• Complex deficiencies of coagulation factors such as coagulopathy due to severe hepatic failure or massive transfusion
• Substitution therapy in coagulation factor deficiencies, in emergency situations, when a specific factor concentrate e.g. factor V or factor XI are not available or when a precise laboratory diagnosis is not possible
• Reversal of the effect on fibrinolysis and rapid reversal of effects of oral anticoagulants (coumarin or indanedione type), when vitamin K is insufficient due to impaired liver function or in emergency situations
• Thrombotic thrombocytopenic purpura (TTP) usually in conjunction with plasma exchange
• In intensive plasma exchange procedures

Recent developments in donor selection and blood screening methods have considerably diminished the risk of transmission of viruses through plasma transfusions, such as HBV (Hepatitis B), HCV (Hepatitis C) and HIV (AIDS). However, a small, but nevertheless significant risk still remains due to denial of risk behaviours, sensitivity and specificity of tests, errors and lack of quality assurance. A further risk exists from viruses that are not routinely tested in the donor population, i.e. HGV, certain variants of HCV and CMV.

It is therefore desirable, and in many countries mandatory, to include virus inactivation and/or removal steps in the manufacture of blood products. This is also a requirement for plasma for transfusion in an increasing number of countries.

Octaplas is a SD treated fresh frozen plasma available in blood groups, A, B, O and AB. Octaplas was developed as an alternative to FFP in order to prevent virus transmission and to meet the need for a standardised, cell free and high quality coagulation active plasma for transfusion, to improve the therapeutic accuracy and reduce adverse reactions.

Transfusion Related Acute Ling Injury (TRALI)

Recent reports from the FDA (US) and SHOT (UK) have highlighted that TRALI is one of the biggest causes of transfusion deaths, accounting for 15% of all fatal complications of blood transfusions. TRALI presents with a number of symptoms including dyspnoea, hypotension and fever and in most of these cases, follow-up donor antibody tests found that donors were multiparous females and were positive for anti-HLA or anti-granulocyte antibodies.

No detectable levels of HLA class I or II have been found in Octaplas and dilution by pooling is believed to reduce the presence of HLA below the limits of detection. There have been no reports of TRALI with Octaplas.


Albumin

Why is albumin important?

About 6 - 8% of blood plasma consists of plasma proteins. Albumin is the major part of these proteins. It has a high water-binding capacity – 1 g of albumin binds 18 ml of water. Up to 80 % of the colloid osmotic pressure of plasma is due to albumin.

Besides the colloid osmotic function, which guarantees a constant blood volume, albumin binds and transports molecules of various substance classes (i.e. hormones, enzymes, medicinal products and toxins), has anti-oxidative actions, contributes to the regulation of apoptosis and maintains micro-vascular integrity.

How human albumin solutions are used clinically.

Human albumin enables physiologically adequate substitution in hypovolemic states with hypoproteinaemia. It remains in the blood for longer than electrolyte and synthetic colloid solutions and is an important transport protein.

In critically ill patients albumin is used for a safe and efficient volume expansion.

In cardio-pulmonary bypass surgery albumin has been shown to significantly reduce post-operative blood loss compared to synthetic colloids.

In liver disease albumin is used for prevention and treatment of circulatory dysfunction and hepato-renal syndrome in patients with cirrhosis.

The dose required depends on the size of the patient, the severity of trauma or illness and on continuing fluid and protein losses.

Human albumin 4-5% is mildly hypo-oncotic compared to normal plasma, while albumin 20-25% has a hyper-oncotic effect. The concentration of the albumin solution, dosage and the infusion rate should be adjusted to the patient´s individual requirements. When there is a need of acute plasma volume expansion, albumin solution 4-5% is normally recommended.


Antithrombin

Blood coagulation in intensive care medicine

Disorders of the blood coagulation are frequent in intensive care medicine. In the case of sepsis, multiple trauma or obstetric complications the fate of a patient often depends on the normalisation of haemostasis. Cytokines, toxins and other substances activate coagulation, the consumption of clotting factor inhibitors (especially antithrombin) increases markedly and the equilibrium between inhibitors and activators is disturbed. This equilibrium must be restored rapidly otherwise there is a risk of disseminated intravascular coagulation (DIC) and multi-organ failure.

What is the role of antithrombin?

Antithrombin is a central inhibitor of blood coagulation. It especially inhibits the activity of the clotting factors Xa and IIa (thrombin). Furthermore, it inhibits factors VIIa, IXa and XIa, the kallikrein-kinin system and through binding to complement C1, the complement system.

Antithrombin replacement in severe disorders of haemostasis stabilises coagulation and accelerates its normalisation. Critical situations are bridged by antithrombin, and valuable time for the diagnosis and treatment of the underlying disease can be gained.

In addition to the inhibition of coagulation, antithrombin also exhibits anti-inflammatory effects. As a result of interaction with glycosaminoglycans on the endothelial cell surface it promotes the release of prostacyclin (PGI2), With the help of the released PGI2, antithrombin inhibits activated cytokines, reduces endothelial damage and promotes normalisation of extrinsic coagulation.