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Ojha S, Tirlotkar A, Gupta AM, S H S, Chavan P, Poojary M. Comparative analysis of platelet concentrates prepared after two hours and overnight storage of buffy coat at room temperature. Transfus Apher Sci 2020; 60:103014. [PMID: 33262053 DOI: 10.1016/j.transci.2020.103014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The overnight storage of the buffy coat (BC) at room temperature has logistic and operational advantages for the blood centre. The present study aimed to evaluate the impact of an overnight hold (stored) of BC at room temperature in comparison with the 2-hour hold (fresh) of buffy coats on the platelet concentrate (PC) characteristics. METHODS A total of 60 BCs were included in the study, 30 PCs (fresh) were prepared after two hours holding time of the BCs and the other 30 PCs (stored) were prepared after the overnight BC storage at room temperature. The primary endpoint of PCs evaluation was the platelet yield, volume, pH, WBC count, RBC count, and platelet swirling in the PC and the secondary endpoints were glucose concentration, lactate, LDH, and sterility of the PCs. All the tests were performed on the day+1 of the blood collection. RESULTS There was no difference concerning the volume, RBC count, and swirling between the two groups (P>0.05). The PCs from the fresh BC had higher pH and glucose concentration (P<0.05). On the other hand, the overnight hold of BC produced higher platelet counts, WBC counts, lactate, and LDH levels (P<0.05). All the 60 PCs did not record any bacterial growth on the culture media for the sterility results. CONCLUSION The overnight hold of BC produces a higher platelet yield with higher storage lesions. This may also allow better supervision, ensuring better quality control.
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Affiliation(s)
- Shashank Ojha
- Department of Transfusion Medicine, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi, Mumbai 410210, India.
| | - Amol Tirlotkar
- Department of Transfusion Medicine, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi, Mumbai 410210, India.
| | - Abhaykumar Malind Gupta
- Department of Transfusion Medicine, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi, Mumbai 410210, India.
| | - Sumathi S H
- Department of Transfusion Medicine, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi, Mumbai 410210, India.
| | - Priti Chavan
- Composite Laboratory, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi, Mumbai, 410210, India.
| | - Minal Poojary
- Composite Laboratory, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi, Mumbai, 410210, India.
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Herzig MC, Fedyk CG, Montgomery RK, Schaffer BS, Bynum JA, Pidcoke HF, Cap AP. Blood component separation of pathogen-reduced whole blood by the PRP method produces acceptable red cells but platelet yields and function are diminished. Transfusion 2020; 60 Suppl 3:S124-S133. [PMID: 32478864 DOI: 10.1111/trf.15766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study evaluated blood components processed by the platelet rich plasma (PRP) method from fresh whole blood (FWB) treated with a pathogen reduction technology (PRT). The effects of storage temperature on PRT treated platelet concentrates (PCs) were also examined. STUDY DESIGN AND METHODS PRT was performed using riboflavin and ultraviolet light on FWB in citrate phosphate dextrose anticoagulant. Following PRT, red blood cells (RBCs), PCs, and plasma for fresh frozen plasma (FFP), were isolated by sequential centrifugation. RBCs were stored at 4°C, FFP at -80°C, and PC at 22°C or at 4°C. Components were assayed throughout their storage times for blood gases, chemistry and CBC, hemostatic function as well as platelet (PLT) and RBC integrity. RESULTS Component processing following PRT resulted in a significant drop in platelet recovery. Most PRT-PC bags fell below AABB guidelines for platelet count. PRT-PC also showed a decrease in clot strength and decreased aggregometry response. Platelet caspases were activated by PRT. Storage at 4°C improved platelet function. In PRT-FFP, prothrombin time and partial thromboplastin time (PT and aPTT) were prolonged; factors V, VII, VIII, and XI, protein C, and fibrinogen were significantly decreased. Free hemoglobin was elevated two-fold in PRT-RBC. CONCLUSION Blood components isolated by the PRP method from PRT-treated WB result in a high percentage of PC that fail to meet AABB guidelines. FFP also shows diminished coagulation capacity. However, PRT-RBC are comparable to control-RBC. PRT-WB retains acceptable hemostatic function but alternatives to the PRP method of component separation may be more suitable.
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Affiliation(s)
- Maryanne C Herzig
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Chriselda G Fedyk
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Robbie K Montgomery
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Beverly S Schaffer
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - James A Bynum
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Institute of Biomedical Studies, Baylor University, Waco, Texas, USA.,Joint Interdisciplinary Biomedical Engineering Program, UT San Antonio & UT Health San Antonio, San Antonio, Texas, USA
| | - Heather F Pidcoke
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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Taha M, Kyluik‐Price D, Kumaran D, Scott MD, Toyofuku W, Ramirez‐Arcos S. Bacterial survival in whole blood depends on plasma sensitivity and resistance to neutrophil killing. Transfusion 2019; 59:3674-3682. [DOI: 10.1111/trf.15550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Mariam Taha
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
| | - Dana Kyluik‐Price
- Centre for Blood Research, University of British Columbia Vancouver British Columbia
| | - Dilini Kumaran
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
| | - Mark D. Scott
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
- Centre for Blood Research, University of British Columbia Vancouver British Columbia
| | - Wendy Toyofuku
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
| | - Sandra Ramirez‐Arcos
- Centre for Innovation, Canadian Blood Services Ottawa Ontario
- Department of Biochemistry, Microbiology and ImmunologyUniversity of Ottawa Ottawa Ontario Canada
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van der Meer PF, Couture C, Hervig T, Kruit G, Devine DV, de Korte D, Kerkhoffs JL. Experiences with semi-routine production of riboflavin and UV-B pathogen-inactivated platelet concentrates in three blood centres. Vox Sang 2016; 112:9-17. [DOI: 10.1111/vox.12465] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/15/2016] [Accepted: 09/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- P. F. van der Meer
- Department of Product and Process Development; Sanquin Blood Bank; Amsterdam The Netherlands
- Department of Clinical Transfusion Research; Sanquin Research; Leiden The Netherlands
| | - C. Couture
- Canadian Blood Services; Ottawa ON Canada
| | - T. Hervig
- Department of Immunology and Transfusion Medicine; Haukeland University Hospital; Bergen Norway
| | - G. Kruit
- Department of Production; Sanquin Blood Bank; Amsterdam The Netherlands
| | | | - D. de Korte
- Department of Product and Process Development; Sanquin Blood Bank; Amsterdam The Netherlands
| | - J.-L. Kerkhoffs
- Department of Clinical Transfusion Research; Sanquin Research; Leiden The Netherlands
- Department of Hematology; Haga Teaching Hospital; The Hague The Netherlands
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Dijkstra-Tiekstra MJ, Hazelaar S, Gkoumassi E, Weggemans M, de Wildt-Eggen J. Comparison of cryopreservation bags for hematopoietic progenitor cells using a WBC-enriched product. Transfus Apher Sci 2015; 52:187-93. [DOI: 10.1016/j.transci.2014.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/25/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
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van der Meer PF, de Korte D. The Effect of Holding Times of Whole Blood and Its Components During Processing on In Vitro and In Vivo Quality. Transfus Med Rev 2015; 29:24-34. [DOI: 10.1016/j.tmrv.2014.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/14/2014] [Accepted: 10/17/2014] [Indexed: 11/25/2022]
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Evaluation of Random Donor Platelets Produced from Buffy Coat Stored for 24 h at Ambient Temperature: Should This be Implemented in India? Indian J Hematol Blood Transfus 2014; 31:264-8. [PMID: 25825570 DOI: 10.1007/s12288-014-0437-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 07/10/2014] [Indexed: 10/25/2022] Open
Abstract
Whole blood derived platelets are made from platelet rich plasma (PRP) method or buffy coat (BC) method. In India majority of random donor platelets (RDPs) are prepared by PRP method. However, BC method offers the advantage of less platelet activation and fewer WBC contamination. Presently in India RDPs are prepared within 8 h of whole blood collection, whereas, in Europe this time limit is up to 24 h. Our aim was to evaluate the platelet count, WBC contamination, platelet CD62P expression, and biochemical parameters of RDPs prepared from BC within 8 h and within 24 h of collection. We prepared 40 units of RDP by the BC method from whole blood stored at room temperature within 8 h of collection (fresh BC), and another 40 units from BC stored at 22 °C for <24 h (stored BC). We analyzed the platelet counts, CD62P expression, WBC counts, glucose levels, pH, PO2, PCO2 in both the groups of RDPs, 24 h after respective preparation. The platelet counts from stored BC was higher in fresh BC. CD62P expression was low in stored BC compared to fresh BC. There were no differences of pH, pO2, pCO2 and glucose levels in fresh BC and stored BC. WBC contamination was more in fresh BC. Our study stored BC contained higher platelet counts, less WBC contamination and less platelet activation. We conclude that RDP prepared from stored BC is the better method for RDP production.
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Dijkstra-Tiekstra MJ, van de Watering LMG, Rondeel JMM, Slomp J, de Wildt-Eggen J. Implementation of a new platelet pooling system for platelet concentrates led to a higher corrected count increment after transfusion: a comparative observational study of platelet concentrates before and after implementation. Transfus Med 2014; 24:99-104. [PMID: 24506143 DOI: 10.1111/tme.12105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 01/10/2014] [Accepted: 01/13/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To study the effect of extended storage of platelet concentrates (PCs) and the implementation of a new platelet pooling system for PCs on corrected count increment (CCI) after transfusion. BACKGROUND Due to new developments and changes in processes or procedures, one should remain alert for the effects of these changes. Besides in vitro studies and validation, in vivo studies are also important, as it has been shown that in vitro results do not always predict in vivo outcomes. METHODS/MATERIALS After introduction of extended storage of PCs for 5-7 days prepared from five buffy coats and plasma, transfusion monitoring for transfusions of PCs in haemato-oncological patients was set up. After 9 months, a new pooling system for PCs was implemented, Composelect instead of Optipure PLT, and transfusion monitoring was continued for another 8 months. The CCI was used as primary outcome. RESULTS In total, 93 patients were included and transfused with PCs prepared in the Optipure PLT system (262 transfusions) or in the Composelect system (127 transfusions). Extended storage of PCs for 7 days had no significant effect on CCI. Although the implementation of the Composelect system did not influence the CCI1 h (13.8 ± 6.0 vs. 13.0 ± 5.8; n.s.), it seemed to have a positive effect on CCI24 h (7.0 ± 4.9 vs. 4.7 ± 4.5; P < 0.05). CONCLUSION Although the influence of confounders could not be excluded, it seemed that implementation of the Composelect system for PCs led to an improved CCI24 h and that extended storage of PCs did not influence the CCI.
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Dijkstra-Tiekstra M, Rondeel J, Slomp J, Smid W, de Wildt-Eggen J. A positive effect of immune suppression on corrected count increment after platelet transfusion at 1 but not at 24h. Transfus Apher Sci 2013; 49:189-92. [DOI: 10.1016/j.transci.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 01/17/2013] [Accepted: 02/13/2013] [Indexed: 12/01/2022]
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Gkoumassi E, Klein-Bosgoed C, Dijkstra-Tiekstra MJ, de Korte D, de Wildt-Eggen J. Noninvasive pH monitoring of platelet concentrates: a large field test. Transfusion 2013; 53:2287-92. [DOI: 10.1111/trf.12099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 11/29/2012] [Accepted: 11/30/2012] [Indexed: 11/30/2022]
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Abstract
Blood services routinely separate whole blood into components that are then stored under different conditions. The storage conditions used for whole blood prior to separation must therefore be a compromise between the needs of the red cells (which benefit from refrigeration) and plasma and platelets (which are better preserved at ambient temperature). For many years, the approach has been to manufacture plasma and platelet components on the day of blood collection, and to refrigerate any unprocessed blood for manufacture into red cell components on the following day. However, this can make it challenging to maintain adequate stocks of all components. The European practice of 'ambient hold' of whole blood for up to 24 hours prior to processing allows greater flexibility in blood component manufacture, and the data reviewed suggest there is relatively little impact on the quality of red cell or plasma components, and an improvement in the quality of platelet components.
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Affiliation(s)
- Stephen Thomas
- Components Development Laboratory, NHS Blood and Transplant, Brentwood, Essex, UK.
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van der Meer PF, Cancelas JA, Cardigan R, Devine DV, Gulliksson H, Sparrow RL, Vassallo RR, de Wildt-Eggen J, Baumann-Baretti B, Hess JR. Evaluation of overnight hold of whole blood at room temperature before component processing: effect of red blood cell (RBC) additive solutions on in vitro RBC measures. Transfusion 2011; 51 Suppl 1:15S-24S. [PMID: 21223291 DOI: 10.1111/j.1537-2995.2010.02959.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Whole blood (WB) can be held at room temperature (18-25°C) up to 8 hours after collection; thereafter the unit must be refrigerated, rendering it unsuitable for platelet (PLT) production. Overnight hold at room temperature before processing has logistic advantages, and we evaluated this process in an international multicenter study for both buffy coat (BC)- and PLT-rich plasma (PRP)-based blood components and compared three red blood cell (RBC) additive solutions (ASs) for their ability to offset effects of overnight hold. STUDY DESIGN AND METHODS Nine centers participated; seven used the BC method, and two used the PRP method. Four WB units were pooled and split; 1 unit was processed less than 8 hours from collection (Group A), and the other three (Groups B, C, and D) were held at room temperature and processed after 24 to 26 hours. RBCs in Groups A and B were resuspended in saline-adenine-glucose-mannitol, Group C in phosphate-adenine-guanosine-glucose-saline-mannitol, and Group D in ErythroSol-4 RBCs were stored at 2 to 6°C for 49 days. RESULTS RBCs from overnight-held WB had lower 2,3-diphosphoglycerate (2,3-DPG) and higher adenosine triphosphate (ATP). At the end of storage there were no differences between groups, apart from a slightly higher hemolysis in Group B. ErythroSol-4 showed a slightly higher initial ATP and 2,3-DPG content, but at the end of storage no differences were found. CONCLUSION Overnight hold of WB before processing has no lasting deleterious effects on in vitro quality of subsequently prepared components. The use of different RBC ASs did not appear to offer significant advantages in terms of RBC quality at the end, regardless of the processing method.
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Affiliation(s)
- Pieter F van der Meer
- Department of Product and Process Development, Sanquin Blood Bank North West Region, Amsterdam, the Netherlands.
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Dijkstra-Tiekstra M, van der Meer P, Cardigan R, Devine D, Prowse C, Sandgren P, de Wildt-Eggen J. Platelet concentrates from fresh or overnight-stored blood, an international study. Transfusion 2011; 51 Suppl 1:38S-44S. [DOI: 10.1111/j.1537-2995.2010.02973.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van der Meer PF, Cancelas JA, Vassallo RR, Rugg N, Einarson M, Hess JR. Evaluation of the overnight hold of whole blood at room temperature, before component processing: platelets (PLTs) from PLT-rich plasma. Transfusion 2011; 51 Suppl 1:45S-49S. [DOI: 10.1111/j.1537-2995.2010.02962.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sandgren P, van Waeg G, Verheggen C, Sjödin A, Gulliksson H. Storage of interim platelet units for 18 to 24 hours before pooling: in vitro study. Transfusion 2010; 51:1213-9. [DOI: 10.1111/j.1537-2995.2010.02978.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Roeloffzen WWH, Kluin-Nelemans HC, Veeger NJGM, Bosman L, De Wolf JTM. Transfused stored platelets have the same haemostatic function as circulating native platelets. Vox Sang 2010; 99:123-30. [DOI: 10.1111/j.1423-0410.2010.01337.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schrezenmeier H, Seifried E. Buffy-coat-derived pooled platelet concentrates and apheresis platelet concentrates: which product type should be preferred? Vox Sang 2010; 99:1-15. [PMID: 20059760 DOI: 10.1111/j.1423-0410.2009.01295.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Thomas S, Beard M, Garwood M, Callaert M, Cardigan R. Platelet concentrates produced from whole blood using the Atreus processing system. Vox Sang 2009; 97:93-101. [DOI: 10.1111/j.1423-0410.2009.01189.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dijkstra-Tiekstra MJ, Kuipers W, Setroikromo AC, de Wildt-Eggen J. Platelet capacity of various platelet pooling systems for buffy coat-derived platelet concentrates. Transfusion 2008; 48:2114-21. [DOI: 10.1111/j.1537-2995.2008.01849.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chakroun T, Abdelkefi S, Bouslama M, Houissa B, Zaier M, Miled A, Kortas M, Yacoub S. [Platelet-leukocyte aggregates as a marker for platelet activation in platelet concentrates]. Transfus Clin Biol 2008; 15:148-53. [PMID: 18760949 DOI: 10.1016/j.tracli.2008.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 07/02/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Several in vitro laboratory tests to assess the quality control of platelet concentrates (PC) are available. Some of them have a good correlation with the platelet recovery index. To assess the quality control of standard PC prepared in our blood bank, we measured the blood gas and the degree of platelet activation. MATERIALS AND METHODS SPC were prepared by the PRP method. Fifty-five SPC (45 SPC at day one of storage and 20 SPC at day five of storage) were analysed. Blood gas (pH, PO(2), PCO(2) and bicarbonate concentration) in the SPC were measured by blood gas automate. Platelet activation profile were determined by measuring the percentage of platelet expressing the CD62p (% CD62) and the percentage of platelet-leukocyte aggregate (% PLA). RESULTS The pH values of all studied SPC were comprised between 7.0 and 7.6. SPC at day 1 of storage have a significantly higher pH than those at day 5 of storage (7.5+/-0.05 versus 7.3+/-0.14; p<0.001). The % CD62p were higher in SPC at day five compared to the SCP at day one without reaching a statistical significance (28.4+/-15% versus 24.3+/-9.7%, p=0.052). The percentage of PLA were higher in SPC at day one compared to SCP at day five although this difference is not statistically significant (22.2+/-7.5% versus 17.9+/-8.0%; p=0.23). CONCLUSION Preparation and storage procedure adopted in our centre did not significantly affect the quality SPC. Our study is the first to assess the PLA in PC. Studies assessing the PLA are warranted to appreciate the clinical impact of this parameter.
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Affiliation(s)
- T Chakroun
- Centre régional de transfusion sanguine, unité de recherche étude des fonctions plaquettaires (UR : 06SP05), hôpital Faraht-Hached, Sousse, Tunisie.
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