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Issues of ConcernExtraction of Plasma It can be separated from whole blood by the process of centrifugation, i.e., spinning whole blood with an anticoagulant in a centrifuge. Plasma is lighter, forming the upper yellowish layer while the denser blood cells fall to the bottom. The plasma collected is frozen within 24 hours to preserve the functionality of the various clotting factors and immunoglobulins; it is thawed before use and has a shelf life of 1 year. Interestingly, while O- is the preferred universal donor for blood, the plasma of AB blood groups is the most preferred because their plasma does not contain antibodies, making it acceptable for everyone without fear of an adverse reaction. Plasma, like whole blood, is initially tested to ensure the safety of recipients. As per the FDA regulations, the collected plasma undergoes a battery of tests to identify transmittable diseases, mainly hepatitis A, B, and C, along with syphilis and HIV. The process of fractionation separates individual plasma proteins.[1] CellularThe specific gravity of plasma is 1.022 to 1.026 compared to the specific gravity of blood which is 1.052 to 1.061. Plasma forms 55%, and red blood cells form 45% of the total blood. Four major products derived from the plasma which can be used are fresh-frozen plasma (FFP), plasma frozen within 24 hours of phlebotomy (FP24), cryoprecipitate-poor plasma (CPP), and thawed plasma. FP24, CPP, and thawed plasma contain varying amounts of clotting factors.[2] DevelopmentPlasma proteins, on the other hand, have distinct organs that produce them based on an individual's stage of development. In Embryo In the embryonic stage, the mesenchymal cells are responsible for plasma cell production. The first protein to be synthesized is albumin, followed by globulin and the other plasma proteins. In Adults The reticuloendothelial cells of the liver are in charge of plasma protein synthesis in adults. The bone marrow, degenerating blood cells, general body tissue cells, and the spleen also contribute to the formation of plasma proteins. Gamma globulins originate from B lymphocytes, which in turn form immunoglobulins. Organ Systems InvolvedThe origin of plasma, which constitutes 55% of total blood, is interesting because no organ produces it. Instead, it is formed from water and salts absorbed through the digestive tract. FunctionAs plasma forms the liquid base of blood, the functions carried out by plasma and blood overlap. The multitude of functions include:
Related TestingWater constitutes about two-thirds of the human body. In an adult man weighing 70 kg, the body water content is about 42L. This water content is divided into two major compartments:
Plasma can be measured using marker substances like radioactive iodine (131 I) and Evans blue (T-1824). Evans blue is the commonly used marker substance (aka tracer) since it binds strongly with albumin. The concept behind using a tracer is to use one that is well distributed in the compartment of interest. A known amount of tracer is introduced into the compartment, and its volume of distribution is measured. [4]
Compartment volumes are measured based on the volume of distribution of tracer. When measuring plasma volume, the albumin-bound tracer, i.e., Evans blue, is used. As albumin tends to continuously leak out of the circulation, the tracer concentration is measured at serial intervals and is plotted on a logarithmic curve. This curve is then extrapolated to identify a “zero time” that allows the estimation of a virtual volume of distribution. The volume of distribution measured is the volume of plasma. PathophysiologyThere are many disease processes associated with plasma:
Clinical SignificanceThe numerous clinical uses of plasma can be best explained when considering the various forms and components of blood plasma: [9]
8. Platelet-rich Plasma (PRP): PRP is defined as autologous blood with a concentration of platelets above baseline reference values. Traditionally, PRP injections have been used over the last three decades in maxillofacial and plastic surgery. More recently, its use throughout orthopedics and sports medicine has been well-established and heavily controversial.[17] The use of PRP injections in the setting of acute or acute-on-chronic musculoskeletal pathology continues to remain debated. One of the more heavily debated areas regarding PRP use is in the management of moderate knee osteoarthritis. Knee osteoarthritis afflicts a significant portion of the adult population. It has an exorbitantly high impact on the healthcare system, financial resources, and overall disability both in the United States and worldwide.[18][19][20] A recent level I study investigating nearly 200 patients randomized between 3 groups (sham control, hyaluronic acid injections, and leukocyte-poor PRP injections) demonstrated superior patient-reported pain and functional outcome scores at 12-month follow-up in patients managed with PRP injections as opposed to the sham control injection group (normal saline only) and those managed with hyaluronic acid injections.[21] Review QuestionsReferences1.Burnouf T. Modern plasma fractionation. Transfus Med Rev. 2007 Apr;21(2):101-17. [PMC free article: PMC7125842] [PubMed: 17397761] 2.Benjamin RJ, McLaughlin LS. Plasma components: properties, differences, and uses. Transfusion. 2012 May;52 Suppl 1:9S-19S. [PubMed: 22578375] 3.Peters T. Intracellular precursor forms of plasma proteins: their functions and possible occurrence in plasma. Clin Chem. 1987 Aug;33(8):1317-25. [PubMed: 3301066] 4.Tobias A, Ballard BD, Mohiuddin SS. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Oct 9, 2021. Physiology, Water Balance. [PubMed: 31082103] 5.Stanley M, Killeen RB, Michalski JM. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 17, 2022. Thrombotic Thrombocytopenic Purpura. [PubMed: 28613472] 6.Loomans JI, Lock J, Peters M, Leebeek FW, Cnossen MH, Fijnvandraat K. [Haemophilia]. Ned Tijdschr Geneeskd. 2014;158:A7357. [PubMed: 25351381] 7.Flood VH, Friedman KD, Gill JC, Morateck PA, Wren JS, Scott JP, Montgomery RR. Limitations of the ristocetin cofactor assay in measurement of von Willebrand factor function. J Thromb Haemost. 2009 Nov;7(11):1832-9. [PMC free article: PMC3825106] [PubMed: 19694940] 8.Justiz Vaillant AA, Ramphul K. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Oct 15, 2021. Antibody Deficiency Disorder. [PubMed: 29939682] 9.Heim MU, Meyer B, Hellstern P. Recommendations for the use of therapeutic plasma. Curr Vasc Pharmacol. 2009 Apr;7(2):110-9. [PubMed: 19355994] 10.Garcia-Martinez R, Noiret L, Sen S, Mookerjee R, Jalan R. Albumin infusion improves renal blood flow autoregulation in patients with acute decompensation of cirrhosis and acute kidney injury. Liver Int. 2015 Feb;35(2):335-43. [PubMed: 24620819] 11.Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013 Nov;58(5):1836-46. [PubMed: 23423799] 12.Salerno F, Navickis RJ, Wilkes MM. Albumin infusion improves outcomes of patients with spontaneous bacterial peritonitis: a meta-analysis of randomized trials. Clin Gastroenterol Hepatol. 2013 Feb;11(2):123-30.e1. [PubMed: 23178229] 13.Traclet J, Delaval P, Terrioux P, Mornex JF. Augmentation therapy of alpha-1 antitrypsin deficiency associated emphysema. Rev Mal Respir. 2015 Apr;32(4):435-46. [PubMed: 25908241] 14.Wewers MD, Crystal RG. Alpha-1 antitrypsin augmentation therapy. COPD. 2013 Mar;10 Suppl 1:64-7. [PubMed: 23527997] 15.Gosselin R, Hawes E, Moll S, Adcock D. Performance of various laboratory assays in the measurement of dabigatran in patients receiving therapeutic doses: a prospective study based on peak and trough plasma levels. Am J Clin Pathol. 2014 Feb;141(2):262-7. [PubMed: 24436275] 16.McLeod BC. Plasma and plasma derivatives in therapeutic plasmapheresis. Transfusion. 2012 May;52 Suppl 1:38S-44S. [PubMed: 22578370] 17.Hall MP, Band PA, Meislin RJ, Jazrawi LM, Cardone DA. Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009 Oct;17(10):602-8. [PubMed: 19794217] 18.Varacallo M, Chakravarty R, Denehy K, Star A. Joint perception and patient perceived satisfaction after total hip and knee arthroplasty in the American population. J Orthop. 2018 Jun;15(2):495-499. [PMC free article: PMC5889697] [PubMed: 29643693] 19.Varacallo MA, Herzog L, Toossi N, Johanson NA. Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital. J Arthroplasty. 2017 Jun;32(6):1739-1746. [PubMed: 28153458] 20.Varacallo M, Luo TD, Johanson NA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 12, 2022. Total Knee Arthroplasty Techniques. [PubMed: 29763071] 21.Huang Y, Liu X, Xu X, Liu J. Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis : A prospective randomized controlled study. Orthopade. 2019 Mar;48(3):239-247. [PubMed: 30623236] |