Spray‐dried plasma deficient in high‐molecular‐weight multimers of von Willebrand factor retains hemostatic properties

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2019-02, Vol.59 (2), p.714-722
• Main Authors: Meledeo, Michael Adam, Liu, Qiyong Peter, Peltier, Grantham C., Carney, Ryan C., McIntosh, Colby S., Taylor, Ashley S., Bynum, James A., Pusateri, Anthony E., Cap, Andrew P.
• Format: Article
• Language: English
• Subjects: Adhesion; Coagulation; Collagen; Glycine; Hydrochloric acid; Microparticles; Molecular weight; Plasma; Plasmas; Platelets; Resuscitation; Ristocetin; Thrombosis; Von Willebrand factor
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.15038

BACKGROUND Dried plasmas can overcome logistical barriers that prevent fresh frozen plasma (FFP) usage in acute resuscitation, but processing of these products can detrimentally alter the composition. Spray‐dried plasma (SpDP) from single units is deficient in high‐molecular‐weight multimers of von Willebrand factor (vWF), a critical facilitator of platelet adhesion and thrombus formation. We hypothesized that converting high‐molecular‐weight multimers to smaller‐molecular‐weight multimers would retain vWF's capacity to mediate platelet adhesion. STUDY DESIGN AND METHODS SpDP obtained from untreated FFP was reconstituted with glycine‐hydrochloric acid (HCl) and glycine (20 mM:50 mM) or pretreated with glycine‐HCl (20 mM) or glycine–glycine‐HCl (20 mM:50 mM) and reconstituted with water. In vitro hemostatic potential of SpDPs versus FFP or FFP spiked with 70 mM of glycine was evaluated, leading to a more detailed in vitro study of glycine‐HCl–glycine (20 mM:50 mM) pretreated SpDP. Plasmas were combined with RBCs and platelets to observe global coagulation response. RESULTS While vWF–ristocetin cofactor activity is significantly decreased (−41.13%; p < .0001) in SpDP, a model of vWF‐mediated platelet adhesion to collagen under flow showed enhanced function (+13%; p < .01). Fewer microparticles, particularly of platelet origin, were observed in SpDP versus FFP (p < .0001). Small but significant differences in thromboelastography results were observed, although SpDP and FFP were within normal ranges. CONCLUSION Comparable coagulability was observed in FFP and SpDP. The apparent paradox between vWF–ristocetin cofactor assay and vWF‐mediated platelet adhesion may be explained by the increase in smaller multimers of vWF in SpDP, producing different outcomes in these assays.