Effects Of Leukocyte Depletion And Gamma Irradiation On Coagulation System Of FFP

fresh frozen plasma(FFP) is a common blood product inclinical use, and has important contribution in replacement therapy formultiple coagulation factor deficiencies and single coagulation factordeficiency for which a concentrate is unavailable.Also FFP can be used fortherapeutic plasma exchange in some cases. Despite freezing and thawing,FFP still contains substantial numbers of viable white blood cells (WBCS),some of which are still able to proliferate. These WBCS have no therapeuticeffects, called “contaminations”. Removing or inactivating WBCS in FFP willreduce the risks of transfusion-associated side effects, especially transfusionassociated graft-versus-host disease (TA-GVHD). There are two ways forleukocyte depletion and inactivation: leukocytes depletion through leukocytereduction filter (LR) and gamma irradiation with30Gy (GI), each method hasthe property of simpleness and strong maneuverability. Each of these twomethods is a practical scheme and can ameliorate or abrogate side effects ofFFP transfusion. But it was reported that the treatments of LR and GI wouldinfluence the proteins in FFP, particularly the coagulation factors, and haveimpacts on the functions of coagulation system. To investigate whether LRand GI will have influences on certain coagulation factors and the extent ofthe influence are necessary. The aim of this study was to investigate theeffects of LR and GI on the coagulation system factors in FFP. Thus probably promote the transfusion safety and effectiveness of FFP and provide potentialreference for clinical use. Objective: After LR and GI, FFP were tested forsome commonly used coagulation items in order to evaluate the influenceupon the coagulation system caused by LR and GI. Methods：30FFP samples(50ml/bag) were collected from thirty healthy blood donors. Single blindrandomized blocks design was applied (the technicians were informed nothingabout subgroups). Samples were divided into thirty blocks and three disposalgroups, totally90cases. The study was carried out as following steps: first,6bags of FFP were taken out from the refrigerator, after thawing, each sampledivided averagely into three cases one block(one case remain in the originalbag, the other two were separated through leukocyte reduction filter into twosatellite bags). In each block every cases were appoint to three experimentalgroups, then mark the bags. Group A served as control (thawed but not LR),group B was LR group and group C was LR plus GI group. Then irradiatedthe C group.2.After the treatment of LR and GI,2ml were collected into18dry and clean tubes from three bags of every block, totally18tubes, then15coagulation tests were determined by the automated blood coagulationanalyzer. Results: Two indexes have statistically significant differences.1.Fibrinogen determination indicators: fibrinogen contents （FbgC）： X SGroup A:2.287±0.358，Group B:1.968±0.296，Group C:2.122±0.331，FbgC variations between groups：Group B decreased14percent comparedwith Group A，Group C increased8percent compared with Group B.After analysis of variance, the differences among groups was statisticallysignificant(P=0.044), then further analysis between groups was carried out byDunnet-t test, the difference between Group A and Group B was statisticallysignificant(P=0.025);2. Activities of coagulation factors comprising theintrinsic pathway: FⅧ:C X SGroup A:105.8±49.6，Group B:98.3±44.8，Group C:87.4±37.5，FⅧ:C variations between groups：Group B decreased7percent compared with Group A，Group C decreased11percent comparedwith Group B. After analysis of variance, the differences among groups wasstatistically significant(P=0.015), then further analysis between groups wascarried out by Dunnet-t test, the difference between Group A and Group Bwas statistically significant(P=0.009);Fourteen indexes have no statisticalsignificant differences：1.Six are global coagulation tests: one screening testof intrinsic pathway: activated partial thromboplastin time(APTT)： X SGroup A:33.6±5.70， Group B:32.8±6.25， Group C:33.4±6.02，P=0.484.APTT variations between groups：Group B decreased2percentcompared with Group A，Group C increased2percent compared with GroupB; four screening tests of extrinsic pathway:Prothrombin time(PT): X SGroup A:12.4±0.92，Group B:12.0±0.73，Group C:11.8±0.69，P=0.089.PTvariations between groups：Group B decreased3percent compared withGroup A，Group C decreased2percent compared with Group B.Prothrombintime activity(PT%)： X SGroup A:77.4±13.9, Group B:81.4±11.2, GroupC:84.4±11.7, P=0.078. Prothrombin time ratio(PTR): X SGroup A:1.06± 0.077, Group B:1.03±0.064，Group C:1.01±0.058, P=0.076; Prothrombintime international normalized ratio(INR)： X SGroup A:1.05±0.07,GroupB:1.03±0.06,Group C:1.01±0.06，P=0.093； Thrombin time（TT)： X SGroup A:20.7±1.43，Group B:21.2±1.37，Group C:21.0±1.26，P=0.515，TT variations between groups：Group B increased2percent compared withGroup A，Group C decreased1percent compared with Group B.2. Twocoagulation factors mainly comprising the intrinsic pathway: factor Ⅸactivity(F Ⅸ:C)： X SGroup A:88.6±20.9，Group B:85.4±21.1，GroupC:82.0±14.1，P=0.155,FⅨ:Cvariations between groups：Group B decreased4percent compared with Group A，Group C decreased4percent comparedwith Group B; factor Ⅺ activity(FⅪ: C) X SGroup A:85.9±37.3，Group B:89.7±36.2，Group C:88.7±35.1，P=0.602,FⅪ:Cvariations betweengroups：Group B increased4percent compared with Group A，Group Cdecreased1percent compared with Group B;3. Three coagulation factorscomprising the extrinsic pathway： factorⅡactivity(FⅡ:C)： X SGroupA:117.6±19.4，Group B:119.8±20.6，Group C:124.0±21.5，P=0.611，FⅡ:Cvariations between groups：Group B increased2percent compared with GroupA，Group C increased4percent compared with Group B; factorⅦ activity(FⅦ:C)：X SGroup A:166.4±117.7，Group B:171.2±117.5，Group C:167.9±115.9，P=0.741，F Ⅶ: Cvariations between groups：Group B increased3percent compared with Group A，Group C decreased2percent compared withGroup B; factorⅩ activity(FⅩ: C)： X SGroup A:129.8±29.4，Group B:146.6±23.3，Group C:144.7±23.1，P=0.224，FⅩ: Cvariations betweengroups：Group B increased13percent compared with Group A，Group Cdecreased1percent compared with Group B;4.One index of anti-coagulationsystem：AT-Ⅲ:A：X SGroup A:88.9±16.6，Group B:92.0±11；5，GroupC:92.2±14.3，P=0.761，AT-Ⅲ:A variations between groups，：Group Bincreased3percent compared with Group A，Group C almost have no changecompared with Group B;5.one indexes of fibrinolysis system：Fibrin(ogen)degradation products(FDP): X SGroup A:0.7±0.32，Group B:0.7±0.29，Group C:0.6±0.28，P=0.816。Conclusions:1. After LR especially afterLR+GI, FFP will be less effective in the replacement therapy of intrinsiccoagulation factors;2. After LR+GI especially after LR,FFP will be moreeffective in the replacement therapy of extrinsic coagulation factors;3. AfterLR FFP will be less effective in the replacement therapy of FbgC, while thetreatment of GI may have possitive effects.