Immunoadsorption-based plasma preparation: In vitro evaluation of anti-A and anti-B antibody depletion and Factor VIII activity preservation

Introduction. Plasma transfusion remains an integral component of intensive care for massive hemorrhage, coagulopathies, and disseminated intravascular coagulation, particularly in emergencies where the recipient’s blood group is unknown or cannot be determined immediately. In such cases, administering group-specific plasma is impossible, while the supply of group AB plasma is limited to 4–5% of the total donor pool. In this study, “ABO-universal plasma” is defined as a donor blood component suitable for use in recipients of any ABO blood group without prior determination of their blood type. This product is designed to expand intravascular volume and restore hemostasis. One promising approach to creating such a product is the immunoadsorption of anti-A/anti-B antibodies; however, domestic data regarding its effect on labile hemostatic factors—primarily Factor VIII (FVIII)—are scarce.

Objective. To evaluate the feasibility of using immunoadsorption to prepare a fresh frozen plasma (FFP) component that is free of anti-A/anti-B antibodies or characterized by ultra low-titers (≤ 1:8), with preserved activity of labile hemostatic factors. This product is intended for use in patients regardless of their ABO blood group, including for hemostasis restoration.

Materials and methods. This in vitro study utilized a paired pre-post design to evaluate 90 FFP samples (30 samples from each blood group: O, A, and B). Anti-A/anti-B antibodies were depleted using immunoadsorbents (POKARD, Russia) in a closed system at 22–25 °C (100-mL plasma volume; 30-min contact time). IgM antibody titers were determined by direct agglutination in gel cards, while IgG antibodies were assessed via the indirect antiglobulin test; Factor VIII activity (FVIII:C) was measured by activated partial thromboplastin time (aPTT) using a coagulometer. Statistical analysis was performed using the Mann-Whitney U test; differences were considered significant at p < 0.05.

Results. For initial anti-A and anti-B antibody titers of ≤ 1:32, adsorption completely removed the antibodies; for initial titers ranging from > 1:32 to 1:512, levels decreased to 1:2–1:8, which meets the international criteria for ultra low-titer plasma. FVIII activity decreased in all groups following adsorption, with technological losses amounting to 18–20%. Baseline FVIII activity in group O plasma was significantly lower than in groups A and B. Following adsorption, all samples from groups A and B retained compliance with the regulatory criterion (FVIII ≥ 0.7 IU/mL), whereas up to 50% of group O samples failed to meet the required minimum and could not be labeled as FFP.

Conclusions. Immunoadsorption ensured effective removal of anti-A/anti-B antibodies from FFP; however, it was associated with an 18–20% loss of FVIII activity, which is critical primarily for group O plasma. The development of a “ABO-universal plasma” production technology using this method is feasible for special-purpose products — such as emergency prehospital care, military medicine, and strategic reserve formation — provided that donors with baseline FVIII activity ≥ 95% are prescreened (group O) and/or the product is reformulated into lyophilized “ABO-universal plasma”.

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