Paired analysis of plasma proteins and coagulant capacity after treatment with three methods of pathogen reduction

Background The effect of photochemical pathogen reduction ( PR ) methods on plasma quality has been the subject of several reports but solid comparative data for the different technologies are lacking. Study Design and Methods Plasma (n = 24) photoinactivated with methylene blue ( MB ), riboflavin ( RF ), or amotosalen ( AS ) was compared using a pool‐and‐split design. Samples were taken before and after treatment with each method and tested for coagulation factors (fibrinogen, Factor [ F ] II , FV , FVIII , F   IX , FXI ), natural coagulation inhibitors (Protein C [ PC ], protein S [ PS ], antithrombin III [ AT ]), prothrombin time ( PT ), activated partial thromboplastin time ( APTT ), and thrombin generation ( TG ). The three methods were mutually compared by repeated‐measures analysis of variance. Results All three PR methods cause significant reduction (p < 0.01) of activity of the procoagulant proteins fibrinogen, FII , FV , FVIII , F   IX , and FXI . Coagulation is also affected, with significant changes in PT , APTT , and TG . RF treatment causes a significantly higher decrease in concentration of coagulation factors, PS , and AT than the other methods (p < 0.01). PT , APTT , and TG are also affected most by RF treatment. FII , FVIII , F   IX , PC , AT , and PT are best preserved with the MB method and FV , FXI , and TG after AS treatment (p < 0.01). Coagulation factor loss due to the volume loss during PR treatment is more important for MB and AS than for RF . Conclusion PR treatment of plasma affects coagulation proteins and coagulant capacity. For the RF method this effect is most pronounced, although to some extent compensated by a smaller volume loss.