Reconstituted whole blood using fresh frozen plasma versus coagulation factor concentrates: an in vitro study

G. E. Iapichino1,2, M. Ponschab1,3, C. J. Schlimp1,4, S. Süssner5, J. Cadamuro6, H. Redl1, H. Schöchl1,6 (1Vienna, Austria, 2Milan, Italy, 3Linz, Austria, 4Edinburgh, United Kingdom, 5 Linz, Austria, 6Salzburg, Austria)

Acquired problems and alterations of coagulation
Date: 17.02.2017,
Time: 17:15 - 18:15

Objective: Current guidelines suggest the use of a combination of red blood cells (RBC) and either fresh frozen plasma (FFP) or coagulation factor concentrates in the coagulation management of patients with massive hemorrhage1. Despite this strong recommendation, data are limited in respect of the actual hemostatic potential of these two different approaches. The aim of this study is to compare qualitative and quantitative parameters of reconstituted whole blood (RWB) aliquots obtained by mixing RBC and platelet concentrate (PC) with either FFP or coagulation factors concentrates i.e. fibrinogen concentrate (FC) and/or prothrombin complex concentrate (PCC).

Methods: Ten healthy volunteers participated in the study to donate RBC, FFP and PC units (manufactured by the blood bank of Red Cross, Linz). FC and PCC were purchased from CSL Behring. Aliquots of RBC (mean unit volume 240mL) and PC (50mL) were mixed with aliquots of FFP (200mL) or FC (1g/50mL) or FC+PCC (1g+250IU/60mL) in a 2:1:1, 1:1:1 and 1:1:2 reconstitution ratio. Blood cell count, endogenous thrombin potential (ETP), single coagulation factors activity, fibrinogen level (Clauss method) and ROTEM® Extem analysis were performed on each reconstitution ratio of the three groups (FFP, FC and FC+PCC).

Results: Hematocrit and fibrinogen were significantly higher in FC and FC+PCC groups at all reconstitution ratios (Figure). ETP values were lowest in FC and highest in FC+PCC, the latter of whome also showed significantly higher activity of coagulation factors II and X (both present in the PCC); however, Extem clotting time was not different among the groups except for a significant prolongation in FC+PCC 1:1:2 versus the corresponding ratio of FFP group.

Conclusion: The use of coagulation factor concentrates to reconstitute whole blood allows keeping higher hematocrit in the final mixture as compared to FFP. Moreover, the mixtures containing FC or FC+PCC result in higher fibrinogen level than FFP based reconstituted whole blood. Noteworthy, thrombin generation in the FC+PCC group was significantly increased in any reconstitution ratios. Reference 1: Rossaint R et al, The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition, Critical Care (2016) 20:100