FRESH-FROZEN PLASMA HAS NO BENEFICIAL EFFECT ON THE HEMOSTATIC SYSTEMIN CHILDREN RECEIVING L-ASPARAGINASE

L-Asparaginase (ASP), a chemotherapeutic agent used in the treatment o f children with acute lymphoblastic leukaemia (ALL), is linked to thro mboembolic complications secondary to an acquired deficiency of antith rombin III (ATIII). Fresh frozen plasma (FFP) is used to prevent and/o r treat thrombotic complications in these children. However, the effec t of FFP on plasma concentrations of ATIII and biochemical markers of activation of coagulation has never been tested. In this study, FFP (2 0 ml/kg) was administered to eight children with ALL receiving ASP in the consolidation phase of their treatment. Plasma samples were drawn pre-infusion, and following infusion at 1, 24, and 48 hr. Prior to the FFP infusions, plasma concentrations of prothrombin, fibrinogen, alph a(2)-macroglobulin, heparin cofactor II, protein C, and protein S were similar to levels in healthy children. Only plasma concentrations of ATIII were significantly decreased (0.55 U/ml). Following FFP infusion s, there was no statistical or clinically important increase in plasma concentrations of any coagulation protein at any time point. Pre-infu sion plasma concentrations of markers of endogenous thrombin generatio n (thrombin-antithrombin III complexes (TAT)) and activation of the fi brinolytic system in response to activation of the coagulation system (D-dimer levels) were significantly increased. However, FFP had no sta tistical or clinically important effect on concentrations of these mar kers. We conclude that FFP administration for the prevention and treat ment of acquired ATIII deficiency secondary to ASP has no demonstrable benefit on plasma levels of coagulation proteins and is unlikely to b e of clinical benefit. (C) 1994 Wiley Liss, Inc.