1 5/8/2015 seven day storage at 4°c of previously -80°c frozen ab plasma sm. remco strelitski, bsc...
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Seven Day Storage At 4°C Of Previously -80°C Frozen AB Plasma
Sm. Remco Strelitski, BScChief Lab technician, Military Blood Bank, Netherlands.
NATO 2009
Borgman MA, et. al, J Trauma, Oct, 2007.
TRANSFUSION AND TRAUMACoagulopathy and massive transfusion
Ratio 1:1 RBC:Plasma improves survival ratesEarly transfusion of plasma is recommended
NATO 2009
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AB Plasma
- 80°C( 7 years)
+ 30°C30 min
AB FFP - 30°C
( ± 0.7 years)
AB DFP
AB DFP
Thaw
Leukodepleted, apheresis unit of FFP (- 30°C)is thawed, repacked and frozen to - 80°C at the MBB
Thaw
Freeze
In theater, the unit is thawed and warmed to + 30º C
NLD MILITARY BLOOD BANKProduction of -80°C frozen plasma
NLD MILITARY BLOOD BANKProducts preparation time and availability
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Product -80ºC 22ºC 4ºC ProductionTime
RBC 10 years
6 hours 2 weeks 90 min
Platelets 2 years 6 hours Not possible
45 min
Plasma 7 years 6 hours ? 35 min
AIM OF STUDY Improved availability of plasma:Storage time of thawed AB -80°C Plasma at 4°C?
NATO 2009
Pilot: storage of units at 4°C for 6 weeks Storage of samples in vials at -80°C
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5
0
10
20
30
40
50
60
70
-1 0 1 2 3 4 5 6
sto
ltijd
(sec
)
Weeknummers
APTT
0
50
100
150
200
250
300
350
400
-1 0 1 2 3 4 5 6
con
c (g
/dl)
Weeknummers
Fibrinogeen
0
20
40
60
80
100
120
140
-1 0 1 2 3 4 5 6
acti
vite
it (I
U/d
L)
Weeknummers
FV
0
20
40
60
80
100
120
140
-1 0 1 2 3 4 5 6ac
tivi
teit
(IU
/dL
)Weeknummers
FVII
0
20
40
60
80
100
120
140
-1 0 1 2 3 4 5 6
acti
vite
it (I
U/d
L)
Weeknummers
FVIII
0
5
10
15
20
25
-1 0 1 2 3 4 5 6
Sto
ltijd
(sec
)
Weeknummers
PT
FV FVII FVIII
APTT PT Fib
Data of frozen samples were different from fresh samplesProject continued with fresh samplesNATO 2009
RESULTSAPTT and Factor VIII
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0
35
70
105
140
175
210
-30°C -80°C 1 week 4°C 2 week 4°C
Days
Ac
tiv
ity
(IU
/dL
)
0
8
16
24
32
40
48
Co
ag
tim
e (
se
c)
FVIII APTT
NATO 2009
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RESULTSINR (PT), Factor V and Factor VII
0
70
140
210
-30°C -80°C 1 week 4°C 2 week 4°C
Ac
tiv
ity
(IU
/dL
)
0,0
0,2
0,4
0,6
0,8
1,0
1,2
1,4
1,6
1,8
2,0
INR
(ra
tio
)
FV FVII INR
NATO 2009
RESULTS 04
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Average product volume 310±7 mLAverage fibrinogen content 0,95 gram/unit at day 7
Fibrinogen
0
50
100
150
200
250
300
350
400
450
-30°C -80°C 1 week 4°C 2 week 4°C
Co
nc
en
tra
tio
n (
mg
/dL
)
NATO 2009
Clinical relevance of guidelines: 70% vs 50%?
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20
30
40
50
60
70
80
90
100
110
120
130
0 10 20 30 40 50 60 70 80 90 100 110 120 130
Activiteit (IU/dL)
Sto
ltijd
(sec)
Gem Kal.curve FV
Gem Kal.curve FVII
Gem Kal.curve FVIII
Coa
gula
tion
time
(sec
)
Activity (%)
FVII
FV
FVIII
NATO 2009
Conclusions
At 7 days FVIII and FV activity are well above 50% Fibrinogen activity is reduced on day 14 at 4°C
-80°C AB Plasma can be stored for 7 days at 4°C without clinically significant loss of its clotting capacity
Since April 2009, 137 stored units have been transfused without any untoward effects reported
In addition, mutual support between MTF in Afghanistan became easier by using 4°C cold chain.
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NATO 2009
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PlateletsDMSO (5% w/v)
- 80°C(2 years)
+ 30°C PlateletsDMSO (5%, 14 ml)
AB Plasma
5 min
Platelets
DMSO ( 0.2%)
+AB Plasma
+ 30°C30 minAB DFP
- 80°C
Leukodepleted unit of (apheresis) platelets is frozen and concentrated in 5% DMSO plasma. In theater, after 5 min of thawing, the PLT’s are reconstituted in thawed -80°C plasma
Future application 4°C plasmaProduction of thawed -80°C frozen platelets?
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Product -80ºC 22ºC 4ºC ProductionTime
RBC 10 years
6 hours 2 weeks 90 min
Platelets 2 years 6 hours Not possible
10 min?
Plasma 7 years 6 hours 7 days 35 min
AIM OF STUDY Improved availability of plasma:Storage time of thawed AB -80°C Plasma at 4°C?
NATO 2009
Future application 4°C plasmaProduction of thawed -80°C frozen platelets?