The dynamics of clot formation in fresh-frozen plasma

Background Factor VIII (FVIII) levels are used as a quality marker of fresh-frozen plasma (FFP); however, other clotting factors are not routinely measured. Methods We assessed additional haemostatic parameters and the dynamics of coagulation using Thrombelastography (TEG (R)) and a thrombin generation test (TGT). FFP was prepared on the day of donation (Day 0) or after overnight hold at 4 degrees C (Day 1). Results Factor VIII in Day 1 FFP was 18% lower than in Day 0. TEG (R) parameters in Day 1 FFP were consistent with increased coagulability and did not correlate with altered levels of clotting factors, but were consistent with the increased levels of microparticles seen in the Day 1 samples. TGT studies exhibited increased lag time, time to peak and reduced peak thrombin generation, but no change in endogenous thrombin potential (ETP) on Day 1. There was a weak association between FVIII level and both ETP and peak thrombin (ETP r(s) >= 0.22, P <= 0.003; peak thrombin r(s) >= 0.48, P <= 0.0001), which was influenced by ABO group, with the lowest levels in group O. Conclusion We conclude that levels of FVIII do not predict the haemostatic potential of FFP and that there may be a role for alternative technologies in monitoring the quality of FFP.