Fresh Frozen Plasma as a Successful Antidotal Supplement in Acute Organophosphate Poisoning

Open access

Despite improvements to intensive care management and specific pharmacological treatments (atropine, oxime, diazepam), the mortality associated with organophosphate (OP) poisoning has not substantially decreased. The objective of this examination was to describe the role of fresh frozen plasma (FFP) in acute OP poisoning. After a deliberate ingestion of malathion, a 55-year-old male suffering from miosis, somnolence, bradycardia, muscular fasciculations, rales on auscultation, respiratory insufficiency, as well as from an inhibition of red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE), was admitted to hospital. Malathion was confirmed in a concentration of 18.01 mg L-1. Apart from supportive measures (including mechanical ventilation for four days), antidotal treatment with atropine, oxime - pralidoxime methylsulphate (ContrathionR), and diazepam was administered, along with FFP. The potentially beneficial effects of FFP therapy included a prompt increase of BuChE activity (from 926 IU L-1 to 3277 IU L-1; reference range from 7000 IU L-1 to 19000 IU L-1) and a reduction in the malathion concentration, followed by clinical recovery. Due to BuChE replacement, albumin content, and volume restitution, FFP treatment may be used as an alternative approach in patients with acute OP poisoning, especially when oximes are not available.

1. Eddleston M, Buckley NA, Eyer P, Dawson AH. Management of acute organophosphorus pesticide poisoning. Lancet 2008;371:597-607. doi: 10.1016/S0140-6736(07)61202-1

2. Rahimi R, Nikfar S, Abdollahi M. Increased morbidity and mortality in acute human organophosphate-poisoned patients treated by oximes: a meta-analysis of clinical trials. Hum Exp Toxicol 2006;25:157-62.doi:10.1191/0960327106ht602oa

3. Doctor BP, Saxena A. Bioscavengers for the protection of humans against organophosphate toxicity. Chem Biol Interact 2005;15:167-71.

4. Guven M, Sungur M, Eser B, Sari Ĭ, Altuntaş F. The effects of fresh frozen plasma on cholinesterase levels and outcomes in patients with organophosphate poisoning. J Toxicol Clin Toxicol 2004;425:613-9.

5. Pichamuthu K, Jerobin J, Nair A, John G, Kamalesh J, Thomas K, Jose A, Fleming JJ, Zachariah A, David SS, Daniel D, Peter JV. Bioscavenger therapy for organophosphate poisoning-an open-labeled pilot randomized trial comparing fresh frozen plasma or albumin with saline in acute organophosphate poisoning in humans. Clin Toxicol 2010;48:813-9. doi: 10.3109/15563650.2010.518970

6. Doctor BP, Maxwell DM, Ashani Y, Saxena A, Gordon RK. New approaches to medical protection against chemical warfare agents. In: Somani SM, Romano JA Jr, editors. Chemical warfare agents:toxicity at low levels. New York (NY):CRC Press; 2002. p. 191-214.

7. Li B, Schopfer LM, Hinrich SH, Masson P, Lockridge O. Matrix-assited laser desorption/ionization time-of-flight mass spectrometry assay for organophosphorus toxicants bound to human albumin at Tyr411. Anal Biochem 2007;361:263-72. doi: 10.1016/j.ab.2006.11.018

8. Peeples ES, Schopfer LM, Duysen EG, Spaulding R, Voelker T, Thompson CM, Lockridge O. Albumin, a new biomarker of organophosphorus toxicant exposure, identified by mass spectrometry. Toxicol Sci 2005;83:303-12. doi: 10.1093/ toxsci/kfi023

9. Guven M, Sungur M, Eser B. The effect of plasmapheresis on plasma cholinesterase levels in a patient with organophosphate poisoning. Hum Exp Toxicol 2004;23:365-8. doi: 10.1191/0960327104ht462cr

10. Fulton JA. FFP in organophosphate poisoning:what´s the secret ingredient? Clin Toxicol 2005;43:215. doi: 10.1081/ CLT-200053343

11. Zivot U, Castorena JL, Gariott JC. A case of fatal ingestion of malathion. Am J Forensic Med Pathol 1993;14:51-3.

12. Farago A. Fatal, suicidal malathion poisonings. Arch Toxicol 1967;23:11-6. doi: 10.1007/BF00577694

Archives of Industrial Hygiene and Toxicology

The Journal of Institute for Medical Research and Occupational Health

Journal Information

IMPACT FACTOR 2017: 1.117
5-year IMPACT FACTOR: 1.335

CiteScore 2017: 1.24

SCImago Journal Rank (SJR) 2017: 0.341
Source Normalized Impact per Paper (SNIP) 2017: 0.494

Cited By


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 366 366 14
PDF Downloads 90 90 6