PB1004 - Waste not, want not: evaluating the hemostatic properties of novel plasma supernatants produced from late-storage low-titer type O whole blood

Tuesday, July 12, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Amudan J. Srinivasan, MD

Surgical Critical Care Fellow
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Co-Author(s)

Emily P. Mihalko, PhD

Research Scientist
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
KR

Katelin C. Rahn

Research Technician
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania, United States
JS

Jansen N. Seheult

Assistant Professor
Department of Pathology, Mayo Clinic, Rochester, MN
Rochester, Minnesota, United States
PS

Philip C. Spinella

Professor, Surgery and Critical Care Medicine
University of Pittsburgh School of Medicine
SEWICKLEY, Pennsylvania, United States
AC

Andrew P. Cap, MD, PhD

Director of Research, Chief Scientific Officer
United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
San Antonio, Texas, United States
DT

Darrell J. Triulzi

Professor of Pathology
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
Pittsburgh, Pennsylvania, United States
MY

Mark H. Yazer

Professor of Pathology
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
Pittsburgh, Pennsylvania, United States
Matthew D. Neal, MD

Associate Professor
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
Susan M. Shea, MSME, PhD

Assistant Professor
Trauma and Transfusion Medicine Research Center, Department of Surgery and Department of Bioengineering, University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Background: Low-titer type O whole blood (LTOWB) may be superior to component therapy in the hemorrhaging trauma patient. Current US regulations limit LTOWB storage in citrate-phosphate-dextrose to 21 days. If unused before day 21, LTOWB units can be manufactured into red cell units, and the supernatant discarded. However, this plasma supernatant may have value as a novel transfusion product.

Aims: We evaluated hemostatic properties of the plasma supernatant produced from LTOWB at storage day 15 in comparison to liquid plasma of the same storage age. We hypothesized that LTOWB supernatant would have higher hemostatic potential due to higher platelet and microparticle content.

Methods: LTOWB supernatants (N=12) were prepared from LTOWB units by manually expressing the supernatant from LTOWB units, and units were sampled aseptically on days 15, 21, and 26. Fresh, never-frozen liquid plasma (N=12) were sampled on days 3, 15, 21, and 26. Complete blood counts, prothrombin time (PT), activated partial thromboplastin time (PTT), fibrinogen (FGN), rotational thromboelastometry (ROTEM, EXTEM and INTEM reagents), thrombin generation (TG, platelet-rich plasma reagent), and enumeration of microparticles using nanoparticle tracking analysis were performed at all timepoints. Groups were compared using a mixed effects model (alpha = 0.05).

Results: Across all timepoints, LTOWB supernatants had significantly higher platelet counts than liquid plasma (p=0.0016) and had comparable PTT and FGN results despite an elevated PT (p=0.002, Figure 1A). LTOWB supernatants had higher endogenous thrombin potential (p < 0.0001, Figure 2A) and peak thrombin generation (p < 0.0001), as well as increased ROTEM-INTEM maximum clot firmness (p=0.0004) and decreased clot formation time (p=0.0483) (Figure 2B). Microparticle sizes and concentrations were increased in LTOWB supernatants throughout storage duration (p=0.0007, Figure 1C).

Conclusion(s): Plasma supernatants separated from LTOWB after 15 days have superior in vitro hemostatic properties than liquid plasma of equivalent age and merit further study as a novel transfusion product.
(*Authors contributed equally)