Patient Plasma Management

Fresh frozen plasma and plasma-derived clotting factors are cornerstones of the transfusion therapy to resolve dysbalances in coagulation. Early transfusion of plasma could reduce mortality in the setting of polytrauma [1]. Hence, the optimal use of plasma products is a major task in transfusion medicine. This involves production, storage, and provision of plasma and its derivatives. In this issue of Transfusion Medicine and Hemotherapy, interesting new aspects on plasma production and plasma therapy are covered.

Cryoprecipitate’s primary clinical use to date is to correct fibrinogen deficiency. Swanson and colleagues [2] compared plasma thawing techniques on cryoprecipitate fibrinogen and factor VIII levels. They compared water bath thawing with 24-h refrigerator thawing. With the latter thawing technique, they showed significantly higher fibrinogen and significantly lower factor VIII activities in cryoprecipitate. Refrigerator plasma thawing over 36–48 h could maximize cryoprecipitate fibrinogen yields.

Importantly, coagulation is influenced by medical therapy. Immune checkpoint inhibitors are increasingly used in cancer treatment but are associated with both thrombosis and hemorrhage. The mechanisms behind are less well understood. Patalakh et al. [3] analyzed the impact of immune checkpoint inhibitors on platelet function and plasma coagulation. Ipilimumab, for example, significantly increased the rate of clotting in platelet-rich plasma, suggesting procoagulant platelet mediated enhancement of plasmatic clotting.

Further, crystalloid and colloid solutions are known to affect coagulation. Jonas et al. [4] assessed the impact of different plasma expanders with rotational thromboelastometry. They could show that the propagation phase of coagulation, maximal strength and elasticity of the coagulum, and the level of functional fibrinogen are altered by these substances.

Finally, robotic-assisted surgery is increasingly performed, but it is unclear how it affects perioperative anemia. In a large case-control study, 15,009 matched patient pairs undergoing surgery were investigated [5]. Robotic-assisted and laparoscopic procedures were associated with reduced blood transfusions compared to open surgery; thus, the advancement of minimally invasive procedures adds an important measure to reduce perioperative blood loss, to control coagulopathy and to improve patient outcomes.

Managing plasma products and patients with an indication for plasma transfusion has many different factettes as illustrated by these articles. The current issue of Transfusion Medicine and Hemotherapy therefore provides new evidence to improve logistics and shape the indications for plasma transfusion therapy.