Plasma Products - key points

Question 1

two types of frozen plasma

Answer 1

Octaplas - pooled

FFP - from a single donor

Question 2

Historical and current use of FFP

Answer 2

Available since 1941
Was used as a volume replacement
Now used in excessive bleeding or to prevent blooding in those with coagulopathy

Question 3

Why urgency to freeze plasma

Answer 3

Labile factor 8
Significantly decreased upon thawing - 5 days

Question 4

How many donors in an Octaplas pool

Answer 4

Up to 1500 donors

Then solvent/detergent treated

Question 5

How is AB octaplas made?

Answer 5

Not blood group specific
Contains 70% A, 20% B, 10% AB

Question 6

How is octaplas detergent treated

Answer 6

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

Question 7

What is affected by detergent treatment and thaeing

Answer 7

protein C and protein S

Question 8

Indications for use

Answer 8

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

Question 9

How is warfarin reversed nowadays?

Answer 9

Octaplex as it contains factors 2, 7, 9 and 10 i.e. the warfarin affected factors

Or prothromplex

Question 10

What does TEG measure

Answer 10

Thromboelastography

Question 11

What are the three main strategies of viral inactivation of plasma?

Answer 11

Solvent/detergent treatment of large pools

Methylene blue with isible light for single units

Amotosalen - new - single-donor virus inactivated FFP and cryo

Question 12

Why didnt the IBTS accept intercept

Answer 12

Due to effects on platelts

Question 13

What is TNBP

Answer 13

Tri(n-butyl) phosphate

Question 14

How does TNBP + Triton X Solvent/detergent treatment work?

Answer 14

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

Question 15

Talk about methylene blue with light

Answer 15

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

Question 16

What is the new method of pathogen removal

Answer 16

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

Question 17

What is cryoprecipitate

Answer 17

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

Question 18

What are some other examples of plasma products?

Answer 18

Lyophilised plasma- used in wales

Spray dried plasma - resuspended in saline - dissolves quicker than lyophilised - still only being tested