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Kirschall J, Uzun G, Bakchoul T, Marini I. In vitro Hemostatic Functions of Cold-Stored Platelets. Transfus Med Hemother 2024; 51:94-100. [PMID: 38584694 PMCID: PMC10996062 DOI: 10.1159/000533735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/21/2023] [Indexed: 04/09/2024] Open
Abstract
Background Transfusion of platelets is a life-saving medical strategy used worldwide to treat patients with thrombocytopenia as well as platelet function disorders. Summary Until the end of 1960s, platelets were stored in the cold because of their superior hemostatic functionality. Cold storage of platelets was then abandoned due to better posttransfusion recovery and survival of room temperature (RT)-stored platelets, demonstrated by radioactive labeling studies. Based on these findings, RT became the standard condition to store platelets for clinical applications. Evidence shows that RT storage increases the risk of septic transfusion reactions associated with bacterial contamination. Therefore, the storage time is currently limited to 4-7 days, according to the national guidelines, causing a constant challenge to cover the clinical request. Despite the enormous efforts made to optimize storage conditions of platelets, the quality and efficacy of platelets still decrease during the short storage time at RT. In this context, during the last years, cold storage has seen a renaissance due to the better hemostatic functionality, reduced risk of bacterial contamination, and potentially longer storage time. Key Messages In this review, we will focus on the impact of cold storage on the in vitro platelet functions as promising alternative storage temperature for future medical applications.
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Affiliation(s)
- Johanna Kirschall
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tuebingen, Tuebingen, Germany
| | - Günalp Uzun
- Center for Clinical Transfusion Medicine Tuebingen, Tuebingen, Germany
| | - Tamam Bakchoul
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tuebingen, Tuebingen, Germany
- Center for Clinical Transfusion Medicine Tuebingen, Tuebingen, Germany
| | - Irene Marini
- Institute for Clinical and Experimental Transfusion Medicine, Medical Faculty of Tuebingen, Tuebingen, Germany
- Center for Clinical Transfusion Medicine Tuebingen, Tuebingen, Germany
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Nash J, Davies A, Saunders CV, George CE, Williams JO, James PE. Quantitative increases of extracellular vesicles in prolonged cold storage of platelets increases the potential to enhance fibrin clot formation. Transfus Med 2023; 33:467-477. [PMID: 37553476 DOI: 10.1111/tme.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Platelet derived extracellular vesicles (EVs) display a pro-coagulant phenotype and are generated throughout platelet concentrate (PC) storage. Cold storage (CS) of PCs is thought to provide a superior haemostatic advantage over room temperature (RT) storage and could prolong the storage time. However, the effect of storage conditions on EV generation and PC function is unknown. We investigated EV production under CS and RT conditions and assessed whether these EVs exhibited a more pro-coagulant phenotype in model experiments. MATERIALS AND METHODS Buffy-coat-derived PCs in a platelet additive solution (PAS) to plasma ratio of approximately 65:35 were stored at RT (22 ± 2°C) or CS (4 ± 2°C) for a prolonged storage duration of 20 days. Impedance aggregometry assessed platelet function. EVs were isolated throughout storage and quantified using nanoparticle tracking analysis. EVs were applied to a coagulation assay to assess the impact on fibrin clot formation and lysis. RESULTS CS produced significantly larger EVs from day 4 onwards. EV concentration was significantly increased in CS compared to RT from day 15. EVs, regardless of storage, significantly reduced time to clot formation and maximum optical density measured compared to the no EV control. Clot formation was proportionate to the number of EV applied but was not statistically different across storage conditions when corrected for EV number. CONCLUSION EVs in CS and RT units showed similar clot formation capacity. However, the higher number of larger EVs generated in CS compared to RT suggests PC units derived from CS conditions may overall exhibit a haemostatically superior capacity compared to RT storage.
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Affiliation(s)
- J Nash
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
- Component Development and Research Laboratory, Welsh Blood Service, Pontyclun, UK
| | - A Davies
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - C V Saunders
- Component Development and Research Laboratory, Welsh Blood Service, Pontyclun, UK
| | - C E George
- Component Development and Research Laboratory, Welsh Blood Service, Pontyclun, UK
| | - J O Williams
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - P E James
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
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3
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Lu J, Karkouti K, Peer M, Englesakis M, Spinella PC, Apelseth TO, Scorer TG, Kahr WHA, McVey M, Rao V, Abrahamyan L, Lieberman L, Mewhort H, Devine DV, Callum J, Bartoszko J. Cold-stored platelets for acute bleeding in cardiac surgical patients: a narrative review. Can J Anaesth 2023; 70:1682-1700. [PMID: 37831350 DOI: 10.1007/s12630-023-02561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/19/2023] [Accepted: 04/30/2023] [Indexed: 10/14/2023] Open
Abstract
PURPOSE Cold-stored platelets (CSP) are an increasingly active topic of international research. They are maintained at 1-6 °C, in contrast to standard room-temperature platelets (RTP) kept at 20-24 °C. Recent evidence suggests that CSP have superior hemostatic properties compared with RTP. This narrative review explores the application of CSP in adult cardiac surgery, summarizes the preclinical and clinical evidence for their use, and highlights recent research. SOURCE A targeted search of MEDLINE and other databases up to 24 February 2022 was conducted. Search terms combined concepts such as cardiac surgery, blood, platelet, and cold-stored. Searches of trial registries ClinicalTrials.gov and WHO International Clinical Trials Registry Platform were included. Articles were included if they described adult surgical patients as their population of interest and an association between CSP and clinical outcomes. References of included articles were hand searched. PRINCIPAL FINDINGS When platelets are stored at 1-6 °C, their metabolic rate is slowed, preserving hemostatic function for increased storage duration. Cold-stored platelets have superior adhesion characteristics under physiologic shear conditions, and similar or superior aggregation responses to physiologic agonists. Cold-stored platelets undergo structural, metabolic, and molecular changes which appear to "prime" them for hemostatic activity. While preliminary, clinical evidence supports the conduct of trials comparing CSP with RTP for patients with platelet-related bleeding, such as those undergoing cardiac surgery. CONCLUSION Cold-stored platelets may have several advantages over RTP, including increased hemostatic capacity, extended shelf-life, and reduced risk of bacterial contamination. Large clinical trials are needed to establish their potential role in the treatment of acutely bleeding patients.
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Affiliation(s)
- Justin Lu
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Miki Peer
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Philip C Spinella
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
- Norwegian Armed Forces Joint Medical Services, Norwegian Armed Forces, Oslo, Norway
| | - Thomas G Scorer
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Walter H A Kahr
- Division of Haematology/Oncology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Cell Biology Program, SickKids Research Institute, Toronto, ON, Canada
- Departments of Paediatrics and Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Mark McVey
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto, ON, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Holly Mewhort
- Department of Surgery, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Jeannie Callum
- Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada
- Department of Pathology and Molecular Medicine, School of Medicine, Queen's University, Kingston, ON, Canada
- Kingston Health Sciences Centre, Kingston General Hospital, Kingston, ON, Canada
| | - Justyna Bartoszko
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 3EN-464, Toronto, ON, M5G 2C4, Canada.
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Zantek ND, Steiner ME, VanBuren JM, Lewis RJ, Berry NS, Viele K, Krachey E, Dean JM, Nelson S, Spinella PC. Design and logistical considerations for the randomized adaptive non-inferiority storage-duration-ranging CHIlled Platelet Study. Clin Trials 2023; 20:36-46. [PMID: 36541257 DOI: 10.1177/17407745221126423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Platelet transfusion is a potentially life-saving therapy for actively bleeding patients, ranging from those undergoing planned surgical procedures to those suffering unexpected traumatic injuries. Platelets are currently stored at room temperature (20°C-24°C) with a maximum storage duration of 7 days after donation. The CHIlled Platelet Study trial will compare the efficacy and safety of standard room temperature-stored platelets with platelets that are cold-stored (1°C-6°C), that is, chilled, with a maximum of storage up to 21 days in adult and pediatric patients undergoing complex cardiac surgical procedures. METHODS/RESULTS CHIlled Platelet Study will use a Bayesian adaptive design to identify the range of cold storage durations for platelets that are non-inferior to standard room temperature-stored platelets. If cold-stored platelets are non-inferior at durations greater than 7 days, a gated superiority analysis will identify durations for which cold-stored platelets may be superior to standard platelets. We present example simulations of the CHIlled Platelet Study design and discuss unique challenges in trial implementation. The CHIlled Platelet Study trial has been funded and will be implemented in approximately 20 clinical centers. Early randomization to enable procurement of cold-stored platelets with different storage durations will be required, as well as a platelet tracking system to eliminate platelet wastage and maximize trial efficiency and economy. DISCUSSION The CHIlled Platelet Study trial will determine whether cold-stored platelets are non-inferior to platelets stored at room temperature, and if so, will determine the maximum duration (up to 21 days) of storage that maintains non-inferiority. TRIAL REGISTRATION ClinicalTrials.gov, NCT04834414.
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Affiliation(s)
- Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Marie E Steiner
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - John M VanBuren
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Roger J Lewis
- Harbor-UCLA Medical Center, Torrance, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Berry Consultants, Austin, TX, USA
| | | | | | | | - J Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | | | - Philip C Spinella
- Department of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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5
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Abstract
There is a crucial need for platelet transfusion during an emergency-surgery and treatment of platelet disorders. The unavailability of donors has furthermore increased the demand for platelet storage. Platelets have limited shelf life due to bacterial contamination and storage lesions. Temperature, materials, oxygen availability, media, platelet processing and manufacturing methods influence the platelet quality and viability during storage. The conception of various platelet additive solutions along with the advent of plastic storage during the 1980s led to enormous developments in platelet storage strategies. Cold storage of platelets gained attention despite its inability to contribute to platelet survival post-transfusion as it offers faster haemostasis. Several developments in platelet storage strategies over the years have improved the quality and shelf-life of stored platelets. Despite the progress, the efficacy of platelets during storage beyond a week has not been achieved. Antioxidants as additives have been explored in platelet storage and have proven to enhance the efficacy of platelets during prolonged storage. However, the molecular interactions of antioxidants in platelets can provide a better understanding of their mechanism of action. Optimization of dosage concentrations of antioxidants is also a critical parameter to be considered as they tend to exhibit toxicity at certain levels. This review provides comprehensive insights into the critical factors affecting platelet storage and the evolution of platelet storage. It also emphasizes the role of antioxidants as additives in platelet storage solutions and their future prospects towards better platelet banking.
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Affiliation(s)
- Vani Rajashekaraiah
- Department of Biotechnology, School of Sciences, JAIN (Deemed-to-be University), #34, 1st Cross, JC Road, Bengaluru, 560027, India.
| | - Magdaline Christina Rajanand
- Department of Biotechnology, School of Sciences, JAIN (Deemed-to-be University), #34, 1st Cross, JC Road, Bengaluru, 560027, India
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Nogawa M, Watanabe N, Koike T, Fukuda K, Ishiguro M, Fujino H, Hirayama J, Shiba M, Handa M, Mori T, Okamoto S, Miyata S, Satake M. Hemostatic function of cold-stored platelets in a thrombocytopenic rabbit bleeding model. Transfusion 2022; 62:2304-2313. [PMID: 36178666 DOI: 10.1111/trf.17128] [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: 11/22/2021] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transfusion of cold-stored platelet concentrates (CS-PCs) appears effective in massively bleeding patients. However, few studies have evaluated their in vivo hemostatic function in severe thrombocytopenia. STUDY DESIGN AND METHODS The in vivo function of plasma-depleted human PCs was evaluated in rabbits with a blocked reticuloendothelial system and busulfan-induced thrombocytopenia. On day 1, a human apheresis PC was processed in a platelet additive solution (PAS-PC) and split evenly for cold or room temperature storage (RTS). On days 3, 6, or 9, RTS- or CS-PAS-PCs were transfused (4.0 × 109 platelets/kg) after plasma depletion into two to four rabbits that developed adequate thrombocytopenia (<25 × 109 /L). Ear bleeding time was measured by two incisions in small veins. The hemostatic rate was defined as the percentage of rabbits achieving bleeding cessation within 600 s at either incision. The experiment was repeated using five different PCs on each storage day. RESULTS The mean pre-transfusion rabbit platelet count was 8.6 ± 5.2 × 109 /L. The hemostatic rates with RTS- and CS-PAS-PCs were both 100% on day 3, 93 ± 15% and 73 ± 15% on day 6 (p = .07), and 65 ± 36% and 73 ± 37% on day 9 (p = .27), respectively, with no statistical differences. Total platelet counts were significantly lower after CS-PAS-PC than RTS-PAS-PC transfusion on all days (e.g., 58.7 ± 5.7 vs. 42.4 ± 14.7 × 109 /L, p = .0007, day 9), and did not reach 50 × 109 /L in several experiments. Platelet count increments correlated significantly with hemostatic efficacy for CS-PAS-PC transfusion only. DISCUSSION CS-PAS-PCs might achieve similar hemostasis as RTS-PAS-PCs in thrombocytopenic patients with mild bleeding. Hemostatic efficacy could be improved by transfusing more CS-PAS-PCs.
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Affiliation(s)
- Masayuki Nogawa
- Department of Research and Development, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Naohide Watanabe
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshiyasu Koike
- Department of Research and Development, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Kanae Fukuda
- Department of Research and Development, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Mariko Ishiguro
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hitomi Fujino
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Hirayama
- Department of Research and Development, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masayuki Shiba
- Department of Research and Development, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Makoto Handa
- Center for Transfusion Medicine and Cell Therapy, Keio University School of Medicine, Tokyo, Japan
| | - Takehiko Mori
- Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shigeki Miyata
- Department of Research and Development, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masahiro Satake
- Department of Research and Development, Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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Platelet Transfusion for Trauma Resuscitation. CURRENT TRAUMA REPORTS 2022. [DOI: 10.1007/s40719-022-00236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Purpose of Review
To review the role of platelet transfusion in resuscitation for trauma, including normal platelet function and alterations in behavior following trauma, blood product transfusion ratios and the impact of platelet transfusion on platelet function, platelet function assays, risks of platelet transfusion and considerations for platelet storage, and potential adjunct therapies and synthetic platelets.
Recent Findings
Platelets are a critical component of clot formation and breakdown following injury, and in addition to these hemostatic properties, have a complex role in vascular homeostasis, inflammation, and immune function. Evidence supports that platelets are activated following trauma with several upregulated functions, but under conditions of severe injury and shock are found to be impaired in their hemostatic behaviors. Platelets should be transfused in balanced ratios with red blood cells and plasma during initial trauma resuscitation as this portends improved outcomes including survival. Multiple coagulation assays can be used for goal-directed resuscitation for traumatic hemorrhage; however, these assays each have drawbacks in terms of their ability to measure platelet function. While resuscitation with balanced transfusion ratios is supported by the literature, platelet transfusion carries its own risks such as bacterial infection and lung injury. Platelet supply is also limited, with resource-intensive storage requirements, making exploration of longer-term storage options and novel platelet-based therapeutics attractive. Future focus on a deeper understanding of the biology of platelets following trauma, and on optimization of novel platelet-based therapeutics to maintain hemostatic effects while improving availability should be pursued.
Summary
While platelet function is altered following trauma, platelets should be transfused in balanced ratios during initial resuscitation. Severe injury and shock can impair platelet function, which can persist for several days following the initial trauma. Assays to guide resuscitation following the initial period as well as storage techniques to extend platelet shelf life are important areas of investigation.
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Meshkin D, Yazer MH, Dunbar NM, Spinella PC, Leeper CM. Low titer Group O whole blood utilization in pediatric trauma resuscitation: A National Survey. Transfusion 2022; 62 Suppl 1:S63-S71. [PMID: 35748128 DOI: 10.1111/trf.16979] [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: 12/06/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renewed interest in low titer group O whole blood (LTOWB) transfusion has led to increased utilization in adult trauma centers; little is known regarding LTOWB use in pediatric centers. STUDY DESIGN AND METHODS A survey of LTOWB utilization at American pediatric level 1 trauma centers. RESULTS Responses were received from 43/72 (60%) centers. These institutions were primarily urban (84%) and pediatric-specific (58%). There were 16% (7/43) centers using LTOWB, 7% (3/43) imminently initiating an LTOWB program, 47% (20/43) with interest but no current plan to develop a LTOWB program, and 30% (13/43) with no immediate interest in an LTOWB program. For the hospitals actively or imminently using LTOWB, 70% (3/10) have a minimum recipient weight criterion, 60% (6/10) have a minimum age criterion, and 70% (7/10) restrict the maximum volume transfused. Before the patient's RhD type becomes known, 30% (3/10) use RhD negative LTOWB for males and females, 40% (4/10) use RhD positive LTOWB for males and RhD negative LTOWB for females, 20% (2/10) use RhD positive LTOWB for males and RhD negative RBCs for females, and 10% (1/10) use RhD positive LTOWB for both males and females. Maximum LTOWB storage duration was 14-35 days and units nearing expiration were used for non-trauma patients (40%), processed to RBC (40%), and/or discarded (40%). The most common barriers to implementation were concerns about inventory management (37%), wastage (35%), infrequent use (33%), cost (21%) and unclear efficacy (14%). CONCLUSION LTOWB utilization is increasing in pediatric level 1 trauma centers in the United States.
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Affiliation(s)
- Dana Meshkin
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark H Yazer
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nancy M Dunbar
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Philip C Spinella
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christine M Leeper
- Department of Surgery and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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9
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Ravicini S, Haines JM, Hwang JK, Wardrop KJ. The effects of additive solutions on the development of storage lesions in canine platelet concentrates stored at 4°C. J Vet Emerg Crit Care (San Antonio) 2022; 32:592-601. [DOI: 10.1111/vec.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Sara Ravicini
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Washington State University Pullman Washington USA
| | - Jillian M. Haines
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Washington State University Pullman Washington USA
| | - Julianne K. Hwang
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Washington State University Pullman Washington USA
| | - K. Jane Wardrop
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Washington State University Pullman Washington USA
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10
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There and Back Again: The Once and Current Developments in Donor-Derived Platelet Products for Products for Hemostatic Therapy. Blood 2022; 139:3688-3698. [PMID: 35482959 DOI: 10.1182/blood.2021014889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/20/2022] [Indexed: 01/19/2023] Open
Abstract
Over 100 years ago, Duke transfused whole blood to a thrombocytopenic patient to raise the platelet count and prevent bleeding. Since then, platelet transfusions have undergone numerous modifications from whole blood-derived platelet-rich plasma to apheresis-derived platelet concentrates. Similarly, the storage time and temperature have changed. The mandate to store platelets for a maximum of 5-7 days at room temperature has been challenged by recent clinical trial data, ongoing difficulties with transfusion-transmitted infections, and recurring periods of shortages, further exacerbated by the COVID-19 pandemic. Alternative platelet storage approaches are as old as the first platelet transfusions. Cold-stored platelets may offer increased storage times (days) and improved hemostatic potential at the expense of reduced circulation time. Frozen (cryopreserved) platelets extend the storage time to years but require storage at -80 °C and thawing before transfusion. Lyophilized platelets can be powder-stored for years at room temperature and reconstituted within minutes in sterile water but are probably the least explored alternative platelet product to date. Finally, whole blood offers the hemostatic spectrum of all blood components but has challenges, such as ABO incompatibility. While we know more than ever before about the in vitro properties of these products, clinical trial data on these products are accumulating. The purpose of this review is to summarize the findings of recent preclinical and clinical studies on alternative, donor-derived platelet products.
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11
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Bibay JI, Margallo S. Stability of hematologic analytes in New Zealand white rabbits using an impedance-based analyzer. Vet Clin Pathol 2022; 51:201-207. [PMID: 35355297 DOI: 10.1111/vcp.13083] [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: 05/03/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The validity of hematologic data is crucial for correctly diagnosing certain conditions and providing accurate research results. However, delays in blood testing are inevitable. OBJECTIVE This study aimed to determine whether prolonged storage at different temperatures affects CBC measurand stability in rabbit whole blood using the impedance-based Scil Vet ABC hematology analyzer. METHODS Hematologic tests were performed on whole blood samples collected from 20 New Zealand white rabbits at <1 hour post-blood collection as the baseline and at 6, 24, 48, and 72 hours post-blood collection, with aliquots stored at 21 and 4°C. CBC measurand stability was determined by comparing the obtained values at each time point to the baseline value. Statistically significant variations were compared with current quality specifications to determine if a meaningful bias existed. RESULTS Hematocrit, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration remained stable for 72 hours in blood stored at 4°C. No meaningful bias was observed for mean corpuscular volume after 48 and 72 hours of storage at 4°C. Only the white blood cell count was stable for 72 hours at 21°C. The platelet count, hemoglobin concentration, and mean platelet volume were not stable at 6 hours post-blood collection at either temperature. CONCLUSIONS The results of this study showed that the hematocrit can be tested for 72 hours in blood stored at 4°C, without a significant change from the baseline value. However, if all hematologic measurands are of interest, the immediate testing of blood samples, namely <1 hour post-blood collection, remains highly recommended.
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Affiliation(s)
- Jan Irving Bibay
- Biological Resource Centre, Agency for Science Technology and Research, Singapore, Singapore
| | - Shiela Margallo
- Biological Resource Centre, Agency for Science Technology and Research, Singapore, Singapore
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12
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Perioperative Platelet Transfusion: Not All Platelet Products Are Created Equal. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-022-00522-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Brown BL, Wagner SJ, Hapip CA, Fischer E, Getz TM, Thompson-Montgomery D, Turgeon A. Time from apheresis platelet donation to cold storage: Evaluation of platelet quality and bacterial growth. Transfusion 2022; 62:439-447. [PMID: 34994468 DOI: 10.1111/trf.16785] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cold storage reduces posttransfusion survival of platelets; however, it can improve platelet activation, lower risk of bacterial contamination, and extend shelf-life compared to room temperature (RT) storage. To facilitate large-scale availability, manufacturing process optimization is needed, including understanding the impact of variables on platelet potency and safety. Short time requirements from collection to storage is challenging for large blood centers to complete resuspension and qualify platelets for production. This study evaluated the impact of time from platelet component collection to cold storage on in vitro properties and bacterial growth. STUDY DESIGN AND METHODS Double-apheresis platelet components were collected from healthy donors, suspended in 65% PAS-III/35% plasma, and split into 2 equal units. One unit was placed into cold storage within 2 h and the other unit after 8 h. Eight matched pairs were evaluated for 12 in vitro parameters. Twenty-four matched pairs were evaluated with 8 bacterial strains tested in triplicate. Samples were tested throughout 21 days of storage. RESULTS In vitro properties were not different between 2 and 8 h units, and trends throughout storage were similar between arms. Time to cold storage did not significantly impact bacterial growth, with <1 log10 difference at all timepoints between units. DISCUSSION Our studies showed that extending time to cold storage from 2 to 8 h from collection did not significantly increase the bacterial growth, and the platelet component quality and function is maintained. The ability to extend the time required from collection to storage will improve blood center logistics to feasibly produce CSPs.
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Affiliation(s)
- Bethany L Brown
- American Red Cross, Holland Lab for the Biomedical Sciences, Rockville, Maryland, USA
| | - Stephen J Wagner
- American Red Cross, Holland Lab for the Biomedical Sciences, Rockville, Maryland, USA
| | - C Anne Hapip
- American Red Cross, Holland Lab for the Biomedical Sciences, Rockville, Maryland, USA
| | - Erin Fischer
- American Red Cross, Holland Lab for the Biomedical Sciences, Rockville, Maryland, USA
| | - Todd M Getz
- U.S Army Medical Research and Development Command Battlefield Resuscitation for Immediate Stabilization of Combat Casualties Portfolio Combat Casualty Care Research Program Office, USA
| | | | - Annette Turgeon
- American Red Cross, Holland Lab for the Biomedical Sciences, Rockville, Maryland, USA
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14
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Storage temperature determines platelet GPVI levels and function in mice and humans. Blood Adv 2021; 5:3839-3849. [PMID: 34478498 DOI: 10.1182/bloodadvances.2021004692] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Platelets are currently stored at room temperature before transfusion to maximize circulation time. This approach has numerous downsides, including limited storage duration, bacterial growth risk, and increased costs. Cold storage could alleviate these problems. However, the functional consequences of cold exposure for platelets are poorly understood. In the present study, we compared the function of cold-stored platelets (CSP) with that of room temperature-stored platelets (RSP) in vitro, in vivo, and posttransfusion. CSP formed larger aggregates under in vitro shear while generating similar contractile forces compared with RSP. We found significantly reduced glycoprotein VI (GPVI) levels after cold exposure of 5 to 7 days. After transfusion into humans, CSP were mostly equivalent to RSP; however, their rate of aggregation in response to the GPVI agonist collagen was significantly lower. In a mouse model of platelet transfusion, we found a significantly lower response rate to the GPVI-dependent agonist convulxin and significantly lower GPVI levels on the surface of transfused platelets after cold storage. In summary, our data support an immediate but short-lived benefit of cold storage and highlight the need for thorough investigations of CSP. This trial was registered at www.clinicaltrials.gov as #NCT03787927.
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15
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Huish S, Green L, Kempster C, Smethurst P, Wiltshire M, Prajapati C, Allen E, Cardigan R. A comparison of platelet function in cold-stored whole blood and platelet concentrates. Transfusion 2021; 61:3224-3235. [PMID: 34622949 DOI: 10.1111/trf.16657] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/09/2021] [Accepted: 07/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is renewed interest in the use of whole blood (WB) for the resuscitation of trauma patients. Platelet function in stored WB compared to platelet concentrates is not well established and was assessed in vitro in this study. METHODS Leucocyte-depleted cold-stored WB (CS-WB) was prepared using a Terumo WB-SP Imuflex kit and held at 2-6°C alongside: (A) UK standard pooled platelets stored at 20-24°C (RT-PLTS), (B) pooled platelets stored at 2-6°C (CS-PLTS), and (C) platelet-rich plasma produced using the Terumo kit (CS-PRP), for 21 days. A series of in vitro assays were assessed platelet function. RESULTS Platelet count was retained to 57 ± 14% of starting number at day 21 in CS-WB. Over time, CS-WB platelets become more activated, with increased CD62P expression (day 1: 7 ± 3.7% vs. day 21: 59 ± 17.1%) and annexin V binding (day 1: 2 ± 0.2% vs. day 21: 21 ± 15.1%). For comparison, 18.6 ± 6% of platelets in RT-PLTS demonstrated CD62P expression at day 7, whereas annexin V binding in RT-PLTS at day 7 was 2.6 ± 0.5%. Over storage, aggregatory response to agonists decreased in all arms. Functional platelet microparticles increased steadily in CS-WB throughout storage. CONCLUSION During storage, platelet count reduced in CS-WB, whereas CD62P expression and annexin V binding increased. This was accompanied by a reduced aggregatory response, although compared to 7-day-old RT-PLTS, CS-WB maintained a maximal response to agonists for longer, suggesting that the shelf life for CS-WB can be considered for up to 21 days.
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Affiliation(s)
- Sian Huish
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Laura Green
- Department of Clinical, NHS Blood and Transplant, London, UK.,Blizzard Institute, Queen Mary University of London, London, UK.,Department of Haematology, Barts Health NHS Trust UK, London, UK
| | - Carly Kempster
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Peter Smethurst
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | - Michael Wiltshire
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK
| | | | - Elisa Allen
- Statistics and Clinical Studies, NHS Blood and Transplant, Stoke Gifford, UK
| | - Rebecca Cardigan
- Component Development Laboratory, NHS Blood and Transplant, Cambridge, UK.,Department of Haematology, University of Cambridge, Cambridge, UK
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16
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Nair PM, Meledeo MA, Wells AR, Wu X, Bynum JA, Leung KP, Liu B, Cheeniyil A, Ramasubramanian AK, Weisel JW, Cap AP. Cold-stored platelets have better preserved contractile function in comparison with room temperature-stored platelets over 21 days. Transfusion 2021; 61 Suppl 1:S68-S79. [PMID: 34269433 DOI: 10.1111/trf.16530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 01/04/2023]
Abstract
Although it is well established that transfusion of platelets in cases of severe bleeding reduces mortality, the availability of platelets is hampered by harsh restrictions on shelf life due to elevated risks of microbial contamination and functional losses with room temperature-stored platelets (RTP) kept at 22°C. In contrast, many recent studies have shown that 4°C cold-stored platelets (CSP) are able to overcome these shortcomings leading to the recent Food and Drug Administration licensure for 14-day stored CSP when conventional platelets are unavailable. This work expands the evidence supporting superiority of CSP function by assaying the less explored platelet-mediated clot retraction of RTP and CSP in either autologous plasma (AP) or platelet additive solution (PAS) for up to 21 days. The results demonstrate that CSP have better preservation of contractile function, exhibiting retraction for up to 21 days in both AP and PAS and forming highly ordered fibrin scaffolds similar to those of fresh platelets. In contrast, RTP stored in AP showed impaired contractile function by Day 5 with no retraction after 10 days, whereas PAS-stored RTP retained contractile function for up to 21 days. Collectively, these findings support extended storage of CSP and suggest that storage in PAS can mitigate functional losses in RTP.
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Affiliation(s)
- Prajeeda M Nair
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Michael A Meledeo
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Adrienne R Wells
- Severe Burns Research Department, Combat Wound Repair Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Xiaowu Wu
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - James A Bynum
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Kai P Leung
- Severe Burns Research Department, Combat Wound Repair Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Bin Liu
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Aswathi Cheeniyil
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Anand K Ramasubramanian
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, Texas, USA.,Department of Chemical and Materials Engineering, San Jose State University, San Jose, California, USA
| | - John W Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew P Cap
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
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17
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Reddoch-Cardenas KM, Peltier GC, Chance TC, Nair PM, Meledeo MA, Ramasubramanian AK, Cap AP, Bynum JA. Cold storage of platelets in platelet additive solution maintains mitochondrial integrity by limiting initiation of apoptosis-mediated pathways. Transfusion 2020; 61:178-190. [PMID: 33294977 DOI: 10.1111/trf.16185] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cold storage of platelets in plasma maintains hemostatic function and is an attractive alternative to room temperature platelets (RTPs). We have recently shown that functional differences between cold-stored platelets (CSPs) and RTPs after 5-day storage are associated with mitochondrial respiration and that CSPs in platelet (PLT) additive solution (PAS) can maintain hemostatic function for at least 15 days. STUDY DESIGN AND METHODS This study tested the hypothesis that cold storage in PAS preserves mitochondrial integrity by reducing PLT apoptosis. CSPs and RTPs in plasma or PAS were stored and assayed for up to 15 days for mitochondrial function and integrity, mitochondrial-associated mRNA transcript expression, apoptotic proteins, and apoptotic flow cytometry metrics. RESULTS CSP preserved mitochondria-associated mRNA comparable to baseline levels, improved mitochondrial respiration, and minimized depolarization to Day 15. Additionally, CSPs had minimal induction of caspases, preservation of plasma membrane integrity, and low expression of pro-apoptotic Bax. Storage in PAS appeared to be protective for RTPs in some parameters and enhanced the effects of CSPs. CONCLUSION Mitochondrial function and molecular analyses defined CSP priming as distinctly different from the well-documented RTP storage lesion. While current blood bank storage at room temperature is limited to 5 to 7 days, refrigeration and storage in PAS for up to 15 days may represent an opportunity to enhance inventories and access to PLT hemostatic support for bleeding patients.
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Affiliation(s)
| | - Grant C Peltier
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
| | | | - Prajeeda M Nair
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
| | - Michael A Meledeo
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
| | | | - Andrew P Cap
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
| | - James A Bynum
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
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18
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19
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Kinoshita H, Saito J, Nakai K, Noguchi S, Takekawa D, Tamai Y, Kitayama M, Hirota K. Clotting functional stability of withdrawing blood in storage for acute normovolemic hemodilution: a pilot study. J Anesth 2020; 35:35-42. [PMID: 32975715 PMCID: PMC7840648 DOI: 10.1007/s00540-020-02856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/12/2020] [Indexed: 11/06/2022]
Abstract
Purpose This study was conducted to time-course changes of clotting function of withdrawing blood for acute normovolemic hemodilution (ANH). Methods Twelve enrolled patients who underwent ANH from August, 2018 to January, 2019. Blood was withdrawn into blood collection pack and shaken at 60–80 rpm for 24 h in room temperature. Clot formation was evaluated using rotational thromboelastometry (ROTEM™) just after blood withdrawal (control) and 4, 8, 12 and 24 h after blood withdrawal. We compared with the control value and each value of extrinsically-activated test with tissue factor (EXTEM), intrinsically-activated test using ellagic acid (INTEM) and fibrin-based extrinsically activated test with tissue factor (FIBTEM). Results Maximum clot firmness (MCF) of FIBTEM did not change significantly. MCF of EXTEM was significantly decreased time-dependent manner but all MCF of EXTEM were within a normal range. Maximum percent change in MCF of EXTEM was 12.4% [95% confidence interval (CI): 9.0–15.8%]. The difference in the maximum clot elasticity (MCE) between EXTEM and FIBTEM (MCEEXTEM−MCEFIBTEM) was significantly decrease from 8 h after blood withdrawal. Maximum percent change in MCEEXTEM−MCEFIBTEM was 30.2% (95% CI:17.6–42.9%) at 24 h after blood withdrawal. Conclusion Even though the MCE significantly decreased in a time-dependent manner, MCF of FIBTEM and EXTEM was normal up to 24 h storage. The blood of ANH can use for the purpose of hemostasis at least 8 h stored at room temperature after blood withdrawal. Future studies are needed to elucidate the clinical impact on the patient after delayed transfusion of ANH blood with regard to patient’s hemostasis. Electronic supplementary material The online version of this article (10.1007/s00540-020-02856-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hirotaka Kinoshita
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan.
| | - Kishiko Nakai
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Satoko Noguchi
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Daiki Takekawa
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
| | - Yoshiko Tamai
- Department of Transfusion and Cell Therapy Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masato Kitayama
- Division of Operating Center, Hirosaki University Medical Hospital, Hirosaki, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, 036-8562, Japan
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20
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Scorer TG, FitzGibbon L, Aungraheeta R, Sharma U, Peltier GC, McIntosh CS, Reddoch-Cardenas KM, Meyer A, Cap AP, Mumford AD. TEG PlateletMapping assay results may be misleading in the presence of cold stored platelets. Transfusion 2020; 60 Suppl 3:S119-S123. [PMID: 32478898 DOI: 10.1111/trf.15753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/28/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Viscoelastic tests (VETs) are used widely to monitor hemostasis in settings such as cardiac surgery. There has also been renewed interest in cold stored platelets (CSPs) to manage bleeding in this setting. CSPs are reported to have altered hemostatic properties compared to room temperature platelets (RTPs), including activation of GPIIb/IIIa. We investigated whether the functional differences between CSP and RTP affected the performance of the PlateletMapping VET on the TEG 5000 and 6s analyzer. METHOD Platelet concentrates were divided equally into CSP (stored at 4°C ± 2°C) and RTP (stored at 22°C ± 2°C) fractions. Whole blood was treated to induce platelet dysfunction (WBIPD) by incubating with anti-platelet drugs (1.0 μM ticagrelor and 10 μM aspirin) or by simulating cardiopulmonary bypass. WBIPD samples were then mixed with 20% by volume of CSPs or RTPs to model platelet transfusion before analysis using the PlateletMapping VET. RESULTS Addition of CSPs to WBIPD increased the PlateletMapping MAFIBRIN and MAADP parameters with the TEG 5000 analyzer (both p < 0.0001 compared to addition of buffer alone). This effect was not observed with RTPs. The differential effect of CSPs on the MAFIBRIN corrected after pre-incubation with the GPIIb/IIIa antagonist tirofiban and was quantitatively less with the PlateletMapping test for the TEG 6s analyzer which contains the GPIIb/IIa antagonist abciximab. DISCUSSION The PlateletMapping MAFIBRIN and MAADP test results may be misleadingly high with CSPs, particularly with the TEG 5000 analyzer, most likely due to constitutive activation of GPIIb/IIIa on CSPs during storage. TEG PlateletMapping results should be interpreted with caution following CSP transfusion.
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Affiliation(s)
- Thomas G Scorer
- Centre of Defence Pathology, Royal Centre of Defence Medicine, Birmingham, UK.,School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.,Coagulation and Blood Research, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Lucy FitzGibbon
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Riyaad Aungraheeta
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Umang Sharma
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Grantham C Peltier
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Colby S McIntosh
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | | | - Andrew Meyer
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.,Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Andrew P Cap
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Andrew D Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
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21
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Reddoch-Cardenas KM, Sharma U, Salgado CL, Cantu C, Darlington DN, Pidcoke HF, Bynum JA, Cap AP. Use of Specialized Pro-Resolving Mediators to Alleviate Cold Platelet Storage Lesion. Transfusion 2020; 60 Suppl 3:S112-S118. [PMID: 32478925 DOI: 10.1111/trf.15750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cold-stored platelets are an attractive option for treatment of actively bleeding patients due to a reduced risk of septic complications and preserved hemostatic function compared to conventional room temperature-stored platelets. However, refrigeration causes increased platelet activation and aggregate formation. Specialized pro-resolving mediators (SPMs), cell signaling mediators biosynthesized from essential fatty acids, have been shown to modulate platelet function and activation. In this study, we sought to determine if SPMs could be used to inhibit cold-stored platelet activation. METHODS Platelets were collected from healthy donors (n = 4-7) and treated with SPMs (resolvin E1 [RvE1], maresin 1 [MaR1], and resolvin D2 [RvD2]) or vehicle (VEH; 0.1% EtOH). Platelets were stored without agitation in the cold and assayed on Days 0 and 7 of storage for platelet activation levels using flow cytometry, platelet count, aggregation response using impedance aggregometry, and nucleotide content using mass spectrometry. RESULTS Compared to VEH, SPM treatment inhibited GPIb shedding (all compounds), significantly reduced both PS exposure and activation of GPIIb/IIIa receptor (RvD2, MaR1), and preserved aggregation response to TRAP (RvD2, MaR1) after 7 days of storage. Similar to untreated cold-stored platelets, SPM-treated samples did not preserve platelet counts or block the release of P-Selectin. Nucleotide content was unaffected by SPM treatment in cold-stored platelets. CONCLUSIONS SPM treatment, particularly Mar1 and RvD2, led to reduced platelet activation and preserved platelet function after 7 days of storage in the cold. Future work is warranted to better elucidate the mechanism of action of SPMs on cold platelet function and activation.
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Affiliation(s)
- Kristin M Reddoch-Cardenas
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Umang Sharma
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Christi L Salgado
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Carolina Cantu
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Daniel N Darlington
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Heather F Pidcoke
- Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
| | - James A Bynum
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
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22
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D’Alessandro A, Thomas KA, Stefanoni D, Gamboni F, Shea SM, Reisz JA, Spinella PC. Metabolic phenotypes of standard and cold-stored platelets. Transfusion 2020; 60 Suppl 3:S96-S106. [PMID: 31880330 PMCID: PMC7971209 DOI: 10.1111/trf.15651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Conventional platelet (PLT) storage at room temperature under continuous agitation results in a limited shelf life (5 days) and an increased risk of bacterial contamination. However, both of these aspects can be ameliorated by cold storage. Preliminary work has suggested that PLTs can be cold stored for up to 3 weeks, while preserving their metabolic activity longer than in PLTs stored at room temperature. As such, in the present study, we hypothesized that the metabolic phenotypes of PLTs stored at 4°C for 3 weeks could be comparable to that of room temperature-stored PLTs at 22°C for 5 days. STUDY DESIGN AND METHODS Metabolomics analyses were performed on nine apheresis PLT concentrates stored either at room temperature (22°C) for 5 days or refrigerated conditions (4°C) for up to 3 weeks. RESULTS Refrigeration did not impact the rate of decline in glutamine or the intracellular levels of Krebs cycle metabolites upstream to fumarate and malate. It did, however, decrease oxidant stress (to glutathione and purines) and slowed down the activation of the pentose phosphate pathway, glycolysis, and fatty acid metabolism (acyl-carnitines). CONCLUSION The overall metabolic phenotypes of 4°C PLTs at Storage Day 10 are comparable to PLTs stored at 22°C at the end of their 5-day shelf life, while additional changes in glycolysis, purine, and fatty acid metabolism are noted by Day 21.
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Affiliation(s)
- Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, Colorado
| | - Kimberly A. Thomas
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St. Louis, Missouri
| | - Davide Stefanoni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, Colorado
| | - Fabia Gamboni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, Colorado
| | - Susan M. Shea
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St. Louis, Missouri
| | - Julie A. Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver – Anschutz Medical Campus, Aurora, Colorado
| | - Philip C. Spinella
- Department of Pediatrics, Division of Critical Care, Washington University School of Medicine, St. Louis, Missouri
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23
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The effect of platelet storage temperature on haemostatic, immune, and endothelial function: potential for personalised medicine. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 17:321-330. [PMID: 31385802 DOI: 10.2450/2019.0095-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/30/2019] [Indexed: 02/06/2023]
Abstract
Reports from both adult and paediatric populations indicate that approximately two-thirds of platelet transfusions are used prophylactically to prevent bleeding, while the remaining one-third are used therapeutically to manage active bleeding. These two indications, prophylactic and therapeutic, serve two very distinct purposes and therefore will have two different functional requirements. In addition, disease aetiology in a given patient may require platelets with different functional characteristics. These characteristics can be derived from the various manufacturing methods used in platelet product production, including collection methods, processing methods, and storage options. The iterative combinations of manufacturing methods can result in a number of unique platelet products with different efficacy and safety profiles, which could potentially be used to benefit patient populations by meeting diverse clinical needs. In particular, cold storage of platelet products causes many biochemical and functional changes, of which the most notable characterised to date include increased haemostatic activity and altered expression of molecules inherent to platelet:leucocyte interactions. The in vivo consequences, both short- and long-term, of these molecular and cellular cold-storage-induced changes have yet to be clearly defined. Elucidation of these mechanisms would potentially reveal unique biologies that could be harnessed to provide more targeted therapies. To this end, in this new era of personalised medicine, perhaps there is an opportunity to provide individual patients with platelet products that are tailored to their clinical condition and the specific indication for transfusion.
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24
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Horioka K, Tanaka H, Isozaki S, Okuda K, Asari M, Shiono H, Ogawa K, Shimizu K. Hypothermia-induced activation of the splenic platelet pool as a risk factor for thrombotic disease in a mouse model. J Thromb Haemost 2019; 17:1762-1771. [PMID: 31237986 PMCID: PMC6851562 DOI: 10.1111/jth.14555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hypothermia, either therapeutically induced or accidental (ie, an involuntary decrease in core body temperature to <35°C), results in hemostatic disorders. However, it remains unclear whether hypothermia enhances or inhibits coagulation, especially in severe hypothermia. The present study evaluated the thrombocytic and hemostatic changes in hypothermic mice. METHODS C57Bl/6 mice were placed at an ambient temperature of -20°C under general anesthesia. When the rectal temperature decreased to 15°C, 10 mice were immediately euthanized, while another 10 mice were rewarmed, kept in normal conditions for 24 hours, and then euthanized. These treatments were also performed in 20 splenectomized mice. RESULTS The hypothermic mice had adhesion of CD62P-positive platelets with high expression of von Willebrand factor (vWF) in their spleens, while the status of the peripheral platelets was unchanged. Furthermore, the plasma levels of platelet factor 4 (PF4) and pro-platelet basic protein (PPBP), which are biomarkers for platelet degranulation, were significantly higher in hypothermic mice than in control mice, indicating that hypothermia activated the platelets in the splenic pool. Thus, we analyzed these biomarkers in asplenic mice. There was no increase in either PF4 or PPBP in splenectomized hypothermic mice. Additionally, the plasma D-dimer elevation and microthrombosis were caused in rewarmed mice, but not in asplenic rewarmed mice. CONCLUSIONS Our results indicate that hypothermia leads to platelet activation in the spleen via the upregulation of vWF, and this activation causes hypercoagulability after rewarming.
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Affiliation(s)
- Kie Horioka
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Hiroki Tanaka
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Shotaro Isozaki
- Division of Gastroenterology and Hematology/OncologyAsahikawa Medical UniversityAsahikawaJapan
| | - Katsuhiro Okuda
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Masaru Asari
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Hiroshi Shiono
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
| | - Katsuhiro Ogawa
- Department of PathologyAsahikawa Medical UniversityAsahikawaJapan
| | - Keiko Shimizu
- Department of Legal MedicineAsahikawa Medical UniversityAsahikawaJapan
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25
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Towards increasing shelf life and haemostatic potency of stored platelet concentrates. Curr Opin Hematol 2019; 25:500-508. [PMID: 30281037 DOI: 10.1097/moh.0000000000000456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Platelet transfusion is a widely used therapy in treating or preventing bleeding and haemorrhage in patients with thrombocytopenia or trauma. Compared with the relative ease of platelet transfusion, current practice for the storage of platelets is inefficient, costly and relatively unsafe, with platelets stored at room temperature (RT) for upto 5-7 days. RECENT FINDINGS During storage, especially at cold temperatures, platelets undergo progressive and deleterious changes, collectively termed the 'platelet storage lesion', which decrease their haemostatic function and posttransfusion survival. Recent progress in understanding platelet activation and host clearance mechanisms is leading to the consideration of both old and novel storage conditions that use refrigeration and/or cryopreservation to overcome various storage lesions and significantly extend platelet shelf-life with a reduced risk of pathogen contamination. SUMMARY A review of the advantages and disadvantages of alternative methods for platelet storage is presented from both a clinical and biological perspective. It is anticipated that future platelet preservation involving cold, frozen and/or pathogen reduction strategies in a proper platelet additive solution will enable longer term and safer platelet storage.
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26
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Scorer TG, Reddoch-Cardenas KM, Thomas KA, Cap AP, Spinella PC. Therapeutic Utility of Cold-Stored Platelets or Cold-Stored Whole Blood for the Bleeding Hematology-Oncology Patient. Hematol Oncol Clin North Am 2019; 33:873-885. [PMID: 31466610 DOI: 10.1016/j.hoc.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bleeding related to thrombocytopenia is common in hematology-oncology patients. Platelets stored at room temperature (RTPs) are the current standard of care. Platelets stored in the cold (CSPs) have enhanced hemostatic function relative to RTPs. CSPs were reported to reduce bleeding in hematology-oncology patients. Recent studies have confirmed the enhanced hemostatic properties of CSPs. CSPs may be the better therapeutic option for this population. CSPs may also offer a preferable immune profile, reduced thrombotic risk, and reduced transfusion-transmitted infection risk. The logistical advantages of CSPs would improve outcomes for many patients who currently cannot access platelet transfusions.
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Affiliation(s)
- Thomas G Scorer
- School of Cellular and Molecular Medicine, University of Bristol, Bristol Royal Infirmary, Research Floor 7, Queens Building, Bristol, BS2 8HW, UK; Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Kristin M Reddoch-Cardenas
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, BLDG 3610, JBSA-Fort Sam Houston, San Antonio, TX 78234, USA
| | - Kimberly A Thomas
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Andrew P Cap
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, BLDG 3610, JBSA-Fort Sam Houston, San Antonio, TX 78234, USA
| | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
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27
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Mukai N, Nakayama Y, Ishi S, Murakami T, Ogawa S, Kageyama K, Murakami S, Sasada Y, Yoshioka J, Nakajima Y. Cold storage conditions modify microRNA expressions for platelet transfusion. PLoS One 2019; 14:e0218797. [PMID: 31269049 PMCID: PMC6608970 DOI: 10.1371/journal.pone.0218797] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/09/2019] [Indexed: 12/15/2022] Open
Abstract
MicroRNAs (miRNAs) are small RNA molecules that modulate gene and protein expression in hematopoiesis. Platelets are known to contain a fully functional miRNA machinery. While platelets used for transfusion are normally stored at room temperature, recent evidence suggests more favorable effects under a cold-storage condition, including higher adhesion and aggregation properties. Thus, we sought to determine whether functional differences in platelets are associated with the differential profiling of platelet miRNA expressions. To obtain the miRNA expression profile, next-generation sequencing was performed on human platelets obtained from 10 healthy subjects. The miRNAs were quantified after being stored in three different conditions: 1) baseline (before storage), 2) stored at 22°C with agitation for 72 h, and 3) stored at 4°C for 72 h. Following the identification of miRNAs by sequencing, the results were validated at the level of mature miRNAs from 18 healthy subjects, by using quantitative polymerase chain reaction (qPCR). Differential expression was observed for 125 miRNAs that were stored at 4°C and 9 miRNAs stored at 22°C as compared to the baseline. The validation study by qPCR confirmed that storage at 4°C increased the expression levels (fold change 95% CI) of mir-20a-5p (1.87, p<0.0001), mir-10a-3p (1.88, p<0.0001), mir-16-2-3p (1.54, p<0.01), and mir-223-5p (1.38, p<0.05), compared with those of the samples stored at 22°C. These results show that miRNAs correlate with platelet quality under specific storage conditions. The data indicate that miRNAs could be potentially used as biomarkers of platelet quality.
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Affiliation(s)
- Nobuhiro Mukai
- Department of Anesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Nakayama
- Department of Anesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, City College of New York, New York, NY, United States of America
- * E-mail:
| | - Sachiyo Ishi
- Department of Anesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takayuki Murakami
- Department of Anesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoru Ogawa
- Department of Anesthesiology and Critical Care, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kyoko Kageyama
- Department of Anesthesiology, Otokoyama Hospital, Kyoto, Japan
| | - Satoshi Murakami
- Thermo Fisher Scientific, Life Technologies Japan Ltd., Life Solutions Group, Tokyo, Japan
| | - Yuji Sasada
- Department of Transfusion Medicine and Cell Therapy, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Yoshioka
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, City College of New York, New York, NY, United States of America
| | - Yasufumi Nakajima
- Department of Anesthesiology and Critical Care, Kansai Medical University, Osaka, Japan and Outcomes Research Consortium, Cleveland, OH, United States of America
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28
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Six KR, Devloo R, Compernolle V, Feys HB. Impact of cold storage on platelets treated with Intercept pathogen inactivation. Transfusion 2019; 59:2662-2671. [PMID: 31187889 PMCID: PMC6851707 DOI: 10.1111/trf.15398] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pathogen inactivation and cold or cryopreservation of platelets (PLTs) both significantly affect PLT function. It is not known how PLTs function when both are combined. STUDY DESIGN AND METHODS Standard PLT concentrates (PCs) were compared to pathogen‐inactivated PCs treated with amotosalen photochemical treatment (AS‐PCT) when stored at room (RT, 22°C), cold (4°C, n = 6), or cryopreservation (−80°C, n = 8) temperatures. The impact of alternative storage methods on both arms was studied in flow cytometry, light transmittance aggregometry, and hemostasis in collagen‐coated microfluidic flow chambers. RESULTS Platelet aggregation of cold‐stored AS‐PCT PLTs was 44% ± 11% compared to 57% ± 14% for cold‐stored standard PLTs and 58% ± 21% for RT‐stored AS‐PCT PLTs. Integrin activation of cold‐stored AS‐PCT PLTs was 53% ± 9% compared to 77% ± 6% for cold‐stored standard PLTs and 69% ± 13% for RT‐stored AS‐PCT PLTs. Coagulation of cold‐stored AS‐PCT PLTs started faster under flow (836 ± 140 sec) compared to cold‐stored standard PLTs (960 ± 192 sec) and RT‐stored AS‐PCT PLTs (1134 ± 220 sec). Fibrin formation rate under flow was also highest for cold‐stored AS‐PCT PLTs. This was in line with thrombin generation in static conditions because cold‐stored AS‐PCT PLTs generated 297 ± 47 nmol/L thrombin compared to 159 ± 33 nmol/L for cold‐stored standard PLTs and 83 ± 25 nmol/L for RT‐stored AS‐PCT PLTs. So despite decreased PLT activation and aggregation, cold storage of AS‐PCT PLTs promoted coagulation. PLT aggregation of cryopreserved AS‐PCT PLTs (23% ± 10%) was not significantly different from cryopreserved standard PLTs (25% ± 8%). CONCLUSION This study shows that cold storage of AS‐PCT PLTs further affects PLT activation and aggregation but promotes (pro)coagulation. Increased procoagulation was not observed after cryopreservation.
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Affiliation(s)
- Katrijn R Six
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Rosalie Devloo
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
| | - Veerle Compernolle
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Blood Service of the Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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29
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Scorer T, Williams A, Reddoch-Cardenas K, Mumford A. Manufacturing variables and hemostatic function of cold-stored platelets: a systematic review of the literature. Transfusion 2019; 59:2722-2732. [PMID: 31184775 DOI: 10.1111/trf.15396] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/09/2019] [Accepted: 05/11/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Thomas Scorer
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom.,Centre of Defence Pathology, RCDM, Birmingham, United Kingdom.,Coagulation and Blood Research, U.S. Army Institute of Surgical Research, JBSA Ft Sam Houston, San Antonio, Texas
| | - Ashleigh Williams
- Department of Anaesthesia, Derriford Hospital, Plymouth, United Kingdom
| | - Kristin Reddoch-Cardenas
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, JBSA Ft Sam Houston, San Antonio, Texas
| | - Andrew Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
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30
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Yang JC, Liu FH, Sun Y, Ma T, Xu CX, Wang WH, Chen P, Xie XX, Song YJ, Yin W. Good hemostatic effect of platelets stored at 4°C in an in vitro model of massive blood loss and thrombocytopenia. Medicine (Baltimore) 2019; 98:e15454. [PMID: 31045818 PMCID: PMC6504340 DOI: 10.1097/md.0000000000015454] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study compared the corrective effects of storage of platelets at 4°C and at 22°C in an in vitro model of massive blood loss and thrombocytopenia to provide an experimental basis for the storage of platelets for clinical applications.In vitro model of massive blood loss and thrombocytopenia were constructed by the in vitro hemodilution method and cell washing method. Using storage of platelets at 4°C (1, 3, 5, 7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the coagulation condition of the different models, by thromboelastography and by routine blood indices.①Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of massive blood loss. Platelet count results improved from 17 to 27 × 10/L to greater than 120 × 10/L for 4°C storage, and 20 to 27 × 10/L to greater than 120 × 10/L for 22°C storage. Thromboelastography maximum amplitude (TEG-MA) results improved from 8.8 to 15.4 mm to greater than 43 mm for 4°C storage, and 12.2 to 14.4 mm to greater than 44.8 mm for 22°C storage. Thromboelastography reaction time values decreased from 9.9-24.9 minutes to 3.8-5.5 minutes for 4°C storage, and 9.9-22.7 minutes to 4.3-4.5 minutes for 22°C storage. ②Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of thrombocytopenia. Platelet count results improved from 12 to 34 × 10/L to greater than 99 × 10/L for 4°C storage, and 12 to 34 × 10/L to greater than 120 × 10/L for 22°C storage. TEG-MA results improved from 21.4 to 32.1 mm to greater than 49.1 mm for 4°C storage, and 21.4 to 31.6 mm to greater than 50.5 mm for 22°C storage.Platelets stored at 4°C and 22°C have the same correcting effect for 1, 3, and 5 days. Platelets stored at 4°C for 7 to 14 days have similarly hemostatic effect on the in vitro model of massive blood loss and thrombocytopenia.
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Affiliation(s)
- Jiang-Cun Yang
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Feng-Hua Liu
- Department of Transfusion Medicine, First Affiliated Hospital of Harbin Medical University, Harbin
| | - Yang Sun
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Ting Ma
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Cui-Xiang Xu
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Wen-Hua Wang
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Ping Chen
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Xin-Xin Xie
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Yao-Jun Song
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital, Xi’an
| | - Wen Yin
- Department of Transfusion Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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31
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The design of an adaptive clinical trial to evaluate the efficacy of platelets stored at low temperature in surgical patients. J Trauma Acute Care Surg 2019. [PMID: 29521797 DOI: 10.1097/ta.0000000000001876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Storage of platelets at 4°C compared with 22°C may increase both hemostatic activity and storage duration; however, the maximum duration of cold storage is unknown. We report the design of an innovative, prospective, randomized, Bayesian adaptive, "duration finding" clinical trial to evaluate the efficacy and maximum duration of storage of platelets at 4°C. METHODS Patients undergoing cardiac surgery and requiring platelet transfusions will be enrolled. Patients will be randomized to receive platelets stored at 22°C up to 5 days or platelets stored at 4°C up to 5 days, 10 days, or 15 days. Longer durations of cold storage will only be used if shorter durations at 4°C appear noninferior to standard storage, based on a four-level clinical hemostatic efficacy score with a NIM of a half level. A Bayesian linear model is used to estimate the hemostatic efficacy of platelet transfusions based on the actual duration of storage at 4°C. RESULTS The type I error rate, if platelets stored at 4°C are inferior, is 0.0247 with an 82% probability of early stopping for futility. With a maximum sample size of 1,500, the adaptive trial design has a power of over 90% to detect noninferiority and a high probability of correctly identifying the maximum duration of storage at 4°C that is noninferior to 22°C. CONCLUSION An adaptive, duration-finding trial design will generate Level I evidence and allow the determination of the maximum duration platelet storage at 4°C that is noninferior to standard storage at 22°C, with respect to hemostatic efficacy. The adaptive trial design helps to ensure that longer cold storage durations are only explored once substantial supportive data are available for the shorter duration(s) and that the trial stops early if continuation is likely to be futile.
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32
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Cancelas JA. Future of platelet formulations with improved clotting profile: a short review on human safety and efficacy data. Transfusion 2019; 59:1467-1473. [DOI: 10.1111/trf.15163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Jose A. Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati Academic Health Center Cincinnati Ohio
- Division of Experimental Hematology and Cancer BiologyCincinnati Children's Hospital Medical Center Cincinnati Ohio
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33
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Reddoch-Cardenas KM, Sharma U, Salgado CL, Montgomery RK, Cantu C, Cingoz N, Bryant R, Darlington DN, Pidcoke HF, Kamucheka RM, Cap AP. An in vitro pilot study of apheresis platelets collected on Trima Accel system and stored in T-PAS+ solution at refrigeration temperature (1-6°C). Transfusion 2019; 59:1789-1798. [PMID: 30725491 DOI: 10.1111/trf.15150] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/20/2018] [Accepted: 12/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Using platelet additive solution (PAS) to dilute fibrinogen during long-term cold storage of platelets (PLTs) decreases PLT activation and increases functional PLT shelf life. We performed a randomized, paired study to assess the in vitro quality of PLTs stored in the cold in T-PAS+ for up to 18 days evaluated against PLTs stored under currently allowable conditions (5-day room temperature-stored PLTs [RTP] and 3-day cold-stored PLTs [CSP]). STUDY DESIGN AND METHODS PLTs were collected from healthy volunteers (n = 10) and diluted to 65% T-PAS+/35% plasma before cold storage. Double-dose apheresis PLTs (in 100% plasma) were collected from the same donors and split into two bags (one bag RTP, one bag CSP). All bags were sampled on the day of collection (Day 0). CSP and RTP bags were sampled on Days 3 and 5, respectively. T-PAS+ samples were assessed on Days 3, 5, 14, 16, and 18 of storage for metabolism, hemostatic function, and activation. RESULTS After 18 days of storage in T-PAS+, pH was 6.71 ± 0.04, PLT count was comparable to Day 3 CSP, PLT function (aggregation and clot strength) was comparable to Day 5 RTP, and PLT activation was significantly increased. CONCLUSION Refrigerated PLTs stored in T-PAS+ for 18 days met FDA pH standards. Functional metrics suggest activity of T-PAS+-stored PLTs and the potential to contribute to hemostasis throughout 18 days of storage. Extending the shelf life of PLTs would increase access to hemostatic resuscitation for bleeding patients in military and civilian settings.
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Affiliation(s)
- Kristin M Reddoch-Cardenas
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Umang Sharma
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Christi L Salgado
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | | | - Carolina Cantu
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Neslihan Cingoz
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Ron Bryant
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Daniel N Darlington
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | | | - Robin M Kamucheka
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Andrew P Cap
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
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34
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Marini I, Aurich K, Jouni R, Nowak-Harnau S, Hartwich O, Greinacher A, Thiele T, Bakchoul T. Cold storage of platelets in additive solution: the impact of residual plasma in apheresis platelet concentrates. Haematologica 2018; 104:207-214. [PMID: 30115655 PMCID: PMC6312032 DOI: 10.3324/haematol.2018.195057] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/09/2018] [Indexed: 11/09/2022] Open
Abstract
Platelet transfusion has become essential therapy in modern medicine. Although the clinical advantage of platelet transfusion has been well established, adverse reactions upon transfusion, especially transmission of bacterial infection, still represent a major challenge. While bacterial contamination is favored by the storage of platelets at room temperature, cold storage may represent a solution for this important clinical issue. In this study, we aimed to clarify whether plasma has protective or detrimental effects on cold-stored platelets. We investigated the impact of different residual plasma contents in apheresis-derived platelet concentrates, stored at 4°C or room temperature, on platelet function and survival. We found that platelets stored at 4°C have higher expression of apoptosis marker compared to platelets stored at room temperature, leading to accelerated clearance from the circulation in a humanized animal model. While cold-induced apoptosis was independent of the residual plasma concentration, cold storage was associated with better adhesive properties and higher response to activators. Interestingly, delta (δ) granule-related functions, such as ADP-mediated aggregation and CD63 release, were better preserved at 4°C, especially in 100% plasma. An extended study to assess cold-stored platelet concentrates produced under standard care Good Manufacturing Practice conditions showed that platelet function, metabolism and integrity were better compared to those stored at room temperature. Taken together, our results show that residual plasma concentration does not have a cardinal impact on the cold storage lesions of apheresis-derived platelet concentrates and indicate that the current generation of additive solutions represent suitable substitutes for plasma to store platelets at 4°C.
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Affiliation(s)
- Irene Marini
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen
| | - Konstanze Aurich
- Institute of Immunology and Transfusion Medicine, University of Greifswald, Germany
| | - Rabie Jouni
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen
| | - Stefanie Nowak-Harnau
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen
| | - Oliver Hartwich
- Institute of Immunology and Transfusion Medicine, University of Greifswald, Germany
| | - Andreas Greinacher
- Institute of Immunology and Transfusion Medicine, University of Greifswald, Germany
| | - Thomas Thiele
- Institute of Immunology and Transfusion Medicine, University of Greifswald, Germany
| | - Tamam Bakchoul
- Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen .,Institute of Immunology and Transfusion Medicine, University of Greifswald, Germany
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35
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Wong KHK, Edd JF, Tessier SN, Moyo WD, Mutlu BR, Bookstaver LD, Miller KL, Herrara S, Stott SL, Toner M. Anti-thrombotic strategies for microfluidic blood processing. LAB ON A CHIP 2018; 18:2146-2155. [PMID: 29938257 PMCID: PMC6082414 DOI: 10.1039/c8lc00035b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The redundant mechanisms involved in blood coagulation are crucial for rapid hemostasis. Yet they also create challenges in blood processing in medical devices and lab-on-a-chip systems. In this work, we investigate the effects of both shear stress and hypothermic blood storage on thrombus formation in microfluidic processing. For fresh blood, thrombosis occurs only at high shear, and the glycoprotein IIb/IIIa inhibitor tirofiban is highly effective in preventing thrombus formation. Blood storage generally activates platelets and primes them towards thrombosis via multiple mechanisms. Thrombus formation of stored blood at low shear can be adequately inhibited by glycoprotein IIb/IIIa inhibitors. At high shear, von Willebrand factor-mediated thrombosis contributes significantly and requires additional treatments with thiol-containing antioxidants-such as N acetylcysteine and reduced glutathione-that interfere with von Willebrand factor polymerization. We further demonstrate the effectiveness of these anti-thrombotic strategies in microfluidic devices made of cyclic olefin copolymer, a popular material used in the healthcare industry. This work identifies effective anti-thrombotic strategies that are applicable in a wide range of blood- and organ-on-a-chip applications.
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Affiliation(s)
- Keith H. K. Wong
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jon F. Edd
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Shannon N. Tessier
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Will D. Moyo
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Baris R. Mutlu
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Lauren D. Bookstaver
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Kathleen L. Miller
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Stefan Herrara
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Shannon L. Stott
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Corresponding author. (M.T.); (S.L.S.)
| | - Mehmet Toner
- BioMEMS Resource Center, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Corresponding author. (M.T.); (S.L.S.)
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36
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Waters L, Cameron M, Padula MP, Marks DC, Johnson L. Refrigeration, cryopreservation and pathogen inactivation: an updated perspective on platelet storage conditions. Vox Sang 2018; 113:317-328. [PMID: 29441601 DOI: 10.1111/vox.12640] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/28/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
Conventional storage of platelet concentrates limits their shelf life to between 5 and 7 days due to the risk of bacterial proliferation and the development of the platelet storage lesion. Cold storage and cryopreservation of platelets may facilitate extension of the shelf life to weeks and years, and may also provide the benefit of being more haemostatically effective than conventionally stored platelets. Further, treatment of platelet concentrates with pathogen inactivation systems reduces bacterial contamination and provides a safeguard against the risk of emerging and re-emerging pathogens. While each of these alternative storage techniques is gaining traction individually, little work has been done to examine the effect of combining treatments in an effort to further improve product safety and minimize wastage. This review aims to discuss the benefits of alternative storage techniques and how they may be combined to alleviate the problems associated with conventional platelet storage.
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Affiliation(s)
- L Waters
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M Cameron
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M P Padula
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - D C Marks
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
| | - L Johnson
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
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37
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Yang J, Yin W, Zhang Y, Sun Y, Ma T, Gu S, Gao Y, Zhang X, Yuan J, Wang W. Evaluation of the advantages of platelet concentrates stored at 4°C versus 22°C. Transfusion 2017; 58:736-747. [PMID: 29266276 DOI: 10.1111/trf.14462] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/30/2017] [Accepted: 11/12/2017] [Indexed: 01/23/2023]
Affiliation(s)
- Jiangcun Yang
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital; Xi'an China
| | - Wen Yin
- Department of Transfusion Medicine; Xijing Hospital, the Fourth Military Medical University; Xi'an China
| | - Yali Zhang
- Department of Blood Components Preparation; Shaanxi Provincial Blood Center; Xi'an China
| | - Yang Sun
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital; Xi'an China
| | - Ting Ma
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital; Xi'an China
| | - Shunli Gu
- Department of Transfusion Medicine; Xijing Hospital, the Fourth Military Medical University; Xi'an China
| | - Ying Gao
- Department of Hematology, Shaanxi Provincial People's Hospital; Xi'an China
| | - Xiaole Zhang
- Department of Transfusion Medicine; Xijing Hospital, the Fourth Military Medical University; Xi'an China
| | - Jun Yuan
- Department of Laboratory; Shaanxi Provincial People's Hospital; Xi'an China
| | - Wenhua Wang
- Department of Transfusion Medicine, Shaanxi Provincial People's Hospital; Xi'an China
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38
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Chen W, Druzak SA, Wang Y, Josephson CD, Hoffmeister KM, Ware J, Li R. Refrigeration-Induced Binding of von Willebrand Factor Facilitates Fast Clearance of Refrigerated Platelets. Arterioscler Thromb Vasc Biol 2017; 37:2271-2279. [PMID: 29097365 DOI: 10.1161/atvbaha.117.310062] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/23/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Apheresis platelets for transfusion treatment are currently stored at room temperature because after refrigeration platelets are rapidly cleared on transfusion. In this study, the role of von Willebrand factor (VWF) in the clearance of refrigerated platelets is addressed. APPROACH AND RESULTS Human and murine platelets were refrigerated in gas-permeable bags at 4°C for 24 hours. VWF binding, platelet signaling events, and platelet post-transfusion recovery and survival were measured. After refrigeration, the binding of plasma VWF to platelets was drastically increased, confirming earlier studies. The binding was blocked by peptide OS1 that bound specifically to platelet glycoprotein (GP)Ibα and was absent in VWF-/- plasma. Although surface expression of GPIbα was reduced after refrigeration, refrigeration-induced VWF binding under physiological shear induced unfolding of the GPIbα mechanosensory domain on the platelet, as evidenced by increased exposure of a linear epitope therein. Refrigeration and shear treatment also induced small elevation of intracellular Ca2+, phosphatidylserine exposure, and desialylation of platelets, which were absent in VWF-/- platelets or inhibited by OS1, which is a monomeric 11-residue peptide (CTERMALHNLC). Furthermore, refrigerated VWF-/- platelets displayed increased post-transfusion recovery and survival than wild-type ones. Similarly, adding OS1 to transgenic murine platelets expressing only human GPIbα during refrigeration improved their post-transfusion recovery and survival. CONCLUSIONS Refrigeration-induced binding of VWF to platelets facilitates their rapid clearance by inducing GPIbα-mediated signaling. Our results suggest that inhibition of the VWF-GPIbα interaction may be a potential strategy to enable refrigeration of platelets for transfusion treatment.
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Affiliation(s)
- Wenchun Chen
- From the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA (W.C., S.A.D., Y.W., C.D.J., R.L.); Department of Pediatrics (W.C., S.A.D., Y.W., C.D.J., R.L.) and Department of Pathology (C.D.J.), Emory University School of Medicine, Atlanta, GA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee (K.M.H.); and Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.)
| | - Samuel A Druzak
- From the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA (W.C., S.A.D., Y.W., C.D.J., R.L.); Department of Pediatrics (W.C., S.A.D., Y.W., C.D.J., R.L.) and Department of Pathology (C.D.J.), Emory University School of Medicine, Atlanta, GA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee (K.M.H.); and Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.)
| | - Yingchun Wang
- From the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA (W.C., S.A.D., Y.W., C.D.J., R.L.); Department of Pediatrics (W.C., S.A.D., Y.W., C.D.J., R.L.) and Department of Pathology (C.D.J.), Emory University School of Medicine, Atlanta, GA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee (K.M.H.); and Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.)
| | - Cassandra D Josephson
- From the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA (W.C., S.A.D., Y.W., C.D.J., R.L.); Department of Pediatrics (W.C., S.A.D., Y.W., C.D.J., R.L.) and Department of Pathology (C.D.J.), Emory University School of Medicine, Atlanta, GA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee (K.M.H.); and Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.)
| | - Karin M Hoffmeister
- From the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA (W.C., S.A.D., Y.W., C.D.J., R.L.); Department of Pediatrics (W.C., S.A.D., Y.W., C.D.J., R.L.) and Department of Pathology (C.D.J.), Emory University School of Medicine, Atlanta, GA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee (K.M.H.); and Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.)
| | - Jerry Ware
- From the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA (W.C., S.A.D., Y.W., C.D.J., R.L.); Department of Pediatrics (W.C., S.A.D., Y.W., C.D.J., R.L.) and Department of Pathology (C.D.J.), Emory University School of Medicine, Atlanta, GA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee (K.M.H.); and Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.)
| | - Renhao Li
- From the Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, GA (W.C., S.A.D., Y.W., C.D.J., R.L.); Department of Pediatrics (W.C., S.A.D., Y.W., C.D.J., R.L.) and Department of Pathology (C.D.J.), Emory University School of Medicine, Atlanta, GA; Blood Research Institute, BloodCenter of Wisconsin, Milwaukee (K.M.H.); and Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.).
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39
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Apelseth TO, Cap AP, Spinella PC, Hervig T, Strandenes G. Cold stored platelets in treatment of bleeding. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/voxs.12380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. O. Apelseth
- Laboratory of Clinical Biochemistry; Haukeland University Hospital; Bergen Norway
- Department of Immunology and Transfusion Medicine; Haukeland University Hospital; Bergen Norway
| | - A. P. Cap
- U.S. Army Institute of Surgical Research; FT Sam Houston; San Antonio TX USA
| | - P. C. Spinella
- Division of Critical Care; Department of Pediatrics; Washington University in St. Louis; St. Louis MO USA
| | - T. Hervig
- Department of Immunology and Transfusion Medicine; Haukeland University Hospital; Bergen Norway
- Institute of Clinical Science; School of Medicine and Dentistry; University of Bergen; Bergen Norway
- Norwegian Armed Forces Medical Services; Oslo Norway
| | - G. Strandenes
- Department of Immunology and Transfusion Medicine; Haukeland University Hospital; Bergen Norway
- Norwegian Armed Forces Medical Services; Oslo Norway
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40
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Stubbs JR, Tran SA, Emery RL, Hammel SA, Haugen DAL, Zielinski MD, Zietlow SP, Jenkins D. Cold platelets for trauma-associated bleeding: regulatory approval, accreditation approval, and practice implementation-just the "tip of the iceberg". Transfusion 2017; 57:2836-2844. [PMID: 28880362 DOI: 10.1111/trf.14303] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/19/2017] [Accepted: 07/21/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Laboratory and clinical evidence suggest that cold-stored platelets (CS-PLTs) might be preferable to room temperature platelets (RT-PLTs) for active bleeding. Ease of prehospital use plus potential hemostatic superiority led our facility to pursue approval of CS-PLTs for actively bleeding trauma patients. STUDY DESIGN AND METHODS From November 18, 2013, through October 8, 2015, correspondence was exchanged between our facility, the AABB, and the US Food and Drug Administration (FDA). An initial AABB variance request was for 5-day CS-PLTs without agitation. The AABB deferred its decision pending FDA approval to use our platelet (PLT) bags for CS-PLTs. On March 27, 2015, the FDA approved 3-day CS-PLTs without agitation. On October 8, 2015, the AABB approved 3-day CS-PLTs without agitation and without bacterial testing for actively bleeding trauma patients. Our facility's goal is to carry CS-PLTs on air ambulances. RESULTS CS-PLTs have been used for trauma patients at our facility since October 2015. As of August 2016, a total of 21 (19.1%) of 119 CS-PLTs have been transfused. The short 3-day storage period combined with the formation of clots in plasma-rich CS-PLTs during storage have been the major causes of a high (80.9%) discard rate. CONCLUSION In the future, pathogen-reduced (PR), PLT additive solution (PAS) CS-PLTs seem more practical due to low risks of bacterial contamination and storage-related clotting. This should make longer storage of CS-PLTs feasible (e.g., 10 days or more). With a longer shelf life, PR PAS CS-PLTs could potentially be used in a wider range of patient populations.
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Affiliation(s)
- James R Stubbs
- Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Sheryl A Tran
- Integrity and Compliance Office, Mayo Clinic Rochester, Rochester, Minnesota
| | - Richard L Emery
- Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - Scott A Hammel
- Department of Laboratory Medicine and Pathology, Division of Transfusion Medicine, Mayo Clinic Rochester, Rochester, Minnesota
| | - De Anna L Haugen
- Department of Anesthesiology, Mayo Clinic Rochester, Rochester, Minnesota
| | - Martin D Zielinski
- Department of Trauma, Critical Care, and General Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Scott P Zietlow
- Department of Trauma, Critical Care, and General Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Donald Jenkins
- Department of Trauma, Critical Care, and General Surgery, Mayo Clinic Rochester, Rochester, Minnesota
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41
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NasrEldin E. Effect of cold storage on platelets quality stored in a small containers: Implications for pediatric transfusion. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2017. [DOI: 10.1016/j.phoj.2017.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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42
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Milford EM, Reade MC. Comprehensive review of platelet storage methods for use in the treatment of active hemorrhage. Transfusion 2017; 56 Suppl 2:S140-8. [PMID: 27100750 DOI: 10.1111/trf.13504] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 12/21/2015] [Accepted: 12/23/2015] [Indexed: 12/14/2022]
Abstract
This review considers the various methods currently in use, or under investigation, for the storage of platelets intended for use in the treatment of active hemorrhage. The current standard practice of storing platelets at room temperature (RT) (20°C-24°C) optimizes circulating time, but at the expense of hemostatic function and logistical considerations. A number of alternatives are under investigation. Novel storage media additives appear to attenuate the deleterious changes that affect RT stored platelets. Cold storage was originally abandoned due to the poor circulating time of platelets stored at 4°C, but such platelets may actually be more hemostatically effective, with a number of other advantages, compared to RT stored platelets. Periodically re-warming cold stored platelets (temperature cycling, TC) may combine the hemostatic efficacy of cold stored platelets with the longer circulating times of RT storage. Alternatives to liquid storage include cryopreservation (freezing) or lyophilization (freeze-drying). The former has had some limited clinical use and larger clinical trials are underway, while the latter is still in the preclinical stage with promising in vitro and in vivo results. The importance of platelet transfusion in the management of active hemorrhage is now well accepted, so it is timely that platelet storage methods are reviewed with consideration of not only their circulating time, but also their hemostatic efficacy.
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Affiliation(s)
- Elissa M Milford
- Australian Defence Force, Australia.,University of Queensland, Australia
| | - Michael C Reade
- Australian Defence Force, Australia.,University of Queensland, Australia
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43
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Nair PM, Pandya SG, Dallo SF, Reddoch KM, Montgomery RK, Pidcoke HF, Cap AP, Ramasubramanian AK. Platelets stored at 4°C contribute to superior clot properties compared to current standard-of-care through fibrin-crosslinking. Br J Haematol 2017; 178:119-129. [PMID: 28580719 DOI: 10.1111/bjh.14751] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/20/2017] [Indexed: 02/05/2023]
Abstract
Currently, platelets for transfusion are stored at room temperature (RT) for 5-7 days with gentle agitation, but this is less than optimal because of loss of function and risk of bacterial contamination. We have previously demonstrated that cold (4°C) storage is an attractive alternative because it preserves platelet metabolic reserves, in vitro responses to agonists of activation, aggregation and physiological inhibitors, as well as adhesion to thrombogenic surfaces better than RT storage. Recently, the US Food and Drug Administration clarified that apheresis platelets stored at 4°C for up to 72 h may be used for treating active haemorrhage. In this work, we tested the hypothesis that cold-stored platelets contribute to generating clots with superior mechanical properties compared to RT-stored platelets. Rheological studies demonstrate that the clots formed from platelets stored at 4°C for 5 days are significantly stiffer (higher elastic modulus) and stronger (higher critical stress) than those formed from RT-stored platelets. Morphological analysis shows that clot fibres from cold-stored platelets were denser, thinner, straighter and with more branch points or crosslinks than those from RT-stored platelets. Our results also show that the enhanced clot strength and packed structure is due to cold-induced plasma factor XIII binding to platelet surfaces, and the consequent increase in crosslinking.
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Affiliation(s)
- Prajeeda M Nair
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA.,Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Shaunak G Pandya
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Shatha F Dallo
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Kristin M Reddoch
- Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Robbie K Montgomery
- Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Heather F Pidcoke
- Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Andrew P Cap
- Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Anand K Ramasubramanian
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, TX, USA.,Department of Biomedical, Chemical and Materials Engineering, San José State University, San José, CA, USA
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44
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Berzuini A, Spreafico M, Prati D. One size doesn't fit all: Should we reconsider the introduction of cold-stored platelets in blood bank inventories? F1000Res 2017; 6:95. [PMID: 28184297 PMCID: PMC5288671 DOI: 10.12688/f1000research.10363.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2017] [Indexed: 01/03/2023] Open
Abstract
Platelet concentrates are universally prepared with a standard method and stored for 5 days at room temperature (20–24°C) in gentle agitation. Currently, there is a renewed interest in the possibility of storing platelet concentrates below the standard temperatures. In fact, cold platelets might be more effective in bleeding patients and have a lower risk of bacterial transmission. Inventories including platelets at different temperatures may favour patient-centred strategies for prophylactic or therapeutic transfusions.
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Affiliation(s)
- Alessandra Berzuini
- Department of Transfusion Medicine and Hematology, Azienda Socio Sanitaria Territoriale (ASST) di Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Marta Spreafico
- Department of Transfusion Medicine and Hematology, Azienda Socio Sanitaria Territoriale (ASST) di Lecco, Alessandro Manzoni Hospital, Lecco, Italy
| | - Daniele Prati
- Department of Transfusion Medicine and Hematology, Azienda Socio Sanitaria Territoriale (ASST) di Lecco, Alessandro Manzoni Hospital, Lecco, Italy
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45
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Eker I, Yilmaz S, Cetinkaya RA, Unlu A, Pekel A, Acikel C, Yilmaz S, Gursel O, Avci İY. Is one-size-fits-all strategy adequate for platelet storage? Transfus Apher Sci 2016; 55:323-328. [DOI: 10.1016/j.transci.2016.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 07/25/2016] [Accepted: 08/19/2016] [Indexed: 10/20/2022]
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46
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Baimukanova G, Miyazawa B, Potter DR, Gibb SL, Keating S, Danesh A, Beyer A, Dayter Y, Bruhn R, Muench MO, Cap AP, Norris PJ, Spinella P, Cohen M, Pati S. The effects of 22°C and 4°C storage of platelets on vascular endothelial integrity and function. Transfusion 2016; 56 Suppl 1:S52-64. [PMID: 27001362 DOI: 10.1111/trf.13455] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although a majority of the studies conducted to date on platelet (PLT) storage have been focused on PLT hemostatic function, the effects of 4°C PLTs on regulation of endothelial barrier permeability are still not known. In this study, we compared the effects of room temperature (22°C) stored and (4°C) stored PLTs on the regulation of vascular endothelial cell (EC) permeability in vitro and in vivo. STUDY DESIGN AND METHODS Day 1, Day 5, and Day 7 leukoreduced apheresis PLTs stored at 4 or 22°C were studied in vitro and in vivo. In vitro, PLT effects on EC permeability and barrier function, adhesion, and impedance aggregometry were investigated. In vivo, using a mouse model of vascular leak, attenuation of vascular leak and circulating PLT numbers were measured. RESULTS Treatment of EC monolayers with Day 5 or Day 7 PLTs, stored at both 22°C and 4°C, resulted in similar decreases in EC permeability on average. However, analysis of individual samples revealed significant variation that was donor dependent. Additional in vitro measurements revealed a decrease in inflammatory mediators, nonspecific PLT-endothelial aggregation and attenuated loss of aggregation over time to TRAP, ASPI, ADP, and collagen with 4°C storage. In mice, while 22°C and 4°C PLTs both demonstrated significant protection against vascular endothelial growth factor A (VEGF-A)-induced vascular leak 22°C PLTs exhibited increased protection compared to 4°C PLTs. Systemic circulating levels of 4°C PLTs were decreased compared to 22°C PLTs. CONCLUSIONS In vitro, 4°C-stored PLTs exhibit a greater capacity to inhibit EC permeability than 22°C-stored PLTs. In vivo, 22°C PLTs provide superior control of vascular leak induced by VEGF-A. This discrepancy may be due to increased clearance of 4°C PLTs from the systemic circulation.
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Affiliation(s)
- Gyulnar Baimukanova
- Blood Systems Research Institute, University of California, San Francisco, California
| | - Byron Miyazawa
- Department of Surgery, University of California, San Francisco, California
| | - Daniel R Potter
- Blood Systems Research Institute, University of California, San Francisco, California
| | - Stuart L Gibb
- Blood Systems Research Institute, University of California, San Francisco, California
| | - Sheila Keating
- Blood Systems Research Institute, University of California, San Francisco, California
| | - Ali Danesh
- Blood Systems Research Institute, University of California, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
| | - Ashley Beyer
- Blood Systems Research Institute, University of California, San Francisco, California
| | - Yelena Dayter
- Blood Systems Research Institute, University of California, San Francisco, California
| | - Roberta Bruhn
- Blood Systems Research Institute, University of California, San Francisco, California
| | - Marcus O Muench
- Blood Systems Research Institute, University of California, San Francisco, California
| | - Andrew P Cap
- Coagulation and Blood Research Program, US Army Institute of Surgical Research, JBSA-FT Sam Houston, Texas
| | - Philip J Norris
- Blood Systems Research Institute, University of California, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
| | - Philip Spinella
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Mitchell Cohen
- Department of Surgery, University of California, San Francisco, California
| | - Shibani Pati
- Blood Systems Research Institute, University of California, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, California
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47
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Wood B, Padula MP, Marks DC, Johnson L. Refrigerated storage of platelets initiates changes in platelet surface marker expression and localization of intracellular proteins. Transfusion 2016; 56:2548-2559. [PMID: 27460096 DOI: 10.1111/trf.13723] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/18/2016] [Accepted: 06/01/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Platelets (PLTs) are currently stored at room temperature (22°C), which limits their shelf life, primarily due to the risk of bacterial growth. Alternatives to room temperature storage include PLT refrigeration (2-6°C), which inhibits bacterial growth, thus potentially allowing an extension of shelf life. Additionally, refrigerated PLTs appear more hemostatically active than conventional PLTs, which may be beneficial in certain clinical situations. However, the mechanisms responsible for this hemostatic function are not well characterized. The aim of this study was to assess the protein profile of refrigerated PLTs in an effort to understand these functional consequences. STUDY DESIGN AND METHODS Buffy coat PLTs were pooled, split, and stored either at room temperature (20-24°C) or under refrigerated (2-6°C) conditions (n = 8 in each group). PLTs were assessed for changes in external receptor expression and actin filamentation using flow cytometry. Intracellular proteomic changes were assessed using two-dimensional gel electrophoresis and Western blotting. RESULTS PLT refrigeration significantly reduced the abundance of glycoproteins (GPIb, GPIX, GPIIb, and GPIV) on the external membrane. However, refrigeration resulted in the increased expression of high-affinity integrins (αIIbβ3 and β1) and activation and apoptosis markers (CD62P, CD63, and phosphatidylserine). PLT refrigeration substantially altered the abundance and localization of several cytoskeletal proteins and resulted in an increase in actin filamentation, as measured by phalloidin staining. CONCLUSION Refrigerated storage of PLTs induces significant changes in the expression and localization of both surface-expressed and intracellular proteins. Understanding these proteomic changes may help to identify the mechanisms resulting in the refrigeration-associated alterations in PLT function and clearance.
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Affiliation(s)
- Ben Wood
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,Proteomics Core Facility, University of Technology Sydney, Sydney, NSW, Australia
| | - Matthew P Padula
- Proteomics Core Facility, University of Technology Sydney, Sydney, NSW, Australia
| | - Denese C Marks
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
| | - Lacey Johnson
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.
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48
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Abstract
A goal of platelet storage is to maintain the quality of platelets from the point of donation to the point of transfusion - to suspend the aging process. This effort is judged by clinical and laboratory measures with varying degrees of success. Recent work gives encouragement that platelets can be maintained ex vivo beyond the current 5 -7 day shelf life whilst maintaining their quality, as measured by posttransfusion recovery and survival. However, additional measures are needed to validate the development of technologies that may further reduce the aging of stored platelets, or enhance their hemostatic properties.
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Affiliation(s)
- Peter A Smethurst
- a Components Development Laboratory, NHS Blood and Transplant, Cambridge, UK, and Department of Haematology , University of Cambridge , Cambridge , UK
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49
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Bynum JA, Adam Meledeo M, Getz TM, Rodriguez AC, Aden JK, Cap AP, Pidcoke HF. Bioenergetic profiling of platelet mitochondria during storage: 4°C storage extends platelet mitochondrial function and viability. Transfusion 2016; 56 Suppl 1:S76-84. [DOI: 10.1111/trf.13337] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- James A. Bynum
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
| | - M. Adam Meledeo
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
| | - Todd M. Getz
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
| | | | - James K. Aden
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
| | - Andrew P. Cap
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
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50
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Handigund M, Bae TW, Lee J, Cho YG. Evaluation of in vitro storage characteristics of cold stored platelet concentrates with N acetylcysteine (NAC). Transfus Apher Sci 2016; 54:127-38. [PMID: 26847865 DOI: 10.1016/j.transci.2016.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
Platelets play a vital role in hemostasis and thrombosis, and their demand and usage has multiplied many folds over the years. However, due to the short life span and storage constraints on platelets, it is allowed to store them for up to 7 days at room temperature (RT); thus, there is a need for an alternative storage strategy for extension of shelf life. Current investigation involves the addition of 50 mM N acetylcysteine (NAC) in refrigerated concentrates. Investigation results revealed that addition of NAC to refrigerated concentrates prevented platelet activation and reduced the sialidase activity upon rewarming as well as on prolonged storage. Refrigerated concentrates with 50 mM NAC expressed a 23.91 ± 6.23% of CD62P (P-Selectin) and 22.33 ± 3.42% of phosphotidylserine (PS), whereas RT-stored platelets showed a 46.87 ± 5.23% of CD62P and 25.9 ± 6.48% of phosphotidylserine (PS) after 5 days of storage. Further, key metabolic parameters such as glucose and lactate accumulation indicated reduced metabolic activity. Taken together, investigation and observations indicate that addition of NAC potentially protects refrigerated concentrates by preventing platelet activation, stabilizing sialidase activity, and further reducing the metabolic activity. Hence, we believe that NAC can be a good candidate for an additive solution to retain platelet characteristics during cold storage and may pave the way for extension of storage shelf life.
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Affiliation(s)
- Mallikarjun Handigund
- Department of Laboratory Medicine, Chonbuk National University Medical School and Hospital, Jeonju 561180, Republic of Korea
| | - Tae Won Bae
- Department of Laboratory Medicine, Chonbuk National University Medical School and Hospital, Jeonju 561180, Republic of Korea
| | - Jaehyeon Lee
- Department of Laboratory Medicine, Chonbuk National University Medical School and Hospital, Jeonju 561180, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 561180, Republic of Korea
| | - Yong Gon Cho
- Department of Laboratory Medicine, Chonbuk National University Medical School and Hospital, Jeonju 561180, Republic of Korea; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 561180, Republic of Korea; Chonbuk National University Hospital branch of National Culture Collection for Pathology, Jeonju 561180, Republic of Korea.
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