Plasma Products - key points Flashcards
two types of frozen plasma
Octaplas - pooled
FFP - from a single donor
Historical and current use of FFP
Available since 1941
Was used as a volume replacement
Now used in excessive bleeding or to prevent blooding in those with coagulopathy
Why urgency to freeze plasma
Labile factor 8
Significantly decreased upon thawing - 5 days
How many donors in an Octaplas pool
Up to 1500 donors
Then solvent/detergent treated
How is AB octaplas made?
Not blood group specific
Contains 70% A, 20% B, 10% AB
How is octaplas detergent treated
Treated with 1% TNBP & 1% Triton-X at 30 degrees for 4 hours
Oil extraction and phase separation to remove TNBP
Clear filtration
Hydrophobic bio-interaction chromatography to remove triton-x
aseptic sealing and fillin
fast freezing to -60
storage at -30
What is affected by detergent treatment and thaeing
protein C and protein S
Indications for use
Replacement of factor V
Neonates with coagulopathy who are bleeding or going for surgery
Inherited deficiencies of inhibitors of coagulation such as protein C or S
Liver disease
C1 esterase inhibitor deficiency
Reversal of warfarin historically
DIC if bleeding
Massive transfusion - guided by TEG
TTP - plasma exchange
convaslescent plasma
myestemia gravis
How is warfarin reversed nowadays?
Octaplex as it contains factors 2, 7, 9 and 10 i.e. the warfarin affected factors
Or prothromplex
What does TEG measure
Thromboelastography
What are the three main strategies of viral inactivation of plasma?
Solvent/detergent treatment of large pools
Methylene blue with isible light for single units
Amotosalen - new - single-donor virus inactivated FFP and cryo
Why didnt the IBTS accept intercept
Due to effects on platelts
What is TNBP
Tri(n-butyl) phosphate
How does TNBP + Triton X Solvent/detergent treatment work?
Disrupt the lipid structures of enveloped viruses e.g. HBV, HCV, HIV
Some loss of clotting factors particularly vwf, protein s activity and fviii activity
Talk about methylene blue with light
MB has an affinity for nucleic acids and viral core proteins
Visible light illumination then leads to the formation of singlet oxygen hence photo-oxidative inactivation
Enveloped and non eveloped are disrupted
30% loss of fibrinogen and FVIII activity
What is the new method of pathogen removal
Riboflavin (microsol) and UV light
Vitamin B6 so doesnt have to be removed from the pack
Damaged nuclear material when light is shone
IBTS trialed this and didnt like the platelet quality
What is cryoprecipitate
Precipitate formed when plasma is frozen colder than 18 degrees then thawed at 4 degrees
Contains factor 8 and fibrinogen
Used in the UK, we might start using it again
We currently use commercial fibrinogen but this is expensive
What are some other examples of plasma products?
Lyophilised plasma- used in wales
Spray dried plasma - resuspended in saline - dissolves quicker than lyophilised - still only being tested
