Pathogen-reduced plasma, cryoprecipitate reduced for therapeutic plasma exchange

Area of Science:

• Hematology
• Transfusion Medicine
• Pathogen Reduction Technology

Background:

• Therapeutic plasma exchange (TPE) for thrombotic thrombocytopenic purpura (TTP) and autoimmune disorders carries risks of transfusion-transmitted infections (TTI).
• Amotosalen-UVA pathogen reduction technology produces pathogen-reduced cryoprecipitate-reduced (PRPCR) plasma, a form of cryoprecipitate-poor plasma (CPP).
• PRPCR may offer improved TPE outcomes and reduced TTI risk compared to traditional allogenic plasma.

Purpose of the Study:

• To evaluate the hemostatic and thrombotic properties of PRPCR.
• To assess the retention of key plasma proteins and factors in PRPCR.
• To determine the suitability of PRPCR for TPE applications.

Main Methods:

• PRPCR was manufactured using amotosalen-UVA pathogen reduction technology.
• Comprehensive analysis of coagulation factors, VWF, ADAMTS13, and immunoglobulins was performed.
• Microfluidic assays assessed platelet adhesion and aggregation under various shear rates.

Main Results:

• PRPCR showed depletion in fibrinogen, Factor VIII, and VWF compared to pathogen-reduced plasma.
• Key factors including thrombin generation, Protein C, Protein S, ADAMTS13, and immunoglobulins were conserved.
• Platelet adhesion occurred at low shear rates, but collagen-induced platelet aggregation was negligible at high shear rates.

Conclusions:

• PRPCR retains hemostatic capacity, anti-thrombotic proteins, and ADAMTS13.
• Depletion of functional high molecular weight VWF in PRPCR minimizes high-shear platelet aggregation.
• PRPCR represents a viable CPP option for TPE, balancing reduced thrombotic and TTI risks with preserved hemostatic function and immunoglobulins.