Recommended methods for conducting radiolabeled platelet survival studies

Exploratory studies of extended storage of apheresis platelets in a platelet additive solution (PAS)

To evaluate the poststorage viability of apheresis platelets stored for up to 18 days in 80% platelet additive solution (PAS)/20% plasma, 117 healthy subjects donated platelets using the Haemonetics MCS+, COBE Spectra (Spectra), or Trima Accel (Trima) systems. Control platelets from the same subjects were compared with their stored test PAS platelets by radiolabeling their stored and control platelets with either (51)chromium or (111)indium. Trima platelets met Food and Drug Administration poststorage platelet viability criteria for only 7 days vs almost 13 days for Haemonetics platelets; ie, platelet recoveries after these storage times averaged 44 ± 3% vs 49 ± 3% and survivals were 5.4 ± 0.3 vs 4.6 ± 0.3 days, respectively. The differences in storage duration are likely related to both the collection system and the storage bag. The Spectra and Trima platelets were hyperconcentrated during collection, and PAS was added, whereas the Haemonetics platelets were elutriated with PAS, which may have resulted in less collection injury. When Spectra and Trima platelets were stored in Haemonetics' bags, poststorage viability was significantly improved. Platelet viability is better maintained in vitro than in vivo, allowing substantial increases in platelet storage times. However, implementation will require resolution of potential bacterial overgrowth during storage.

Introducing a dexamethasone mouse model for monitoring in vivo viability of stored human platelets

OBJECTIVES

The aim of this study is to establish an available animal model which can evaluate in vivo viability of stored human platelets (HuPLTs).

BACKGROUND

The viability in vivo of HuPLTs was usually evaluated by transfusing HuPLTs into animals before clinical trials. It is necessary to develop a method which may slow down rapid clearance of HuPLTs from circulation of the animal.

METHODS

Carbon clearance tests were performed by treating mice with dexamethasone (DEX) to determine the phagocytic ability of the mice macrophages. HuPLTs in mice whole blood were detected by flow cytometric analysis with mouse anti-human CD41-fluorescein isothiocyanate monoclonal antibody. Recovery and survival of the HuPLTs stored at 22 °C for 1 day were evaluated after transfusing these HuPLTs into DEX-treated mice, and compared with those either stored at 22 °C for 5 days or at 4 °C for 1 day.

RESULTS

Corrected phagocytic indexes of DEX-treated mice decreased significantly compared with those of control mice (P < 0.05). The recovery after 24 h and survival time of fresh HuPLTs in DEX-treated mice were much higher than those in control mice (P < 0.01). After transfused into the DEX-treated mice, HuPLTs stored either at 22 °C for 5 days or at 4 °C for 1 day showed decrease in recovery and survival compared with those stored at 22 °C for 1 day (P < 0.05).

CONCLUSION

Dexamethasone slows down the rate of HuPLTs clearance efficiently in mouse circulation. And the DEX-treated mouse model was able to evaluate the in vivo viability of stored HuPLTs.

Extended storage of autologous apheresis platelets in plasma

BACKGROUND AND OBJECTIVES

The purpose of our studies was to determine the effects of extended platelet storage on poststorage platelet viability.

MATERIALS AND METHODS

Normal subjects were recruited to donate platelets using two different apheresis systems: either the COBE Spectra (n = 58) or the Haemonetics MCS+ (n = 84). Platelet recovery and survival data from the two systems were compared with each other and with in vitro measurements of the stored platelets.

RESULTS

There were no significant differences in either platelet recoveries or survivals between the two machines between 1 and 8 days of storage. Combining the data from both machines, platelet recoveries decreased by 2.6% and survivals by 0.3 days/storage day. In vitro assays did not predict either platelet recoveries or survivals during storage for 5-8 days. After 9 days of storage, pHs were unacceptable (≤ 6.1), suggesting that 8 days will be the longest possible storage time.

CONCLUSIONS

These data suggest that, if stored platelet bacterial contamination issues are resolved, significant extension of platelet storage times is possible.

Evaluation of the properties of components prepared and stored after holding of whole blood units for 8 and 24 hours at ambient temperature

BACKGROUND

The capability of holding whole blood (WB) units at ambient temperature, overnight, should help in platelet (PLT) concentrate preparation logistics. We summarize the results of a study conducted in the early 1990s that compared, in particular, PLT and red blood cell (RBC) in vivo viability properties following storage after preparation after 8- and 24-hour WB hold periods.

STUDY DESIGN AND METHODS

Individuals donated units of WB on two occasions. Centrifugation at 20 to 24°C to separate PLTs and additive system RBC placement at 1 to 6°C was completed 8 hours after phlebotomy or after 24 hours in randomized order. Components were not leukoreduced. Studies including in vitro biochemical and hematologic analyses and autologous in vivo RBC and PLT evaluations were conducted at two sites.

RESULTS

RBC 24-hour in vivo (mean ± SD) recoveries (single-label approach), after 35 days of storage, were 79.2 ± 4.3 and 79.4 ± 3.9% (n = 9; p > 0.05), with WB holding periods of 8 and 24 hours, respectively. With 42 days of storage, recovery after a 24-hour hold was slightly less than with an 8-hour hold (72.9 ± 6.5% vs. 76.0 ± 5.4%; n = 17; p < 0.05). RBC 2,3-diphosphoglycerate acid levels were substantially less after the 24-hour hold compared to after the 8-hour hold (n = 18; p < 0.05). PLT recovery after 5 days of storage with 8- and 24-hour hold periods were similar, 51.1 ± 14.9 and 50.6 ± 17.7%, respectively (n = 18; p > 0.05). The PLT survival variable and in vitro properties reflecting storage quality also showed no significant difference.

CONCLUSION

RBC and PLT in vivo variables, and most in vitro variables, were not significantly different after storage with WB holding times of 8 and 24 hours except for a slight diminution of RBC recovery with the 24-hour hold after 42 days of storage.

The platelet storage lesion

The gradual loss of quality in stored platelets as measured collectively with various metabolic, functional, and morphologic in vitro assays is known as the platelet storage lesion. With the advent of pathogen reduction technologies and improved testing that can greatly reduce the risk for bacterial contamination, the platelet storage lesion is emerging as the main challenge to increasing the shelf life of platelet concentrates. This article discusses the contribution of platelet production methods to the storage lesion, long-established and newly developed methods used to determine platelet quality, and the significance for clinical transfusion outcome. Highlighted are the novel technologies applied to platelet storage including platelet additive solutions and pathogen inactivation.

Hemostatic and signaling functions of transfused platelets

Metabolic studies have revealed a gradual impairment in platelet integrity during storage, a process termed the platelet storage lesion. Recent evidence shows that stored platelets also lose signaling responses to physiological agonists with impaired integrin activation, secretion, and aggregation of the cells. On the other hand, storage leads to a gain in platelet activation properties, such as release of microparticles and appearance of surface epitopes for their clearance by macrophages. New techniques for measuring flow-induced thrombus formation and platelet-dependent coagulation provide evidence that the hemostatic activity of platelets decreases during storage. Besides pharmacological inhibition, novel storage strategies, like metabolic suppression, should be considered to better preserve platelet functionality while limiting the expression of clearance markers. Understanding the changes that occur in association with the platelet storage lesion and the use of updated storage methods will help to generate platelets for transfusion with optimal hemostatic function and a long circulation time after transfusion.

Further evaluation of a new standard of efficacy for stored platelets

BACKGROUND

The proposal to assess the viability capabilities of platelets (PLTs) collected, treated, or stored in a developmental system against "fresh" PLTs from the same subject poses several important methodologic issues pertaining to the timing and manner of the collecting and separating the fresh PLTs. This study extended the previous validation of this method of comparing fresh and stored PLTs, applying it to an assessment of apheresis PLTs stored for 7 days with a newly standardized radiolabeling protocol.

STUDY DESIGN AND METHODS

Eighteen normal subjects donated 1 unit of leukoreduced PLTs, pheresed with a standard, approved system. They received an aliquot radiolabeled with 51Cr on Day 7 simultaneously with 111In-labeled fresh PLTs that had been separated by a manual method. Recovery and survival were compared to determine whether the stored PLTs were not inferior to the criterion of 67 percent of recovery and 50 percent of survival of fresh PLTs. Separate studies were undertaken to document the similarity of recovery and survival with 51Cr and 111In radiolabeling in PLTs stored to 8 days and to determine the importance of correcting the radioactivity in timed samples for the activity remaining in blood beyond the life span of the retransfused PLTs.

RESULTS

PLTs stored for 7 days demonstrated 88.7 +/- 35.2 percent of the recovery and 89.9 +/- 21.2 percent of the survival of PLTs collected via a nonproprietary, manual system and thus met the comparative criterion. In a separate study (n = 12), labeling Day 8 PLTs with 51Cr or 111In resulted in recoveries and survivals that were not different. Radiolabel eluted from labeled PLTs in vitro was taken up by cellular blood elements in a reuptake incubation.

CONCLUSION

Apheresis PLTs stored for 7 days met the criterion proposed for comparison with fresh PLTs. This analytic approach is feasible with PLTs collected and prepared via a manual method. A standardized protocol for radiolabeling PLTs with 51Cr and 111In and analyzing the results in a standardized fashion was employed successfully, with the two radioisotopes yielding similar results. The importance of correcting for residual activity after disappearance of injected cells was noted.

Assessment of the correlation of platelet morphology with in vivo recovery and survival

BACKGROUND

There is continuing interest in the development of in vitro tests evaluating the in vivo function, recovery, and survival of platelets stored for transfusion. A recent forum concluded that no completely reliable test exists, although discoid morphology indicates a platelet's good health. We evaluated a novel device, the NAPSAC (Noninvasive Assessment of Platelet Shape and Concentration), designed to determine noninvasively the proportion of discoid platelets in a stored concentrate, as well as platelet concentration.

STUDY DESIGN AND METHODS

Twenty-eight plateletapheresis concentrates stored 24 hours in PL-146 were evaluated. Percent discoid platelet results were correlated with radiolabeled autologous recovery and survival performed using 111Indium oxyquinoline and calculated using linear (L) and multiple-hit (M) models. pH of 8 concentrates was raised at the end of storage with 6N NaOH. Platelet concentration measured by NAPSAC and Coulter Thrombocounter C was compared in 256 plateletapheresis products.

RESULTS

Percent discoid platelets at 24 hours did not correlate significantly with platelet recovery or survival (recovery L = 0.29, M = 0.28; survival L = 0.16, M = 0.03). Raising the pH (mean 6.38 to 6.94) resulted in a significant increase in percent discoid platelets (21% to 41%). Platelet concentration values for both methods studied were linearly correlated with a slope of 1.01 +/- 0.03, r = 0.81.

CONCLUSION

Percent discoid platelets was not predictive of posttransfusion platelet recovery or survival. The results suggest that non-discoid platelets may survive posttransfusion and even revert to discoid shape, since raising the pH approximately doubled the percent of discoid platelets. The NAPSAC was shown to be a reliable instrument for noninvasively determining platelet concentration in PL-146 concentrates.

Efficacy of apheresis platelets treated with riboflavin and ultraviolet light for pathogen reduction

BACKGROUND

Pathogen reduction technologies for platelet (PLT) components offer a means to address continued viral transmission risks and imperfect bacterial detection systems. The efficacy of apheresis PLTs treated with riboflavin (vitamin B2) plus ultraviolet (UV) light (Mirasol, Navigant Biotechnologies) was investigated in a single-blind, crossover study in comparison to untreated PLTs.

STUDY DESIGN AND METHODS

Normal subjects (n = 24) donated PLTs by apheresis on two occasions at least 2 weeks apart. Units were randomized to control or test arms, the latter receiving the addition of 28 mL of 500 micromol per L B2 and exposure to 6.2 J per mL UV light. PLTs were stored for 5 days with biochemical and hematologic analyses performed before and after illumination on Day 0 and at the end of storage. An aliquot of each unit was radiolabeled and returned to determine recovery and survival.

RESULTS

The PLT content of treated units was maintained from Day 0 (4.1 x 10(11) +/- 0.4 x 10(11)) to Day 5 (4.0 x 10(11) +/- 0.4 x 10(11)). Treatment with B2 plus UV light was associated with an increase in lactate production with concomitant increases in glucose consumption. pH (control, 7.38 +/- 0.07; test, 7.02 +/- 0.10) was well maintained throughout storage. Recovery of treated PLTs (50.0 +/- 18.9%) was reduced from that of control PLTs (66.5 +/- 13.4%); survival was similarly shortened (104 +/- 26 hr vs. 142 +/- 26 h; p < 0.001).

CONCLUSIONS

PLTs treated with B2 plus UV light demonstrate some alterations in in vitro measures but retain in vitro and in vivo capabilities similar to pathogen-reduced and licensed PLT components that have been shown to have useful clinical applicability. The recovery, survival, and metabolic properties of Mirasol PLTs should provide sufficient hemostatic support in thrombocytopenia to justify patient clinical trials.

Preliminary validation of a new standard of efficacy for stored platelets

BACKGROUND

Platelet preparation and storage systems, unlike those for RBC, lack an objective, absolute performance criterion to determine acceptability. Recently, a criterion based on paired comparison with the radiolabeled recovery and survival of "fresh" platelets has been proposed, namely, recovery = two-thirds and survival = half of "fresh" platelets.

STUDY DESIGN AND METHODS

Eleven normal subjects donated a unit of leukoreduced apheresis platelets using a standard, approved system. They received an aliquot radiolabeled with 111In or 51Cr (random selection) 4 to 20 hours after donation and, using the other radioisotope, on Day 5 of storage. The recovery was calculated based on the injectate radioactivity. The survival was determined using the multiple-hit model. The area under the platelet survival curve was calculated using the COST program.

RESULTS

Reinfusion of platelets less than 20 hours after collection resulted in a recovery of 74.7 +/- 12.3 percent and a survival time of 7.5 +/- 1.1 days. Reinfusion on Day 5 resulted in a recovery of 58.2 +/- 12.0 percent and a survival time of 6.9 +/- 1.4 days, values that were 77.9 +/- 9.5 percent and 91.8 +/- 16.1 percent of the observation using "fresh" platelets, respectively. The area under the curve using Day 5 platelets was 67.8 +/- 11.5 percent of that using "fresh" platelets.

CONCLUSION

The proposed criterion for objective evaluation of platelet preparation and storage systems appears applicable to a commonly accepted approach, leukoreduced apheresis platelets stored in plasma for 5 days, and merits evaluation using other collection, treatment, and storage systems.

Reversibility of severe metabolic stress in stored platelets after in vitro plasma rescue or in vivo transfusion: restoration of secretory function and maintenance of platelet survival

BACKGROUND

Determining reversible aspects of the platelet storage lesion may result in improved function and survival of transfused platelets.

STUDY DESIGN AND METHODS

Using a model of high-dose (apheresis-derived) platelet concentrates (PC), functional changes imposed by transient adverse metabolic conditions (pH < 6.0 for 1-2 hr) that could be reversed by autologous plasma rescue followed by standard platelet storage were investigated. Whole-blood-derived PCs were transfused into a small number of normal volunteers to determine platelet recovery and survival.

RESULTS

Without rescue, high-dose PCs developed severe in vitro functional derangements at the time of the pH nadir including 1) loss of resting morphology; 2) complete abrogation of osmotic recovery and platelet aggregation and glycoprotein IIb/IIIa up-regulation to agonist; and 3) decreased alpha-granule release. By contrast, spontaneous and agonist-induced binding of annexin V were unaffected by adverse metabolic conditions. Plasma rescue to an optimal pH improved morphology scores, stabilized osmotic recovery, and completely restored platelet secretory responses, as measured by aggregation, glycoprotein IIb/IIIa up-regulation, and alpha-granule release. In a limited number of studies, plasma rescue was accompanied by preserved in vivo platelet recovery and survival after autologous transfusion after 5 days of storage.

CONCLUSION

Transient derangement of platelet metabolism, which does not increase membrane phosphatidylserine exposure, causes in vitro functional abnormalities that are fully reversed or stabilized by metabolic rescue. Preliminary data suggest that such rescued platelets may have normal posttransfusion recovery and survival.

Recombinant human macrophage colony-stimulating factor-induced thrombocytopenia in dogs

To characterize recombinant human macrophage-colony stimulating factor (rhM-CSF)-associated thrombocytopenia (TCP), in vivo studies were performed in dogs, including the biodistributions and recoveries of radiolabelled autologous and allogeneic platelets. rhM-CSF induced a reversible, dose-dependent decrease in platelet counts. The number of megakaryocytes in spleen and marrow of rhM-CSF-treated dogs was increased two to threefold. Recoveries of allogeneic platelets transfused from rhM-CSF-treated donors into tolerized recipients (n = 3) were not significantly different from allogeneic baseline studies (93 +/- 10% of baseline values at 24 h and 90 +/- 1% at 40 h), whereas autologous platelets infused back into rhM-CSF-treated donors had decreased recoveries (45 +/- 2% of baseline values at 24 h, P = 0.03 and 20 +/- 4% at 40 h, P = 0.001). Platelet biodistribution studies showed increased accumulation of radiolabelled platelets over the spleens and livers of rhM-CSF-treated dogs. Histochemistry showed increased levels of platelet-specific antigen (CD41; glycoprotein IIb) associated with Kupffer cells. The sensitivity of platelets from rhM-CSF-treated dogs to activation from thrombin, as measured by expression of P-selectin (CD62P), was not significantly different when compared with baseline studies (P = 0.18; n = 4). These results support the concept that rhM-CSF induces an activation of the monocyte-macrophage system (MMS), which causes a reversible TCP in a dog model.

Evaluation of an automated system for the collection of packed RBCs, platelets, and plasma

BACKGROUND

This study evaluated the quality of WBC-reduced platelets, RBCs, and plasma collected on a new system (Trima, Gambro BCT) designed to automate the collection of all blood components. The study also evaluated donor safety and suitability of these components for transfusion.

STUDY DESIGN AND METHODS

In Phase I, the quality of the components collected on the new system was evaluated by standard in vitro and in vivo testing methods. Results were compared to those from control components collected by currently approved standard methods. In Phase II, additional collections were performed to evaluate the acceptability of the new system and the safety of platelets collected.

RESULTS

In vivo 24-hour RBC recovery was 76.8 +/- 3.1 percent for the test RBC units and 77.1 +/- 4.4 percent recovery for whole-blood (control) RBCs. The differences between test and control platelet results in the in vivo and in vitro assays were not clinically significant. Plasma clotting factors and fibrinogen levels met international standards. The system was well accepted by donors, and no major adverse donor reactions were reported for the 68 procedures performed. No problems were reported with transfusing the blood components collected.

CONCLUSION

Blood components collected with the Trima are equivalent to currently available components, and they meet the applicable regulatory standards. This system provides consistent, standardized components with predictable yields. It provides the option of fully automating the collection of all blood components.

Enhanced circulatory parameters of human platelets cryopreserved with second-messenger effectors: an in vivo study of 16 volunteer platelet donors

Platelet transfusion represents an important component of the therapy for thrombocytopenic patients. Prolonged storage capabilities for platelets would alleviate many problems associated with blood banking. Unfortunately, current cryopreservation methods are complex to implement and result in loss of cell number and functional activity. Previous in vitro studies have shown that the use of ThromboSolTM, a platelet-stabilizing formulation, in the cryopreservation of platelets results in significant retention of cell number and in vitro functional activities in addition to reducing the DMSO requirement to only 2%. We evaluated the in vivo circulatory parameters of platelets cryopreserved with ThromboSol. Single donor platelet units were obtained from healthy volunteers (n = 16); the units were then split and cryopreserved with either ThromboSol and 2% DMSO or 6% DMSO alone. Following storage at -80 degrees C for 7-10 d the samples were thawed, washed and radiolabelled with either 51Cr or 111In. The paired samples were then mixed and reinfused into the autologous volunteer. At various time intervals following transfusion a blood sample was drawn and the quantity of circulating labelled platelets was determined. The percent recovery and survival time was determined by multiple-hit analysis. The ThromboSol-treated platelets, as compared to the 6% DMSO-treated platelets, displayed statistically higher percent recovery (40.2% v 28.8%) and survival time (166.3 h v 152.1 h). These results demonstrated that platelets cryopreserved with ThromboSol displayed superior in vitro and in vivo characteristics as compared to the standard 6% DMSO method. The use of ThromboSol allowed for a 3-fold reduction in the DMSO concentration in conjunction with a 40% increase in circulating cell number and normal survival times.

A primary production deficit in the thrombocytopenia of equine infectious anemia

The purpose of this study was to identify the mechanisms responsible for the thrombocytopenia that develops following infection of horses by the lentivirus equine infectious anemia virus (EIAV). Immunocompetent Arabian foals and Arabian foals with severe combined immunodeficiency (SCID), which lack functional B and T lymphocytes, were experimentally infected with EIAV. Levels of viremia and a number of clinical and hematologic parameters were examined prior to and following infection. Thrombocytopenia was not dependent on the immune response: SCID foals were affected as severely as immunocompetent foals. Production of platelets, measured by metabolic incorporation of radioactive label, was significantly reduced. The decrease ranged from 35 to 89% in three SCID and two immunocompetent foals examined. Platelet survival, measured by 51Cr labeling, also declined following infection in both SCID and immunocompetent foals: 51 and 68%, respectively, relative to the preinfection life spans. The difference between immunocompetent and immunodeficient foals was not statistically significant. The number of megakaryocytes (MK) per square millimeter of bone marrow, determined by digitizing morphometry, was not significantly altered in either SCID or immunocompetent thrombocytopenic foals. Numbers of denuded MK nuclei per unit area increased, but the elevation was not statistically significant. No evidence for viral replication in MK was found. Three different parameters of intravascular coagulation (activated prothombin time, fibrin degradation products, and one-step prothombin time) remained normal until after platelet numbers had declined significantly, arguing against an important role for disseminated intravascular coagulation. The findings indicate that EIAV induces thrombocytopenia principally through an indirect, noncytocidal suppressive effect on platelet production, the mechanism of which is unknown. A shortening of platelet life span apparently contributes moderately to the platelet deficit as well. The shortening of platelet life span is multifactorial in origin, including both mechanisms that depend on an active immune response and those that do not.

Use of prostaglandin E1 during preparation of platelet concentrates

A paired study in 10 autologous volunteer donors was undertaken to investigate the efficacy of adding prostaglandin E1 (PGE1) in vitro during routine platelet concentrate (PC) production. After 5 days storage, PCs prepared with PGE1 were compared with control PCs. In vivo platelet recovery, survival and biodistribution were determined following autologous infusion of indium-111 labelled platelets into volunteers, together with the in vitro evaluation of platelet function and biochemistry. PGE1 facilitated easier and faster platelet resuspension following centrifugation. After storage there were few significant in vitro differences between PCs prepared with PGE1 and control PCs. The artifactual leucocyte concentration was significantly lower in the presence of PGE1, suggesting less platelet aggregates had been formed during storage and beta-thromboglobulin release was significantly reduced by PGE1, 14.0 +/- 6.0 micrograms per 10(9) platelets compared with 22.3 +/- 9.8 micrograms per 10(9) platelets in control PCs, (P < 0.01), indicating PGE1 reduced both platelet aggregation and activation probably at the initial preparation stage, known to produce the greatest trauma. Initial in vivo platelet recovery for PCs prepared with PGE1 was similar to that of control PCs, 41.1 +/- 12.5% vs. 44.4 +/- 8.0%, respectively, and there were no differences in organ distribution at 24 h. However, in vivo multiple hit survival was reduced in the presence of PGE1, 5.8 +/- 1.6 days compared with 6.9 +/- 1.4 days in control PCs (P < 0.05). Despite the ability of PGE1 to facilitate platelet resuspension and inhibit platelet aggregation and activation during preparation of the PCs, the reduced in vivo survival time may preclude the use of PGE1 during routine PC preparation.

Bacterial infection-associated improvement of platelet counts in two patients with chronic and unresponsive idiopathic thrombocytopenic purpura with normal platelet survival studies

Approximately 20% of adult patients with idiopathic thrombocytopenic purpura (ITP) do not respond to splenectomy and require alternative therapies to achieve a clinically safe platelet count. A small percentage of these patients have very refractory disease and are either unresponsive or poorly responsive to almost any therapy. In this report we describe two patients with chronic and unresponsive ITP with normal platelet survivals. Neither patient had responded to a large variety of treatments including corticosteroids, splenectomy, IVIgG, anti-D, chemotherapy, and ascorbic acid. However, both had a rapid, but short-lived, rise in their platelet count following a bacterial infection. One patient had a rise in platelet count for 6 months following the acute episode of bacteraemia. The second patient had a shorter response of 1 week. It is possible that these two patients represent a subset of patients with ITP who may benefit from cytokine therapy.

Evaluation of apheresis platelet concentrates collected with a reduced (30-ml) collection chamber with resuspension and storage in a synthetic medium

Recently, the CS-3000 Plus Blood Cell Separator with the TNX-6 platelet separation chamber insert has been furnished with a small-volume (30-ml) collection chamber. In this study, a platelet synthetic medium containing glucose and bicarbonate (PSM) was used for resuspension and storage of this highly concentrated platelet product. Eighteen donors participated in a paired study design where each participant donated platelets on two occasions, once following collection in a standard chamber with resuspension and storage in plasma and once following collection in the new chamber with resuspension and storage in PSM. Substantially higher total platelet counts were obtained using platelets collected in the small chamber and stored in PSM as compared to control (4.4 +/- 0.9 x 10(11) vs. 3.5 +/- 0.9 x 10(11) platelets, p < 0.01 by paired t test). After 5 days of storage, PSM-stored platelets demonstrated higher ATP levels, less lactate dehydrogenase in the supernatant and increased lactate production with resulting lower pH at day 5 of storage (6.94 +/- 0.15 vs. 7.08 +/- 0.09, p < 0.05). There were no statistically significant differences of the survival by multiple-hit estimation of PSM-stored as compared to plasma-stored platelets as determined by 111In labeling and infusion. A slight decrease in the initial percent recovery with the additive-suspended as compared to suspended plasma cells was noted: 50 +/- 8 versus 54 +/- 9%, respectively (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of agitation on the quality of platelet concentrates

Platelet concentrates (PCs) were stored for 4 days at 22 degrees C in 400 ml second-generation (PL1240) platelet packs with either constant agitation, manual mixing once every 24 h or without agitation at any time. After 4 days storage, in vivo recovery, survival and biodistribution were determined following indium-111 labelling of platelets and infusion into autologous volunteers. In vitro assays of platelet function and biochemistry were likewise carried out after 4 days storage. The PCs stored without agitation had significantly lower in vivo recoveries, pH and aggregation responses to ionophore A23187 and a combination of collagen and epinephrine and significantly higher beta-thromboglobulin and indium-111 release than the agitated PCs. The manually mixed PCs were not significantly different from the constantly agitated PCs. PCs mixed simply once every 24 h remained viable with active oxidative phosphorylation and a pH above 6.74 in all but 1 case indicating that PCs stored at 22 degrees C for up to 4 days with only intermittent mixing are satisfactory for transfusion. A change from constant agitation would reduce capital costs in mixing equipment and simplify the transport of PCs from the transfusion centre to small hospital blood banks.

Paired in vivo and in vitro comparison of apheresis and "recovered" platelet concentrates stored for 5 days

Using a paired study, in vivo and in vitro characteristics of apheresis platelets collected on a cell separator and single-donor whole-blood (recovered) platelets via platelet-rich plasma (PRP) were compared after storage for 5 days in similar plastic containers. Autologous platelets from each of 12 volunteers were labeled with 111Indium after storage and reinjected. There was no significant difference in circulating recovery between platelets prepared by the two methods, and only one of five models of survival showed a significant difference. Hypotonic shock recovery was significantly better in apheresis than recovered platelets (57.0% and 32.4%, respectively), whilst aggregation to ADP at 3.2 microM and 32 microM was significantly higher in recovered than in apheresis platelets (17.0% and 45.2% versus 7.8% and 32.9%, respectively). Lactate dehydrogenase (LDH) content was significantly higher in recovered platelets (143.3 versus 77.1 IU/10(11) platelets), but LDH release was similar (15.0% cf. 12.6%). There was no significant difference between the two platelet preparations for platelet concentration, pH, aggregation with the calcium ionophore A23187 or collagen plus epinephrine, or ATP content or release. beta-TG release was lower in apheresis platelets. Neither product was consistently better than the other for the parameters tested, but apheresis platelets have the advantage of lower donor exposure to the patient.

Radioisotopic labels for blood cell survival studies: a review

The different methods of labeling blood cells, in particular erythrocytes and platelets, for survival studies are reviewed. Besides the technical information about these procedures, attention is also paid to the indications of blood cell survival studies, the effective dose equivalent involved and the interpretation of the resulting data. In the final section the possibilities created by dual-labeling procedures are discussed.

Concurrent label method with 111In and 51Cr allows accurate evaluation of platelet viability of stored platelet concentrates

The precision and reproducibility of 111In and 51Cr platelet radiolabel agents for in vivo kinetic studies of stored platelet concentrates (PC) were investigated. The objective was to develop a precise method with concurrent labelling of two platelet populations using different isotopes, which would allow identification of small differences in in vivo platelet quality. Identical labelling procedures were used to investigate the effects of PC storage age, different methods of red cell (RBC) and white cell (WBC) contamination correction, and label elution correction on the results of 111In and 51Cr kinetic studies. 111In and 51Cr platelet survival curves from the same PC, even when uncorrected for elution and RBC contamination, exhibited excellent correlation, irrespective of the age of the concentrate and its viability. However, slightly higher, but statistically significant, post-infusion per cent recoveries with 51Cr labelled platelets were found. Two factors were identified as the cause for this difference. There was a higher affinity of contaminating RBC/WBC in PC for 51Cr than for 111In. With determination of RBC/WBC activity by centrifugation/density separation, RBC/WBC fractions from the injectate were found to contain 12.6 +/- 3.8% v 7.1 +/- 3.6% of total 51Cr and 111In activity, respectively, in 20 studies. In addition, there was a significantly higher 111In activity in plasma immediately post-infusion than with 51Cr, 5.2 +/- 1.3% v 2.8 +/- 1.6%, respectively, suggesting more label elution or carryover. After correction for the activity of RBC/WBC and for elution or carryover, essentially identical 51Cr/111In platelet survival curves were found. In 31 stored PC studies, the absolute average difference between 51Cr and 111In per cent recoveries was only 4 +/- 3% in a group of donors whose platelet recoveries ranged from 10% to 80%. Similarly, the average difference between 51Cr and 111In survival was only 8 +/- 4 h within a range of survivals from 40 to 220 h. In conclusion, after correction for elution and contaminating RBC/WBC binding, these studies show that 51Cr and 111In may be used interchangeably for labelling of stored PC, and that small differences between test and control platelets could be reliably detected using concurrent labelling with simultaneous infusion.

Platelet concentrates in an additive solution prepared from pooled buffy coats. In vivo studies

Leukocyte-depleted platelet concentrates were prepared from pools of 4 buffy coats on the day after blood collection (BC-PC). The storage medium was composed of citrate phosphate dextrose plasma and a platelet-additive solution. Autologous transfusions of 111In-labelled platelets in 9 healthy volunteers were performed on the day of preparation (day 1) and on day 5. The recovery was 54.6 +/- 8.7 (day 1) and 51.9 +/- 10.4% (day 5), T1/2 was 101 +/- 28 and 61 +/- 9 h, respectively. The survival was 8.3 +/- 1.7 and 5.7 +/- 1.0 days, respectively, using linear plot, and 7.8 +/- 2.0 and 5.8 +/- 0.5 days using the multiple hit method. In a prospective clinical study a comparison of the corrected posttransfusion increments was made between BC-PCs and apheresis-PC, and between fresh (1-2 days) and stored (3-5 days) preparations. No difference was found between BC-PCs and apheresis PCs. However, fresh BC-PCs gave higher increments than stored BC-PCs. A slight numerical difference between fresh and stored apheresis-PCs was not statistically significant. It is concluded that the BC-PC method results in platelets of equal quality to apheresis-PC.

Five-day storage of platelets in a non-diethylhexyl phthalate-plasticized container

A non-diethylhexyl phthalate (DEHP)-plasticized blood bag for 5-day storage of random-donor platelet concentrates has been developed. The plastic bag is composed of polyvinylchloride plastic with a butyryl trihexyl citrate plasticizer. The suitability of this plastic for the storage of platelet concentrates for use in clinical transfusion practice was evaluated. In vitro storage studies showed no significant differences at Day 5 for a series of in vitro assays (test plastic vs. control plastic) including pH (7.31 vs. 7.44), lactate dehydrogenase discharge (21.8 vs. 17.1%), pO2 (103 vs. 120 torr), osmotic recovery (52 vs. 57%), and morphology score (527 vs. 516). For paired radiolabeled recovery and survival data from autologous blood donors, results showed equivalence between the test plastic and two control plastics. A small but significant difference between test and control plastics in regard to survival was found by using a linear computer model, but not with a gamma function (multiple-hit) model. For paired transfusions to thrombocytopenic patients, the corrected count increments at 1 to 4 hours (test vs. control) were 13,534 versus 15,494 (p > 0.05, NS). Similar results were seen for corrected count increments determined at 12 to 24 hours. It can be concluded that platelets stored in the test plastic are acceptable for use in clinical practice.

A new dual-label technique for platelet survival studies with the use of 111indium and 114mindium tropolonate

A dual-label technique to study the survival of two different populations of platelets within one individual was developed using 111indium and 114mindium. The validity of the technique was demonstrated in seven individuals with an expected equal survival time of two platelet populations and in two persons with an expected difference in platelet survival time. Since the energy spectra of the two indium isotopes are very close, a well-type germanium semiconductor detector was applied. By adaptation of the counting time the effective dose equivalent of the dual-label procedure could be restricted to 1.6 mSv. The dual-label technique provides an instrument for studying the survival of two different populations of platelets simultaneously within one individual.

Platelet storage lesions in second-generation containers: correlation with in vivo behavior with storage up to 14 days

The relationship between in vivo behavior and in vitro characteristics of 59 platelet concentrates (PC) stored for up to 14 days in a synthetic medium or in CPDA-1 plasma was systematically investigated. 25 paired studies (1 study was incomplete) were performed comparing platelets suspended either in the synthetic medium or CPDA-1 plasma with 5 days (n = 5); 7 days (n = 10); 10 days (n = 5); and 14 days (n = 5) of storage. In addition, 10 control studies were performed with freshly prepared PC (6-24 h) in CPDA-1 plasma. Both percent recovery and survival estimations showed decreases with increasing storage duration, irrespective of storage medium used. In both media, with prolonged storage, the platelet survival curves not only became shorter, but also increasingly exponential, suggesting that in vitro storage caused progressive damage to the platelets present in circulation. Survival curves of platelets suspended in synthetic medium remained more linear, indicative of less random damage during storage. Mean population lifespan (MPL) of the stored PC was determined by the area below the survival curve divided by the mean percent recovery for the fresh PC, which was 55%. MPL decreased from 4.5 days (fresh PC) to 0.4 days after 14 days of storage in plasma, with a 50% reduction (t1/2) estimated at 7.2 days of storage. MPL t1/2 for PC stored in the synthetic medium was estimated to be 8.8 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Studies on the procurement of blood coagulation factor VIII. In vivo studies on blood components prepared in half-strength citrate anticoagulant

To determine the viability of blood cells collected in half-strength (0.5 CPD.A2) and full-strength citrate anticoagulants, paired crossover autologous survival studies were performed in normal volunteers using 51Cr-labelled red cells after 35 days storage and 111In-labelled platelets after 5 days storage. For both studies, viability was better maintained in 0.5 CPD.A2 anticoagulant. This was significant for red cells (24-hour survival: 80 +/- 6 vs. 52 +/- 21%) but not for platelets by either linear or multiple-hit models (recovery 51 +/- 13 vs. 38 +/- 14%, survival 5.1 +/- 1.4 vs. 3.7 +/- 1.5 days). The poor viability of red cells after storage in full-strength anticoagulant was associated with low cellular adenosine triphosphate levels and was confirmed in follow-up studies.

Plasma glycocalicin. An aid in the classification of thrombocytopenic disorders

In some patients with thrombocytopenia, it is difficult to determine whether the condition is caused by underproduction of platelets (reduced numbers of megakaryocytes) or an increase in the rate of their destruction (normal or increased numbers of megakaryocytes). A non-invasive test to help distinguish between these two categories of thrombocytopenia would be useful. We related the plasma concentration of glycocalicin, a fragment of the platelet-membrane glycoprotein Ib, to the mechanism of thrombocytopenia by evaluating bone marrow megakaryocyte content and measuring platelet life span. Plasma glycocalicin was measured with a monoclonal antibody to the glycocalicin component of platelet glycoprotein Ib. The mean (+/- SD) plasma concentration of glycocalicin in 34 healthy controls was 87 +/- 20 percent of the level in pooled normal plasma (range, 52 to 127 percent). All of eight patients with aplastic anemia or amegakaryocytic thrombocytopenia confirmed by examining bone marrow (in all patients) and by determining the life span of autologous platelets (in six patients) had glycocalicin levels significantly below the normal range (5 to 27 percent). In contrast, each of 25 patients with thrombocytopenia thought to be caused by a reduction in platelet life span, whose bone marrow contained normal or increased numbers of megakaryocytes, had glycocalicin levels that fell within or above the normal range (48 to 261 percent). There was no overlap of values between the two patient populations. These studies indicate that the measurement of plasma glycocalicin may be a useful adjunct in classifying thrombocytopenic disorders.