Global sources of cryoprecipitate demonstrate variability in coagulant factor levels and functional hemostasis.

Journal Article (Journal Article)

Cryoprecipitate (cryo) is a plasma-derived blood product utilized during trauma resuscitation, surgery, and other major bleeding. Although local quality control metrics exist, inherent donor variability, and processing may confer differences in hemostatic effect between sources. The purposes of this study were to quantify procoagulant content in three global sources of cryo and evaluate their functional hemostatic effect. In this Institutional Review Board exempt study, 24 units of group A cryo from three different sources, American Red Cross single donor and pooled donor, Australian Red Cross single donor, Southwestern United States single donor, and Southwest pooled donor, were evaluated. Procoagulant factors were quantified from each source using ELISA and automated clot-based assays. Functional hemostasis was evaluated using rotational Thromboelastometry (ROTEM). Microparticles isolated from cryo units were enumerated and evaluated for cellular origin by flow cytometry, as well as their capacity to support thrombin generation. Southwestern United States single donor units demonstrated highest levels of fibrinogen, fibronectin, factor VIII, and von Willebrand factor in the selected units. In the coagulopathy model, successive doses from all cryo units were significantly correlated to decreasing coagulation time (P = 0.0100), and increasing maximum clot firmness (P = 0.0002) and alpha angle (P = 0.0009). Southwest pooled donor demonstrated significantly shorter coagulation time at all three doses (P = 0.02) than other sources. Microparticles support prothrombinase activity and thrombin generation. In this study of global cryo sources, procoagulant activity and in-vitro clot formation varied by source. This could be explained by variance in production and storage protocols. Further study is warranted to assess functional variance in cryo to optimize and standardize the use of cryo products.

Full Text

Duke Authors

Cited Authors

  • Evans, BA; Kamyszek, RW; Piegore, M; Stoner, K; Fuller, M; Welsby, IJ; Mooberry, M

Published Date

  • March 1, 2021

Published In

Volume / Issue

  • 32 / 2

Start / End Page

  • 87 - 102

PubMed ID

  • 33186132

Electronic International Standard Serial Number (EISSN)

  • 1473-5733

Digital Object Identifier (DOI)

  • 10.1097/MBC.0000000000000982

Language

  • eng

Conference Location

  • England