Oral Abstracts

Background: The TRIP national hemovigilance and biovigilance office receives reports on side effects and incidents associated with the transfusion of labile blood products. The findings are publicly reported in annual hemovigilance reports. The category of anaphylactic reaction, defined as allergic reactions with systemic features such as airway obstruction, fall in blood pressure, vomiting or diarrhoea, accounts for the largest number of serious transfusion reactions. In most cases no cause is found for these reactions. TRIP data show that anaphylactic reactions occur relatively frequently during or after transfusion of plasma or (plasma rich) platelet concentrates. Data from blood services show that approximately 10% or more of plasma donors regularly use medication which is permitted under donation guidelines. It is conceivable that medication taken by the donor, or its metabolites in plasma for transfusion, could cause an anafylactic transfusion reaction in the recipient. Aims: This exploratory study investigated the presence of drug or drug metabolites in donor plasma after quarantine, storage and thawing. Method: In a large hospital, samples (5 ml) were taken from thawed quarantine fresh frozen plasma units which had to be rejected for transfusion because of leaks or length of time after thawing. The samples were stored frozen at 70°C until screening. Only samples for which the blood supply organisation confirmed that the donor had consented to research use were included. The samples were analysed for approximately 800 drugs or drug metabolites using ITox screening and LC-MSMS. All detectable substances that were recognised as drug or drug metabolite were considered as positive screening results. Results: Currently 87 samples have been collected and analysed. ITox screening was positive in 14 samples, In 11 samples only one substance was determined and in three samples the presence of two or three drugs was measured. Summary/conclusions: In 14 out of 87 analysed quarantine fresh frozen plasma units (16%) drug or drug metabolites could be detected. This is in line with the expectation that 10-20% of the plasma donors use medication on a regular basis. The measured concentrations did not exceed the concentrations expected with normal use of the medication. All of the detected drugs are permitted under donor guidelines. The finding of methyl paraben in one sample, not in association with medication, was unexpected. Methyl paraben is widely used as preservative by cosmetic and pharmaceutical industries. Parabens are also used as food additives. After freezing, quarantine, storage and thawing of fresh frozen plasma units it is possible to detect medication in therapeutic concentrations in donor plasma. After dilution in an adult recipient, no relevant pharmaceutical effects would be expected from the substances. It cannot be excluded that a sensitised patient could have an anaphylactic reaction due to administration of plasma containing medication taken by the donor. Further investigation of the effects of donor medication in the recipients of plasma or plasma rich blood products is recommended. Table 1: Overview of the drugs that were screened