GPR: 2020 - Week 07

From MGH Learn Pathology

Clinical history

Anesthesia resident paging the blood bank before transfusion of FFP because: "The plasma looks green. Is it OK to transfuse?"

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Normal discoloration of plasma
  • Normal plasma is usually yellow, and clear to semi-opaque, but can range from light yellow to light green
  • Green discoloration is often due to elevation in ceruloplasmin (Cu2+)
  • Most common causes: estrogen OCPs, pregnancy, rheumatoid arthritis
  • Acceptable for transfusion

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Lipemic plasma

  • Opaque to milky white appearance
  • Caused by excessive amounts of lipids and cholesterol
  • Does not affect safety of product
  • May affect pre-transfusion testing

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Icteric plasma

  • Ranges from bright/neon yellow to brown
  • Caused by high bilirubin content
  • Seen in eligible donors with Gilbert's syndrome
  • Acceptable for transfusion

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Bacterial contamination

  • May look normal
  • May contain clots and fibrin strands
  • May have milky or murky appearance
  • Excessively bubbly
  • Contamination with pseudomonas can result in greenish hue
Dr. W. Dzik

Dr. R. Makar

A. Slater
  • Blood Component Visual Inspection Guide, American Red Cross, AABB, 2006.
  • Visual Assessment Guide, Canadian Blood Services, 2009.
  • Tovey LAD and Lathe GH. Ceruloplasmin and Green Plasma in Women Taking Oral Contraceptives, in Pregnant Women, and in Patients with Rheumatoid Arthritis. The Lancet (1968).
  • Elkassabany NM, et al. Green Plasma Revisited. Anesthesiology (2008).
  • Gorlin JB, Engblom A, and Janzen M. Green Plasma in Female Blood Donors on Estrogen-containing Birth Control Pills. Transfusion (2013).

This week's Gross Pathology Roundup was presented by Tasos Gogakos, MD on Mon, Feb 10, 2020.