Better hemostatic profiles of never-frozen liquid plasma compared with thawed fresh frozen plasma.

Author(s): Matijevic N, Wang YW, Cotton BA, Hartwell E, Barbeau JM, Wade CE, Holcomb JB

Publication: J Trauma Acute Care Surg, 2013, Vol. 74, Page 84-90; discussion 90-1

PubMed ID: 23271081 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   The purpose of this study was to determine the effects of refrigeration, freezing, and subjecting plasma to a freeze-thaw cycle after refrigeration on TEG, thrombogram, plt counts, PMPs, clotting factors, and coagulation inhibitors. Frozen plasma was thawed in a 37 degrees C water bath, analyzed immediately and again after 5 days at 2-6 degrees C. Fresh plasma was refrigerated and analyzed at all time-points, and an additional aliquot was taken at each timepoint and was frozen and thawed once before analysis.

   Summary of Findings:

   The plt count was 10.8 fold higher in fresh plasma than in plasma that was frozen (p<0.0001), but after 26 days of refrigerated storage the plt count was not significantly different from that in plasma that was frozen and analyzed immediately after thawing or 5 days later. PMPs were comparable in fresh and frozen plasma on day 0, but they were higher in plasma that was refrigerated for 26 days than in plasma that was frozen, thawed, and refrigerated for 5 days before analysis (p<0.001). The thrombogram revealed that ETP was higher in fresh than frozen plasma on day 0, but it declined by 16% during 26 days of refrigerated storage and was comparable to levels in frozen plasma. Thrombogram tracings revealed that plasma either showed a gradual decrease in homeostatic potential throughout the refrigerated storage or decreased initially and then rebounded. Initially fresh plasma had significantly higher maximum amplitude, shear elastic module strength, and total thrombus generation than frozen plasma, but the capacity of plasma to clot decreased with refrigerated storage, such that, after 26 days, values were comparable to those in frozen plasma that had been thawed and refrigerated for 5 days before analysis. Similar to the thrombograms, some TEG showed a gradual decrease during refrigerated storage of plasma, while others showed an initial decrease followed by an increase during storage. Most clotting factors, fibrinogen and coagulation inhibitors remained within 88% of values measured in fresh plasma during the 26 days of refrigerated storage, but APTT, PT, factor VII, factor XII and von Willebrand factor levels increased, and factor V, factor VIII and free protein S decreased by day 26 of storage. Subjecting refrigerated plasma, after 0-26 days of refrigeration, to a single freeze-thaw cycle decreased the plt count by up to 50% (p<0.001), and decreased the TEG-maximum amplitude compared to plasma refrigerated for the same duration, but never frozen

   Biospecimens

   • Bodily Fluid - Plasma

   Preservative Types

   • None (Fresh)
   • Other Preservative
   • Frozen

   Diagnoses:

   • Normal

   Platform:

   Analyte	Technology Platform
   Cell count/volume	Flow cytometry
   Protein	Hematology/ auto analyzer
   Morphology	Hematology/ auto analyzer
   Glycoprotein	Hematology/ auto analyzer
   Peptide	Hematology/ auto analyzer

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Storage	Freeze/thaw cycling	0 cycles 1 cycle
   Storage	Storage duration	0 days 5 days 10 days 15 days 20 days 26 days
   Biospecimen Preservation	Type of fixation/preservation	Frozen None (fresh) Refrigeration

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