GPR: 2020 - Week 07

• GPR Quiz
• Answer
• DDx1
• DDx2
• DDx3
• Acknowledgments
• Reference(s)

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

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

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

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).

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