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Transfusion medicine
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
An alternative approach to blood safety is pathogen inactivation, treatments designed to inactivate a range of pathogens rather than testing for individual ones. Techniques had been developed for the plasma fractionation industry, but new approaches were required for cellular components. Pooled, solvent detergent plasma was already available, and clinical trials had been completed for treatment of platelets. Most of the methods developed were effective against lipid-enveloped viruses and bacteria, but less so for non-enveloped viruses. In addition, most techniques had some impact on function. The UK blood services and, therefore, the DMS have not yet adopted pathogen inactivation. However, this did not stop a series of enquiries on this topic under the Freedom of Information Act and Parliamentary questions during November 2010 and January 2011. Pathogen inactivation technology continues to develop for plasma-rich components. More recently, the techniques have been applied to red cells. Whereas blood safety technology may become suitable for larger more permanent facilities, the current focus in DMS remains transfusion safety.
Blood Groups, Blood Components and Alternatives to Transfusion
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Samah Alimam, Kate Pendry, Michael F. Murphy
Solvent detergent plasma, which is prepared from more than 1000 donation pools of plasma, undergoes pathogen inactivation including bacteria and viruses such as hepatitis B and C and HIV. Donations are sourced from countries at low risk of vCJD. As it is pooled, the concentration of coagulation factors is more standardized. It is recommended for patients who have thrombotic thrombocytopenic purpura.
Case 87
Published in Atul B. Mehta, Keith Gomez, Clinical Haematology, 2017
The cornerstone of treatment is plasma exchange. Solvent detergent plasma is preferred to reduce the risk of transmission of transfusion associated infections and allergic reactions, but if not available then fresh-frozen plasma (FFP) or cryosupernatant may be used. Daily plasma exchanges should be continued until a minimum of 2 days after normalisation of the platelet count.
Risk factors, management and prevention of transfusion-related acute lung injury: a comprehensive update
Published in Expert Review of Hematology, 2019
Susan A. Kuldanek, Marguerite Kelher, Christopher C. Silliman
Solvent/detergent (S/D) plasma (Octaplas®) is comprised of plasma pools from 500–1600 donors that undergoes pathogen inactivation followed by filtration. Due to a dilutional effect, leukocyte antibody concentrations are likely reduced to clinically negligible levels. Indeed, since the introduction of this product in Norway in 1993, no cases of TRALI were reported over a 10-year period [123]. A consensus panel of experts in Italy recently reviewed the existing literature regarding the efficacy and safety of using solvent detergent plasma (SD-plasma). Therefore, the use of SD-plasma, where available, may reduce the incidence of TRALI.
Developments in the use of plasma exchange and adjunctive therapies to treat immune-mediated thrombotic thrombocytopenic purpura
Published in Expert Review of Hematology, 2019
To date, exogenous plasma is the only way to bring ADAMTS13 to the deficient, iTTP patient. Thus, there is a need to optimize the treatment using plasma as the sole replacement fluid for TPE. Several preparations of human plasma have been used, differing in the use and nature of a technology for pathogen reduction or inactivation. The physical or chemical processes to which plasma is subjected for safety are likely to affect their qualitative content, especially regarding proteins involved in hemostasis. Indeed, ADAMTS13 activity seems to be preserved in all kinds of plasma preparation [51,52]. In contrast, solvent detergent plasma appears to have a reduced content in high-molecular-weight vWF [52]. Several studies, mostly retrospective and small sized, have looked for clinical consequences of these disparities when each plasma was used as replacement fluid for iTTP. Overall, no differences in efficacy could be demonstrated between the historical quarantined fresh frozen plasma, solvent–detergent plasma, or amotosalen-inactivated plasma [53–55]. However, the use of solvent–detergent or amotosalen-inactivated plasmas could be associated with a lower incidence of plasma-related adverse events [54,56]. Additionally, while remission rates did not differ, a faster platelet count recovery has been observed with the use of amotosalen-inactivated plasma [55] [Garraud et al., in preparation]. The use of methylene-blue inactivated plasma has been discontinued in several countries due to allergy concerns. Moreover, such plasma seemed to be less effective when compared with fresh frozen plasma [57–59]. Finally, independently of the safety measure, a cryoprecipitate-poor plasma can be obtained after slow thawing of a frozen plasma and removal of the formed sediment. The theoretical interest of this preparation, variously referred as cryoprecipitate-poor, cryosupernatant, or cryodepleted plasma, lies in its depletion in ‘cryofactors’, including vWF [52]. Nevertheless, cryosupernatant plasma did not show clear superiority in any of the three trials that evaluated its use as a replacement fluid for TPE in iTTP [60–62]. Moreover, such preparation is not routinely available in all countries.