NVB/TRIP symposium – 25 May, 2016
Omniplasma vs. Q-FFP in whole blood using thromboelastography
Nicholas H. Saadah
J.G. (Anske) van der Bom, Martin Schipperus - advisors
N. Saadah (MD/PhD candidate)
Hyperfibrinolysis:
Hyperfibrinolysis following
SDP transfusion is an active
area of research…
1998 study showing rate of
HF greater with ESDEP (an
SDP no longer used)
2000 study showing no
difference in HF between QFFP and SDP
2007 case report on HF
related deaths during liver
transplantation
Previous studies:
Pitkänan et al. (2015)
evaluated fibrinolytic
potential of pure SDP
vs. Q-FFP
van Beers et al.
(2015) confirmed
these results
Research goal
Characterize effect of SDP on coagulation characteristics of
whole blood, especially fibrinolytic potential
RP441 – Omniplasma vs. Q-FFP in whole blood:
60% or 80% Plasma
fSDP = SDP frac on
TEG
machine
fQ-FFP = Q-FFP frac on
10 or 150x109 platelets/L
40% or 20% RBCs
Channel 1 Channel 2 Channel 3 Channel 4
fSDP=0%
fSDP=50% fSDP=75%
fSDP=100%
fQ-FFP=100% fQ-FFP=50% fQ-FFP=25% fQ-FFP=0%
RP441 – Omniplasma vs. Q-FFP in whole blood:
Lab set-up:
Results – definitions of outcome parameters:
Clot strength vs. time for various SDP fractions
40
30
100% SDP
20
25%/75% Q-FFP/SDP
50%/50% Q-FFP/SDP
MA
amplitude
10
½MA
CLT50%
100% Q-FFP
CLT
0
R time
-10
-20
-30
-40
0
5
10
15
20
25
time (mins)
30
35
40
45
50
Results – non-repeatability:
TEG traces (clot strength vs. time)
60
40
clot strength
20
0
-20
-40
-60
0
10
20
30
SDP fraction
40
50
60
Results – tPA calibrations:
Results – definitions of outcome parameters:
Clot strength vs. time for various SDP fractions
40
30
100% SDP
20
25%/75% Q-FFP/SDP
50%/50% Q-FFP/SDP
MA
amplitude
10
½MA
CLT50%
100% Q-FFP
CLT
0
R time
-10
-20
1
0.2
-30
0.5
0.7
-40
0
5
10
15
20
25
time (mins)
30
35
40
45
50
Results – all data:
all data
1.4
1.2
CLT50% relative to Q-FFP
1
0.8
0.6
ORSDP =0.48 (0.40-0.55)
0.4
0.2
0
0
0.1
0.2
0.3
0.4
0.5
SDP fraction
0.6
0.7
0.8
0.9
1
0
0
0
0.2
0.4
Results – Hct, PLT held constant, tPA varied:
0.6
0.8
1
0
SDP fraction
effect of tPA on CLT 50%
1.4
CLT50% relative to Q-FFP
CLT50% relative to Q-FFP
1.4
ef
tPA=150
tPA=100
tPA=50
1.2
1
0.8
0.6
0.4
-SDP : -0.59 [-0.69,-0.48]
0.2
3
-tPA(# 10 ): 0.04 [-0.80,0.88]
0
0
0.2
0.4
0.6
1.2
1
0.8
0.6
0.4
0.2
0
0.8
SDP fraction
effect of Hct, plt on MA
1
0
0
Hct
: -0.05 [-0.35,0.25]
1 Results – Hct, PLT
0 varied, tPA
0.2held constant:
0.4
1
0.6
0.8
1
SDP fraction
effect of Hct, plt on CLT 50% (tPA=50ng/mL)
CLT50% relative to Q-FFP
1.4
plt=150
plt=10
1.2
1
0.8
0.6
-SDP : -0.50 [-0.59,-0.40]
0.4
- (# 10 3 ): -0.55 [-1.05,-0.04]
plt
- : -0.04 [-0.40,0.31]
0.2
Hct
0
0
0.2
0.4
0.6
0.8
SDP fraction
effect of Hct, plt on R time
1
Conclusions:
• SDP increases the fibrinolytic potential of reconstituted whole blood
• Relative CLT50% is unaffected by Hct, and may be increased by higher platelet
count
Thank you! Questions?