Hemostatic potential of reconstituted whole blood using fresh frozen plasma versus increasing concentration of lyoplasma

G. E. Iapichino1,2, M. Ponschab1,3, C. J. Schlimp1,4, C. Gabriel3, J. Cadamuro5, H. Redl1, H. Schöchl1,5 (1Vienna, Austria, 2Milan, Italy, 3Linz, Austria, 4Edinburgh, United Kingdom, 5Salzburg, Austria)

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

Objective: Whole blood reconstituted with Red Blood Cell to Platelet Concentrate to Fresh Frozen Plasma (RBC:PC:FFP) ratio of 1:1:1 has lower levels of hematocrit and fibrinogen compared to original fresh whole blood1. The aim of this study is to compare reconstituted whole blood (RWB) using FFP versus lyophilized plasma (Lyoplasma) in multiple reconstitution ratios. Two additional groups, in which the dilution volume of Lyoplasma is reduced to half and one quarter respectively, are added to the analysis.

Methods: Ten healthy volunteers donated Blood for the study (RBC, FFP and PC; blood bank Red Cross Linz). Ten Lyoplasma vials were purchased2. Aliquots of RBC (mean unit volume 240mL) and PC (50mL) were mixed with either FFP (200mL) or Lyoplasma in a 2:1:1, 1:1:1 and 1:1:2 reconstitution ratio. The Lyoplasma vials were first diluted with 50mL of water (serving for the Lyo50 group) then increasing amounts of water were added for the Lyo100 and Lyo200 groups respectively (200mL is the reconstitution volume suggested by the manufacturer2). Blood cell count, endogenous thrombin potential and fibrinogen (Clauss) analysis were performed on each combination of reconstitution ratio and plasma component (total of 12 groups).

Results: Hematocrit, platelet count and fibrinogen level were not different between FFP and Lyo200 in any ratio tested. Decreasing the dilution volume of the Lyoplasma (Lyo50) led to a progressive increase in hematocrit, platelet count and fibrinogen level compared to the Lyo200 and FFP groups. Conversely, thrombin potential did not vary among groups in any ratio tested (Figure).

Conclusion: RWB using Lyoplasma had the same cellular component and hemostatic potential than RWB obtained with corresponding volume of FFP. Increasing the concentration of Lyoplasma offers the advantage to reach higher hematocrit and fibrinogen levels without a relevant increase in thrombin generation, presumably because of a preserved balance between pro and anti-coagulant factor in the concentrated plasma preparations. References: 1) Ponschab M et al, Haemostatic profile of reconstituted blood in a proposed 1:1:1 ratio of packed red blood cells, platelet concentrate and four different plasma preparations, Anaesthesia 2015, 70:528-536. 2) https://www.blutspendedienst-west.de/ueber_uns/zentren_einrichtungen/plasma_en/informationen_fuer_kliniken_aerzte/gefriergetrocknetes_plasma.php