Enhanced thrombin generation and reduced intact protein S in processed solvent detergent plasma

Area of Science:

• Hematology
• Transfusion Medicine
• Biochemistry

Background:

• Solvent/detergent (S/D)-treated plasma is an alternative to fresh frozen-plasma (FFP) for severe bleeds.
• Investigating compositional changes in S/D-treated plasma is crucial for its clinical application.

Purpose of the Study:

• To explore compositional modifications in S/D-treated plasma.
• To assess the impact of these modifications on hemostatic and fibrinolytic properties.

Main Methods:

• Comparison of S/D-treated plasma and FFP for procoagulant microparticles and coagulation factors/inhibitors.
• Evaluation of PT, APTT, thrombin generation, and thromboelastography.

Main Results:

• S/D-treated plasma lacks procoagulant microparticles; coagulation factors are generally normal.
• Reduced intact functional protein S (12-14%) in S/D-treated plasma leads to increased thrombin generation.
• Enhanced fibrinolysis observed, with shortened clot lysis times, manageable with tranexamic acid.

Conclusions:

• S/D-treatment may induce a procoagulant phenotype due to reduced functional protein S.
• The clinical significance of increased fibrinolysis and potential benefits in anticoagulant deficiencies require further study.
• Tranexamic acid co-administration is beneficial for controlling enhanced fibrinolysis.