• Peter Hellstern.
• Institute of Hemostaseology and Transfusion Medicine, Academic City Hospital, Ludwigshafen, Germany. peterhellstern@medicusnet.de
• Curr. Opin. Hematol. 2004 Sep 1;11(5):346-50.

Purpose Of ReviewRecent reports on adverse events associated with solvent/detergent-treated plasma have raised concerns about the efficacy and safety of this type of therapeutic plasma. Comparisons of various brands of solvent/detergent-treated plasma have revealed substantial differences in their composition.Recent FindingsRetrospective analyses and case reports suggest an association between the low protein S activity levels found in solvent/detergent-treated plasma and venous thromboembolism when solvent/detergent-treated plasma is given for thrombotic thrombocytopenic purpura or transfused massively during liver transplantation surgery. Augmented bleeding caused by hyperfibrinolysis, possibly caused by the low plasmin inhibitor (also termed alpha2-antiplasmin) activity of solvent/detergent-treated plasma, has also been a matter of concern. The efficacy and safety of various types of solvent/detergent-treated plasma have been studied intensively for all indications for therapeutic plasma by at least five prospective trials, four observational studies, and post-licensure monitoring. A review of the literature shows that the clinical significance of transient protein S and plasmin inhibitor deficiency has been considerably overstated, even when such deficiency might be aggravated by the administration of large amounts of solvent/detergent-treated plasma. However, different brands of solvent/detergent-treated plasma differ substantially with respect to their composition and hemostatic balance. It cannot be completely excluded that the very low citrate and protein S concentrations versus higher clotting factor concentrations found in a given brand of solvent/detergent-treated plasma could contribute to coagulation activation in the settings of thrombotic thrombocytopenic purpura and liver transplantation.SummaryFuture research should seek to optimize the composition of solvent/detergent-treated plasma. Prospective trials and prospective hemovigilance studies are required to determine the rate of adverse events occurring after treatment with solvent/detergent-treated plasma and other types of therapeutic plasma.

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