemoglobin, measurement, after-transfusion

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52 year Male with Haemophila-A; Presented with Scrotal Haematoma: Managed in Resource Constraint Settings - A Case Report

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v10i2.41173 ◽

2019 ◽

Vol 10 (2) ◽

pp. 118-121

Author(s):

Shoaeb Imtiaz Alam ◽

Md Mustafizur Rahman ◽

Ferdoush Rayhan ◽

ASM Farhad Ul Hasan

Keyword(s):

Factor Viii ◽

Good Alternative ◽

Fresh Frozen Plasma ◽

Haemophilia A ◽

Soft Tissue Trauma ◽

Fresh Frozen ◽

Secondary Closure ◽

Tissue Trauma ◽

The Cost ◽

Frozen Plasma

Haemophilia A is an X linked disorder characterized by bleeding manifestations due to deficiency of factor VIII. Administration of factor VIII is the mainstay of treatment in case of bleeding which is very costly. That’s why fresh frozen plasma is a very good alternative in the management of mild to moderate bleeding. Here we present a case of 50 years old male presented to us with traumatic scrotal haematoma who was newly diagnosed with Haemophilia A. As the patient was unable to bear the cost of factor VIII, we managed the patient by transfusing fresh frozen plasma. After raising his activity of factor VIII up to 30% which was adequate for soft tissue trauma, surgical exploration of scrotum was done. Both the testes were found viable. Evacuation of clot was done followed by secondary closure of the wound J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 118-121

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Effect of Whole Blood Storage on Factor VIII Recovery in Fresh Frozen Plasma and Cryoprecipitate

Vox Sanguinis ◽

10.1159/000462046 ◽

1996 ◽

Vol 71 (3) ◽

pp. 150-154 ◽

Cited By ~ 5

Author(s):

D. P. Allersma ◽

R. M. R. Imambaks ◽

L. J. Meerhof

Keyword(s):

Factor Viii ◽

Whole Blood ◽

Fresh Frozen Plasma ◽

Blood Storage ◽

Fresh Frozen ◽

Frozen Plasma

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Use of Plasma Segments for Estimating Factor VIII Activity in Pools of Fresh Frozen Plasma

Vox Sanguinis ◽

10.1159/000461660 ◽

1987 ◽

Vol 52 (3) ◽

pp. 254-256

Author(s):

F.A. Ofosu ◽

L.M. Smith ◽

M.A. Blajchman ◽

J. (b) Campbell ◽

C. De Vries ◽

...

Keyword(s):

Factor Viii ◽

Fresh Frozen Plasma ◽

Factor Viii Activity ◽

Fresh Frozen ◽

Frozen Plasma

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Transfusion of blood products

10.1093/med/9780199642663.003.0011 ◽

2016 ◽

Author(s):

Alison Smith

Keyword(s):

Blood Transfusion ◽

Carrying Capacity ◽

Blood Cells ◽

Fresh Frozen Plasma ◽

Major Haemorrhage ◽

Blood Products ◽

Unlimited Supply ◽

Fresh Frozen ◽

Oxygen Carrying Capacity ◽

Frozen Plasma

The transfusion of blood products may be required in the pre- and post-operative periods. However, there are inherent risks associated with blood transfusion, and there is not an unlimited supply of blood donations available. When a patient is anaemic, red blood cells should be transfused to maintain the oxygen-carrying capacity of blood. Blood products, such as platelets and fresh frozen plasma, are transfused to correct a coagulopathy and during major haemorrhage. This chapter reviews the physiology of blood, including ABO compatibility and rhesus status, the main blood products available for transfusion, and transfusion policy, including the treatment of major haemorrhage and the refusal of blood products.

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