Solvent-detergent plasma: use in neonatal patients, in adult and paediatric patients with liver disease and in obstetric and gynaecological emergencies

We assessed the efficacy and tolerance of solvent-detergent (SD) plasma in neonates, in obstetric and gynaecological patients, and in patients with liver disease in three large hospitals in Dublin over an 18-month period.

Forty-one neonates received 67 transfusions of SD plasma at a mean dose ± standard deviation of 18.4 ± 3.2 ml/kg. Thirty-eight obstetric and gynaecological patients received 57 SD plasma transfusions at a mean dose of 15.3 ± 7.7 ml/kg. Thirty-six women (94.7%) had haemorrhage with mean blood loss per patient of 3345.8 ± 2738.1 ml. Fifteen children with liver disease received 33 SD plasma transfusions at a mean volume of 38.0 ± 41.5 ml/kg body weight. Seventeen adult patients with severe endstage liver disease were transfused with SD plasma either following liver transplantation or prior to other invasive procedures, at a mean dose of 10.2 ± 3.4 ml/kg.

There were statistically significant decreases in APTT and PT in neonates, in obstetric and gynaecological patients, and in patients with liver disease. Pre-transfusion and post-transfusion APTT was measured in 40/67 neonatal transfusion episodes, PT in 43/67, fibrinogen in 39/67, and platelets in 49/67. After plasma infusion the mean APTT improved from 68.9 ± 37.4 s to 44.0 ± 15.6 s (t = 4.79; P < 0.001); PT from 28.7 ± 20.3 s to 20.7 ± 14.2 s (t = 2.64; P < 0.02); fibrinogen from 1.94 ± 1.1 g/l to 2.51 ± 1.14 g/l (t = 3.41; P < 0.002). Pre-transfusion and post-transfusion APTT was measured in 41/57 transfusions in the obstetric/gynaecology group; PT and fibrinogen in 42/57. The mean APTT improved from 50.1 ± 18.4 s to 32.7 ± 6.9 s (t = 6.40; P < 0.001); PT from 21.0 ± 5.2 s to 15.6 ± 1.9 s (t = 7.71; P < 0.001); fibrinogen from 1.55 ± 0.75 g/l to 2.74 ± 0.86 g/l (t = 9.15; P < 0.001). Pre-transfusion and post-transfusion APTT, PT and platelets were measured in 22/33 transfusion episodes in the group of children with liver disease, and fibrinogen in 13/33. The APTT decreased from 61.5 ± 33.0 s to 47.8 ± 12.5 s (t = 5.15, P < 0.001) and the PT from 24.4 ± 10.0 s to 19.9 ± 4.2 s (t = 5.05, P < 0.001). Fibrinogen improved from 1.46 ± 0.75 g/l to 1.66 ± 0.59 g/l (t = 1.25; P > 0.05). In the group of adult patients with severe end-stage liver disease, precoagulation and postcoagulation test results were available for 14 of 17 transfusion episodes. There was a statistically significant improvement in the PT from 23.2 ± 4.9 s to 18.6 ± 2.9 s (t = 4.46, P < 0.001) and in the APTT from 45.1 ± 8.9 s to 36.4 ± 7.1 s (t = 3.95, P < 0.002).

No adverse reactions were observed for SD plasma infusion.

Use of SD plasma in critically ill neonates, in women with obstetric and gynaecological emergencies, and in patients with liver disease appears safe, and improves laboratory indices of coagulopathy.