Cryopoor plasma [CPP] (or cryosupernatant) is a component derived from blood, is a lesser-known product of blood separation. Understanding what it is, its uses, and the complexities surrounding its application and storage, can provide deeper insight into its critical role in transfusion medicine.
What is Cryopoor Plasma?
Plasma is the liquid component of blood, primarily composed of water, electrolytes, proteins, hormones, waste products, and gases. When plasma is frozen and subsequently thawed, a precipitate forms containing a concentrated mix of specific proteins. The liquid that remains after removing this precipitate is called cryopoor plasma.
Why is Cryopoor Plasma Used?
Replacement Therapy for Deficient Proteins:
Some individuals might be deficient in certain proteins that are not part of the cryoprecipitate. In such cases, cryopoor plasma provides a more suitable treatment option.Therapeutic Plasma Exchange:
Therapeutic Plasma Exchange (TPE) involves replacing a patient's plasma with donor plasma via apheresis. Cryopoor plasma, obtained as a byproduct after cryoprecipitate production, offers an option for this procedure. In conditions like TTP, where ADAMTS13 is crucial and the additional fibrinogen and other factors in regular plasma are not necessary, cryopoor plasma can be a suitable choice. Utilizing it also ensures that the plasma remaining after cryoprecipitate extraction is efficiently used. It may also be used in Hemolytic Uremic Syndrome (HUS) during a TPE procedure as well.
Advantages of Using Cryopoor Plasma
Targeted Treatment: By removing the concentrated proteins in cryoprecipitate, cryopoor plasma offers a more specialized treatment for those who require specific plasma proteins without the ones present in the precipitate.
Safety: Like other blood products, cryopoor plasma undergoes testing for infectious agents, reducing the risk of disease transmission.
Versatility: Beyond therapeutic uses, cryopoor plasma can be used in laboratory settings, serving as a plasma control in coagulation assays.
Disadvantages of Using Cryopoor Plasma
Limited Shelf Life: Once thawed, cryopoor plasma has a short shelf life, which can make storage and timely usage a challenge.
Potential for Transfusion Reactions: As with any plasma product, there's a risk of allergic reactions, transfusion-associated circulatory overload (TACO), or transfusion-related acute lung injury (TRALI). It is also very one dimensional with limited usage indication. Why would a hospital pay to have Cryopoor Plasma on hand, if they can simply use the FFP/FP24 they already have in stock?
Resource Intensity: The production of cryopoor plasma requires resources for freezing, thawing, and separating, which might not be feasible in all settings.
Storage and Handling of Cryopoor Plasma
Storing cryopoor plasma involves unique considerations to maintain its efficacy and safety:
Freezing and Thawing: To produce cryopoor plasma, fresh frozen plasma (FFP) is first thawed, typically at 1-6°C (refrigeration temperatures). The cryoprecipitate that forms is then removed by centrifugation or manual expression. The remaining liquid is the cryopoor plasma.
Storage Duration: While FFP can be stored frozen for up to 12 months, once it's thawed and processed into cryopoor plasma, it should be used within a short timeframe, typically 5 days if refrigerated.
Labeling and Tracking: Given its shorter shelf life post-thawing, meticulous labeling and tracking are necessary to ensure the product is used within its viable window.
Cryopoor plasma may play a pivotal yet nuanced role in transfusion medicine. It caters to specific therapeutic needs, standing apart from its counterpart, cryoprecipitate. While the processing and storage demand meticulous attention, the benefits it offers in targeted treatment make it an invaluable tool in the medical arsenal. As with all transfusion products, its use should be tailored to the individual needs of the patient, taking into consideration the unique attributes and potential challenges associated with it.