Comparison of fresh frozen plasma vs. coagulation factor concentrates for reconstitution of blood: An in vitro experimental study

Authors: Gratz, J., Ponschab, M., Iapichino, G. E., Schlimp, C. J., Cadamuro, J., Grottke, O., Zipperle, J., Oberladstatter, D., Gabriel, C., Ziegler, B., and Schochl, H.

Publication: Eur.J Anaesthesiol.; April 2020

Affiliations: Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna (JG), Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre Vienna, Vienna, Austria (MP, CJS, JZ, DO, HS), Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre Linz, Linz, Austria (MP, CJS), Department of Anaesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center, Rozzano, Italy (GEI), Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria (JC), Department of Anesthesiology, University Hospital of the RWTH Aachen, Aachen, Germany (OG), Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz (CG), Formerly: Red Cross Transfusion Service of Upper Austria, Linz (CG), Department of Anaesthesiology and Intensive Care Medicine, University Hospital Salzburg (BZ), Department of Anaesthesia and Intensive Care Medicine, AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg (HS).

Abstract: BACKGROUND: Many trauma centres have adopted the administration of fixed ratios of packed red blood cells (PRBCs), platelet concentrates and fresh frozen plasma (FFP) for bleeding patients. However, the haemostatic efficacy of this concept is not well proven. OBJECTIVE: Our objective was to characterise the haemostatic profile of different ratios (2 : 1 : 1, 1 : 1 : 1 and 1 : 1 : 2) of PRBCs, platelet concentrates and FFP in comparison with coagulation factor concentrates (fibrinogen and/or prothrombin complex concentrate). DESIGN: An in vitro experimental study. SETTING: Research laboratories of the department of transfusion medicine, Linz, Austria. MATERIALS: Whole blood donations from a total of 20 male volunteers. INTERVENTION: Reconstitution of blood at different ratios of PRBCs, platelet concentrates and FFP or coagulation factor concentrates. MAIN OUTCOME MEASURES: Cell count, conventional and thromboelastometric coagulation parameters, single coagulation factor activities as well as endogenous thrombin potential. RESULTS: Fibrinogen levels and haematocrit were lower in the FFP group at any ratio compared with the concentrate-based groups (P < 0.0001). Reconstitution of blood with FFP at different ratios resulted in haematocrit or fibrinogen levels that were borderline with regard to recommended substitution triggers (haematocrit 41 +/- 2% and fibrinogen 1.5 +/- 0.3 g l at the 2 : 1 : 1 ratio vs. 21 +/- 1% and 2.1 +/- 0.4 g l respectively at the 1 : 1 : 2 ratio). Compared with FFP at any ratio, maximum clot firmness showed higher values in the groups using fibrinogen concentrate (P < 0.0001), whereas endogenous thrombin potential revealed higher values in the groups using prothrombin complex concentrate (P < 0.0001). CONCLUSION: Use of coagulation factor concentrates for the reconstitution of blood allows for delivery of a higher haematocrit and a higher fibrinogen content compared with FFP. However, prothrombin complex concentrate might result in an unnecessary excess of thrombin generation. Clinical studies are warranted to further investigate these in vitro findings.