Global Journal of Transfusion Medicine

LETTERS TO EDITOR
Year
: 2020  |  Volume : 5  |  Issue : 2  |  Page : 234--235

Green plasma day … Was sterilization agent the culprit?


Jayasree Cherukat, Abhishekh Basavarajegowda 
 Department of Transfusion Medicine, JIPMER, Puducherry, India

Correspondence Address:
Abhishekh Basavarajegowda
Department of Transfusion Medicine, JIPMER, Puducherry
India




How to cite this article:
Cherukat J, Basavarajegowda A. Green plasma day … Was sterilization agent the culprit?.Glob J Transfus Med 2020;5:234-235


How to cite this URL:
Cherukat J, Basavarajegowda A. Green plasma day … Was sterilization agent the culprit?. Glob J Transfus Med [serial online] 2020 [cited 2021 Apr 16 ];5:234-235
Available from: https://www.gjtmonline.com/text.asp?2020/5/2/234/300634


Full Text



Sir,

There are many reports in the literature about green plasma collected from blood donors. In almost all of these, the cause is donor related.[1] Here, we describe a unique scenario where plasma separated from whole blood collected from 37 donors on a single day was found to be green in color.

Following whole blood collection in a triple non-SAGM bag on a regular day, during component separation, it was noticed that the plasma and the platelet were green in color. The bags were quarantined. This particular bag had been collected from a healthy 25-year-old male donor who had no history of drug intake. The plasma sample was sent for “liver function tests.” All values were within normal limits. Quality check (QC) of the components with regard to physical appearance, platelet count, Factor VIII levels, and Factor IX levels was done. Products met the QC criteria. However, the bags were discarded suspecting some unknown contamination.

The same day, following the collection of blood in a bag, it was noticed that the top portion of the satellite bags had a greenish discoloration, as shown in [Figure 1]. The bags were discarded. The next day, 37 donors were bled in a camp. During component separation, it was noticed that all the plasma and platelets were green in color, as shown in [Figure 2]. All the bags were non-SAGM, CPDA 350 ml bags. The donors had predominantly been healthy male donors. Only four had been female donors.{Figure 1}{Figure 2}

When packed cells were observed after lying undisturbed for some time, it was seen that the supernatant plasma was also green tinged. The bags were all manufactured by “Poly Medicure LTD.” There were two different lots of bags involved in the collection on that day are shown in [Figure 3]. The day of collection was well before the date of expiry.{Figure 3}

The green color of the plasma persisted even after one of the bags was opened, and the plasma was transferred to a glass test tube indicating that it was not a visual effect attributable to bag material, as shown in [Figure 4]. We also tried transferring the green plasma into another transfer bag of another company. The same intensity of green color persisted as shown in [Figure 5].{Figure 4}{Figure 5}

Two of the green plasma bags were sent for bacterial culture, while two for fungal culture. Further, two empty bags of the involved lots were sent for culture. No organisms were isolated from fungal/bacterial culture. Factor VIII and Factor IX were assayed in a few of the bags. All were within normal levels.

In almost all of the cases in the literature there was either a raised level of ceruloplasmin (a copper containing protein) in the donors due to various causes, such as use of oral contraceptives, pregnancy, and rheumatoid arthritis, or as a result of sepsis with Gram-negative cryophilic bacteria such as Pseudomonas.[2],[3]

After a few days of storage, it was seen that most of the bags changed color to the normal expected yellow. After ruling out the known cause, we hypothesize that probably the discoloration was due to the agent used for sterilization. The remnants of the sterilization agent must have mixed with the yellow plasma and turned green in color. Following storage, the gas may have been leached off and the plasma must have regained normal yellow color.

Acknowledgment

Dr. Aditya Shivahare and Dr. Indranil Das, Residents, Department of Transfusion Medicine, JIPMER, for general and technical support rendered was acknowledged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Elkassabany NM, Meny GM, Doria RR, Marcucci C. Green plasma-revisited. Anesthesiology 2008;108:764-5.
2Pai S, Hasan Z, Jena M. Green colored plasma discovered in a male blood donor: A cause for concern? Glob J Transfus Med 2020;5:93.
3Gorlin JB, Engblom A, Janzen M. Transfusion medicine illustrated. Green plasma in female blood donors on estrogen-containing birth control pills. Transfusion 2013;53:2122.