|Year : 2020 | Volume
| Issue : 1 | Page : 93-95
Green colored plasma discovered in a male blood donor: A cause for concern?
Shweta Pai, Zubair Hasan, Madhusmita Jena
Department of Pathology, East Point College of Medical Sciences and Research Center, Bengaluru, Karnataka, India
|Date of Submission||23-Oct-2019|
|Date of Decision||28-Dec-2019|
|Date of Acceptance||10-Feb-2020|
|Date of Web Publication||17-Apr-2020|
Department of Pathology, East Point College of Medical Sciences and Research Center, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
The normal color of plasma is yellow, which is owing to the presence of factors such as bilirubin, hemoglobin, carotenoids, and iron transferrin. We recently came across an interesting case of greenish colored plasma in our blood bank. An extensive literature survey revealed that our conspicuous finding was not an isolated one and that similar such rare incidents have been reported in the past, on a sporadic basis. Several diverse reasons have been attributed to the peculiar greenish color like the presence of high ceruloplasmin levels, Pseudomonas aeruginosa infection and so on, but they were ruled out in our case. We thus, report our finding of greenish colored plasma in an otherwise healthy donor because of the rarity of its occurrence and also, to allay any sense of fear or alarm that an encounter may raise in the blood bank staff.
Keywords: Ceruloplasmin, green colored plasma, Pseudomonas aeruginosa
|How to cite this article:|
Pai S, Hasan Z, Jena M. Green colored plasma discovered in a male blood donor: A cause for concern?. Glob J Transfus Med 2020;5:93-5
| Introduction|| |
Plasma is the largest component of blood (around 55% by volume), the rest being taken up by the formed elements. It keeps the blood cells in suspension and acts as a medium of transport for proteins in the body. Normally, plasma is yellowish in color; however, this is not always the case, as there have been past reports of variants that range from yellow to orange to even brown plasma. The cause(s) of these peculiar observations have been attributed to the various normal elements of metabolism such as bilirubin, hemoglobin, carotenoids, and iron transferrin. Recently, we encountered a highly unusual sample of green colored plasma in our blood bank. This case study was, therefore, undertaken to assess the possible reasons behind it and also to ascertain its safety for the purpose of transfusion.
| Case Report|| |
We report a case of greenish discoloration of plasma [Figure 1] and [Figure 2]. Donor was a healthy male with no known medical ailments. He was 30-year-old, weighing 95 kg with B positive blood group having hemoglobin of 13.5 g/dl. At the time of donation, his heart rate was 70 beats/min, and his blood pressure was 126/86 mm Hg. Blood donor consent was obtained as per institutional requirements in line with international ethical guidelines. A volume of 450 ml of blood was drawn from the donor which was then subjected to slow centrifugation process in a component separator (REMI, KBM-70 plus centrifuge) that fractionated the whole blood into packed red blood cells and plasma. Plasma was extracted from the bag using TECSONIC plasma extractor. High-speed centrifugation was then applied to the platelet-rich plasma, which yielded one unit of fresh frozen plasma and one unit of platelets. What baffled us is the appearance of a greenish color in the plasma component. We decided to do a literature survey to find out if this was normal and if not, to ascertain the causes responsible for it. Hence, we contacted the donor and elicited a detailed history. There was no known history of intake of sulfonamides or any other drugs, nor was there any past history of rheumatoid arthritis. Donor's serum was subjected to various tests. Serum ceruloplasmin level was ascertained through nephelometric assay in BN ProSpec System (SIEMENS) and was found to be 0.35 g/l (normal range: 0.2–0.6 g/l). Total and direct bilirubin were assayed by the AU480 Beckman Coulter analyzer employing the Jendrassik-Grof method. Total bilirubin level was 0.72 mg/dl (normal range: 0.1–1.2 mg/dl) and direct bilirubin was 0.17 mg/dl (normal range: <0.2 mg/dl). All the blood tests were found to be in the normal range. Subsequently, donor's plasma was sent to the microbiology department for culture, but no growth was reported.
|Figure 2: Comparison of greenish colored plasma unit (left, arrow) with normal yellow colored plasma unit (right)|
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| Discussion|| |
The normal color of plasma is yellow owing to the presence of factors such as bilirubin, hemoglobin, carotenoids, or iron transferrin. Even though there have been reports of other colors of plasma in the literature, greenish colored plasma is mentioned less frequently. The attributed reasons for greenish color in plasma are diverse. One such reason is elevated ceruloplasmin levels which is usually seen in pregnancy, in women on oral contraceptives and in rheumatoid arthritis., Another more grave reason is the presence of Pseudomonas aeruginosa infection.
Swinburne et al. identified greenish colored plasma in patients with rheumatoid arthritis and correlated the decrease in the normal plasma yellowishness with the duration of the disease. Tovey and Latheand Clemetson in their independent studies also reported a striking green color in plasma., However, the donors involved in their studies were young married women who did not have rheumatoid arthritis. Their attempts to extract the greenish pigment were met with failure. However, they managed to extract an unexpected bluish precipitate which was later identified to be ceruloplasmin. Ceruloplasmin functions as a carrier of copper and is a normal plasma glycoprotein as well as an acute phase reactant. High ceruloplasmin levels can occur when body copper levels are high, in rheumatoid arthritis, in high estrogen states such as pregnancy and use of oral contraceptives.,
Wolf et al. also found that high ceruloplasmin to be responsible for the extremely greenish color of plasma in 15 donors of his study. They were all females and were on oral contraceptives. Elkassabany et al., Raghuwanshi and Pehlajani and Gorlin et al. also found oral contraceptives to be the cause of the greenish color of the plasma in their studies as well.,, According to the Canadian blood services, the green colored plasma due to oral contraceptives was found to be safe and acceptable for transfusion.
Further Cotton et al. found in their study that as compared to normal colored plasma, the green colored plasma had higher coagulation factor levels (Factors II, VII, IX, and XI), higher hypercoagulable thromboelastogram profile (for values such as r-value, k-time, and angle, mA), a higher lag time and enhanced endogenous thrombin potential.
Another cause of green colored plasma is the intake of sulfonamide drugs as documented by Flexman et al.
The unit of plasma that we encountered in our case study was greenish in color. Donor gave no history of intake of sulfonamides and there was no history or clinical features suggestive of rheumatoid arthritis. Hence, these etiologies were ruled out. Serum ceruloplasmin and bilirubin levels were also found to be normal. When plasma was sent to microbiology department to rule out any infectious causes, it was reported as sterile plasma. Hence, P. aeruginosa was ruled out as the etiology. Thus, we eliminated all the possible etiologies of concern for greenish colored plasma in the donor.
| Conclusion|| |
Greenish colored plasma is an interesting entity owing to its rarity and the apprehension it causes among the blood bank staff to issue such a unit to the recipients. However as is evident from our case, there was nothing pathogenic about greenish colored plasma and it was indeed benign. In conclusion, if etiologies like infection with P. aeruginosa are ruled out, then it can be safely used for transfusion. However, the effect of the hypercoagulable profile of green colored plasma on the recipient remains to be evaluated.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Elkassabany NM, Meny GM, Doria RR, Marcucci C. Green plasma-revisited. Anesthesiology 2008;108:764-5.
Scheinberg IH, Cook CD, Murphy JA. Concentration of copper and ceruloplasmin in maternal and infant plasma at delivery. J Clin Invest 1954;33:963.
Koskelo P, Kekki M, Virkkunen M, Lassus A, Somer T. Serum ceruloplasmin concentration in rheumatoid arthritis, ankylosing spondylitis, psoriasis and sarcoidosis. Acta Rheumatol Scand 1966;12:261-6.
Wolf P, Enlander D, Dalziel J, Swanson J. Green plasma in blood donors. N
Engl J Med 1969;281:205.
Swinburne K, Losowsky MS, Hall DA. Pigmentation of serum in rheumatoid arthritis. Proc R Soc Med 1963;56:818-20.
Tovey LA, Lathe GH. Caeruloplasmin and green plasma in women taking oral contraceptives, in pregnant women, and in patients with rheumatoid arthritis. Lancet 1968;2:596-600.
Clemetson CA. Caeruloplasmin and green plasma. Lancet 1968;2:1037.
Johnson DA, Osaki S, Frieden E. A micromethod for the determination of ferroxidase (ceruloplasmin) in human serums. Clin Chem 1967;13:142-50.
Raghuwanshi B, Pehlajani NK. Green colour donor plasma. Indian J Anaesth 2016;60:778-9.
] [Full text]
Gorlin JB, Engblom A, Janzen M. Transfusion medicine illustrated. Green plasma in female blood donors on estrogen-containing birth control pills. Transfusion 2013;53:2122.
Flexman AM, Del Vicario G, Schwarz SK. Dark green blood in the operating theatre. Lancet 2007;369:1972.
[Figure 1], [Figure 2]