DISCUSSION: (mg) Frequency of control Factor IX

DISCUSSION: FFP is a rich source of coagulation factor including both procoagulant and anticoagulant proteins, it is always recommended to have total concentration of coagulation proteins estimated in the product to have good therapeutic outcome and for comparing with national standards. Our study demonstrated that the mean coagulation protein concentration of heat labile and stable coagulation proteins as shown in the below table     Labile Coagulation factors Current study Dghs European council33 Factor levels (IU/ml) Frequency of control Factor levels (IU/ml) Frequency of control Factor V 0.9 IU/ml Nil 4 units per month Nil Nil Factor VIII 0.6 IU/ml >0.7 IU/ml 4 units per month >0.7 Every 3 months 10 units in the first month of storage               Stable Coagulation factors Current study Dghs European council Factor levels Factor levels Frequency of control Factor levels (mg) Frequency of control Factor IX 0.

9 IU/ml 1 IU/ml 4 units per month Nil Nil Fibrinogen 260 mg 200 to 400 mg 4 units per month ? 60 per cent of the potency of the freshly-collected plasma unit Every 3 months 10 units in the first month of storage   In our study Fibrinogen levels meet the quality control requirements but Factor V, Factor VIII and Factor IX levels do not meet the quality control requirement by DGHS or European council guidelines. This can be attributed to poor storage conditions, in our centre we do not use card board covers to store FFPs rather FFPs are piled together due to lack of space which allows poor air current to the centrally stored FFP products. Other causes include maintenance breakdown which frequently in our centre.  Factor VIII level is a quality control parameter required for FFP as per Directorate General Of Health Services (DGHS)34. Total fibrinogen content of our FFP bags were more than 200 mg (200-400mg) which is within the quality requirement range provided by NACO and NABH standards18. There is no guidelines for factor V and factor IX content of FFP in India, our study results showed that factor V and factor IX contents were more than 0.

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!


order now

90 IU/ml and found to be more than 0.5 IU/ml (minimum range by Standard haematology reference value). Factor VIII content of FFP should be more than 0.7 IU/ml as per NACO and NABH standards and in our study we found factor VIII content to be more than 0.7 IU/ml in units stored for up to 8 months but in units stored for 12 months our mean factor VIII content was found to be 66.

57 IU which is less than the quality required to meet NACO and NABH requirements, but more than standard reference haematological value of 0.5 IU/ml. For therapeutic efficacy in clinical conditions like massive transfusion, disseminated intravascular coagulation, multiple coagulation deficiencies and in plasma exchange factor level of more than 0.5 IU/ml is sufficient, but these FFPs whose FVIII concentration are less than 0.

7 IU/ml are not suitable for use in patients with haemophilia.  Factor V levels were compared between blood bank and camp site collection, both showed that there is no significant difference in factor V levels and they were more than the minimum range by Standard haematology reference value15. Factor V levels were compared between two different time of component preparation and found to have no significant difference, both of their mean factor V levels were more than the minimum range by Standard haematology reference value15. We did compare factor V levels between different time periods of storage and found to have insignificant difference, all the mean values were more than the minimum range by Standard haematology reference value.

 Factor VIII levels were compared between blood bank and camp site collection, both showed that there is no significant difference in factor VIII levels and they were more than the minimum range by Standard haematology reference value15 but less than the quality required to meet NACO and NABH requirements. Factor VIII levels were compared between two different time of component preparation and  DISCUSSION: FFP is a rich source of coagulation factor including both procoagulant and anticoagulant proteins, it is always recommended to have total concentration of coagulation proteins estimated in the product to have good therapeutic outcome and for comparing with national standards. Our study demonstrated that the mean coagulation protein concentration of heat labile and stable coagulation proteins as shown in the below table     Labile Coagulation factors Current study Dghs European council33 Factor levels (IU/ml) Frequency of control Factor levels (IU/ml) Frequency of control Factor V 0.9 IU/ml Nil 4 units per month Nil Nil Factor VIII 0.6 IU/ml >0.

7 IU/ml 4 units per month >0.7 Every 3 months 10 units in the first month of storage               Stable Coagulation factors Current study Dghs European council Factor levels Factor levels Frequency of control Factor levels (mg) Frequency of control Factor IX 0.9 IU/ml 1 IU/ml 4 units per month Nil Nil Fibrinogen 260 mg 200 to 400 mg 4 units per month ? 60 per cent of the potency of the freshly-collected plasma unit Every 3 months 10 units in the first month of storage   In our study Fibrinogen levels meet the quality control requirements but Factor V, Factor VIII and Factor IX levels do not meet the quality control requirement by DGHS or European council guidelines.

This can be attributed to poor storage conditions, in our centre we do not use card board covers to store FFPs rather FFPs are piled together due to lack of space which allows poor air current to the centrally stored FFP products. Other causes include maintenance breakdown which frequently in our centre.  Factor VIII level is a quality control parameter required for FFP as per Directorate General Of Health Services (DGHS)34. Total fibrinogen content of our FFP bags were more than 200 mg (200-400mg) which is within the quality requirement range provided by NACO and NABH standards18. There is no guidelines for factor V and factor IX content of FFP in India, our study results showed that factor V and factor IX contents were more than 0.90 IU/ml and found to be more than 0.5 IU/ml (minimum range by Standard haematology reference value). Factor VIII content of FFP should be more than 0.

7 IU/ml as per NACO and NABH standards and in our study we found factor VIII content to be more than 0.7 IU/ml in units stored for up to 8 months but in units stored for 12 months our mean factor VIII content was found to be 66.57 IU which is less than the quality required to meet NACO and NABH requirements, but more than standard reference haematological value of 0.5 IU/ml. For therapeutic efficacy in clinical conditions like massive transfusion, disseminated intravascular coagulation, multiple coagulation deficiencies and in plasma exchange factor level of more than 0.5 IU/ml is sufficient, but these FFPs whose FVIII concentration are less than 0.7 IU/ml are not suitable for use in patients with haemophilia.

 Factor V levels were compared between blood bank and camp site collection, both showed that there is no significant difference in factor V levels and they were more than the minimum range by Standard haematology reference value15. Factor V levels were compared between two different time of component preparation and found to have no significant difference, both of their mean factor V levels were more than the minimum range by Standard haematology reference value15. We did compare factor V levels between different time periods of storage and found to have insignificant difference, all the mean values were more than the minimum range by Standard haematology reference value.  Factor VIII levels were compared between blood bank and camp site collection, both showed that there is no significant difference in factor VIII levels and they were more than the minimum range by Standard haematology reference value15 but less than the quality required to meet NACO and NABH requirements. Factor VIII levels were compared between two different time of component preparation and found to have significant difference, both of their mean factor VIII levels were more than the minimum range by Standard haematology reference value but FFPs prepared within 4 hours of whole blood collection did not meet the quality required by NACO and NABH. We did compare factor VIII levels between different time periods of storage and found to have insignificant difference, all the mean values were more than the minimum range by Standard haematology reference value but surprisingly mean factor levels of 4 month, 8 month and 12 month old bags did not meet the quality required by NACO and NABH.

On comparing factor VIII levels between ABO blood groups, there were no significant difference in the factor levels, in our study B group plasma had the maximum factor VIII content and AB group FFPS had minimum factor VIII content, our results were comparable and contradictory with the other study done by klarmann et al where they compared factor VIII levels between o group and non o group individuals and found to have increased levels of factor VIII in non o group individuals35,36. to have significant difference, both of their mean factor VIII levels were more than the minimum range by Standard haematology reference value but FFPs prepared within 4 hours of whole blood collection did not meet the quality required by NACO and NABH. We did compare factor VIII levels between different time periods of storage and found to have insignificant difference, all the mean values were more than the minimum range by Standard haematology reference value but surprisingly mean factor levels of 4 month, 8 month and 12 month old bags did not meet the quality required by NACO and NABH. On comparing factor VIII levels between ABO blood groups, there were no significant difference in the factor levels, in our study B group plasma had the maximum factor VIII content and AB group FFPS had minimum factor VIII content, our results were comparable and contradictory with the other study done by klarmann et al where they compared factor VIII levels between o group and non o group individuals and found to have increased levels of factor VIII in non o group individuals35,36. 

x

Hi!
I'm Ruth!

Would you like to get a custom essay? How about receiving a customized one?

Check it out