Effects of Co-infusion of Plasma, Whole Blood and Anticogulants on Their Clotting Activities.

Aims: Nafamostat mesilate (NM), a protease inhibitor is available for treating acute pancreatitis and disseminated intravascular coagulopathy and it is used as an anticoagulant for hemodialysis in Japan. A plasmapheresis circuit using NM can easily be blockaded. Therefore, we investigated the influence of co-infusion of fresh frozen plasma (FFP), whole blood and NM on clotting activities mainly in the static condition compared with other anticoagulants including heparin sodium and gabexate mesilate. Study Design: In vitro study. Methodology: We investigated the effect of co-incubation of expired FFP and various concentrations of NM (0–0.1mg/mL). We measured the plasma fibrinogen level and activities of factor XIII, anti-thrombin III, protein C (PC) and protein S (PS). In addition, we examined the influence of NM on coagulation tests using whole blood from healthy volunteers. Results: NM reduced PC and PS activities in FFP, although it did not affect plasma fibrinogen levels or the activities of anti-thrombin III or factor XIII. While anti-thrombin III activity and plasma fibrinogen level increased in NM-containing whole blood, PC and PS activities decreased. Gabexate mesilate, sodium heparin and citrate did not reduce the activities of PC or PS. Conclusion: Co-infusion of FFP, whole blood and NM reduces PC and PS activities and we speculate that it may lead to the obstruction of the plasmapheresis circuit when using NM as an anticoagulant.

Bromocresol Dye-binding Methods Underestimate Serum Albumin Value in Patients Treated with High Dose of Penicillin G.

Background: Various factors contribute to the discrepancies observed between the bromocresol green (BCG) and bromocresol purple (BCP) assays of serum concentration. Either a BCG or a modified BCP assay is a routine laboratory for albumin measurement in Japan. High-dose of penicillin G underestimates serum albumin level using a modified BCP method in vitro. Therefore, we examined the serum albumin level in the patients treated with high-dose of penicillin G and also performed the experiments on coincubation with plasma, or albumin product and penicillin G solution in vitro. Methods: The medical records of 71 patients treated with high-dose of Penicillin G collected between 2009 and 2012 were reviewed for age, gender, biochemistry (total protein, albumin and potassium), underlying diseases and usage of albumin product. Patients were divided into 2 groups: BCG group (N = 38) and a modified BCP group (N = 33). We compared serum albumin levels between two groups. We performed the experiments on co-incubation with albumin product or human plasma and penicillin G solution in vitro. Results: Serum albumin levels using a modified BCP assay decreased during the treatment with high dose penicillin G (-0.4 ± 0.1 g/dL), while serum albumin levels by a BCG method did not decrease (0.06 ± 0.05 g/dL). Although only one patient revealed hypoalbuminemia (<2.0 g/dL) by a BCG method (2.6%), ten patients revealed hypoalbuminemia by a modified BCP method (33%). Penicillin G underestimated plasma albumin levels using a modified BCP methods (% underestimation: 42.9 ± 0.0%) more than those using a BCG method (% underestimation: 10.6 ± 0.0%) in co-incubation experiments in vitro. Conclusion: High-dose of penicillin G might cause the underestimation of serum albumin levels using bromocresol dye-binding methods.