354 Use of solvent/detergent – treated plasma (Octaplas) in children

IntroductionThe use of fresh frozen plasma (FFP) has increased significantly in recent years. Clinical practice guidelines recommend plasma transfusion in children and neonates with coagulation disorder and clinically significant bleeding or before invasive procedures with a high risk of bleeding. The use of solvent/detergent (S/D) treatment before freezing significantly reduced the risk of possible side effects. Octaplas is a bio pharmaceutically standardized coagulation active substitute for plasma, and has been used in Europe since 1991. Harmful antibodies and allergic substances have been neutralized and lipid – coated viruses (HIV, HBV and HCV) have been inactivated by S/D. Octaplas contains a well-standardized content of coagulation factors and inhibitors. The structure and function of plasma proteins are not changed, blood cells and leukocyte antibodies, micro vesicles, cell fragments, bioactive lipids are completely removed and the cytokine concentration is lower.ObjectiveTo examine the indications for use of Octaplas in children and its efficiency.MethodsA review of the available literature related to application of Octaplas in children.ResultsThe use of Octaplas in severe patients reduces the possibility of immune and anaphylactic reactions and transfusion – induced acute lung injury. Also, a smaller volume of Octaplas compared to FFP is required to correct coagulopathy. No additional bleeding with reduction in the number of transfusions in liver transplant patients was observed. An increase in platelets has been demonstrated in patients with thrombotic thrombocytopenic purpura who were refractory to FFP. The survival rate in Pediatric Intensive Care Unit (PICU) was higher in children treated with Octaplas compared to FFP. Recent research has shown that in children who received Octaplas during cardiac surgery ACT values were lower with lower doses of heparin, and platelets, APTV, INR, fibrinogen values were higher compared to children who received FFP. Reduction in postoperative infections and shorter stay in PICU were observed. The latest prospective, multicenter study in the United States examined the safety, tolerability, and efficacy of Octaplas in the treatment of children who required replacement of multiple coagulation factors due to cardiac surgery, transplantation and/or liver dysfunction, with coagulopathy and sepsis – related coagulopathy as well as hypoxic encephalopathy. No thromboembolic events associated with hyper fibrinolysis or treatment have been reported. The overall safety, tolerability and efficiency was defined as excellent. Hemostatic parameters measured with INR, PT, APTV, thromboelastography, or thromboelastometry were within the expected range.ConclusionThe results of previous research support the use of Octaplas in children. Octaplas has an advantage over FFP due to its strong hemostatic effect, less frequent side effects, safety and in critically ill children may be associated with improved survival.