A colleague at a Southern California hospital reports that he has encountered situations where units of Cryoprecipitate Poor Plasma (CPP) have been thawed for a therapeutic plasma exchange (TPE) treatment of TTP, only to discover that the TPE was postponed due to a Quinton Catheter becoming non-functional, or for some other reason. He wants to know if there are data regarding the concentration of ADAMTS13 in thawed CPP that has been stored for more than 24 hours in the refrigerator at 1-6 °C. He also wants to know if any colleagues store Thawed CPP in a manner similar to Thawed Plasma (i.e. maintained at 1-6 °C and used within 5 days of thawing).

The following comments have been received.

ADDENDA Apr 27, 2005

1. According to Dr. Han-Mou Tsai of Montefiore Medical Center (attribution used with permission), levels of ADAMTS13 have been determined in plasma samples from blue-top tubes and found to be stable for at least 3 days at 4 °C or room temperature. However, because the blood bank plasma uses slightly different anticoagulants, this question has not been formally investigated and he is not aware of any controlled studies on this subject.

2. A transfusion medicine physician in North Carolina reports that the following information from the 8th edition of Collected Questions and Answers (Edited by Brecher ME and Hay SN and published by AABB in 2004) is germane to the present discussion:

Question: "When we thaw plasma, we generally extend the shelf-life from 24 hours to 5 days (re-labeling it from FFP to thawed plasma). As such plasma is frequently used for plasma exchange for Thrombotic Thrombocytpenia Purpura (TTP) it would be important to know the stability of the vWB cleaving protease at both room and refrigerator temperatures."

Response: "The vWB cleaving protease (also referred to as a metalloproteinase or ADAMTS13) is the enzyme in which a severe deficiency has been linked to the pathophysiology of TTP. It has been shown to be stable in citrated plasma with overnight room temperature storage and over several days, at 37C. At 37C there was a steady but slow decrease of protease activity with a half-life longer than 1 week. Presumably, the stability would be even greater if refrigerated."

References:

Gerritsen HE, Robles R, Lammle B, Furlan M. Partial amino acid sequence of purified von Willebrand factor-cleaving protease. Blood. 2001 Sep 15;98(6):1654-61

Yarranton H, Lawrie AS, Purdy G, Mackie IJ, Machin SJ. Comparison of von Willebrand factor antigen, von Willebrand factor-cleaving protease and protein S in blood components used for treatment of thrombotic thrombocytopenic purpura. Transfus Med. 2004 Feb;14(1):39-44.

3. A Technical Support Program Director affiliated with a multistate blood provider reports that the 23rd edition of the AABB Standards for Blood Banks and Transfusion Services (effective May 1, 2005) modified the expiration of thawed Cryoprecipitate Reduced Plasma to 5 days if stored at 1-6 C. This is a change from the 22nd edition which listed a 24 hour expiration.

ADDENDA Dec. 24, 2006

4. Editors' note: Colleagues may find the article "Comparison and stability of ADAMTS13 activity in therapeutic plasma products" to be germane to the present discussion.

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Ira A. Shulman, MD
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