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Waters L, Marks DC, Johnson L. Downscaling platelet cryopreservation: Are platelets frozen in tubes comparable to standard cryopreserved platelets? Transfusion 2024; 64:517-525. [PMID: 38230448 DOI: 10.1111/trf.17724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Platelet cryopreservation extends the shelf-life to at least 2 years. However, platelets are altered during the freeze/thaw process. Downscaling platelet cryopreservation by freezing in tubes would enable rapid screening of novel strategies to improve the quality of cryopreserved platelets (CPPs). The aim of this study was to characterize the effect of freezing conditions on the in vitro phenotype and function of platelets frozen in a low volume compared to standard CPPs. METHODS Platelets were prepared for cryopreservation using 5%-6% DMSO and processed using standard protocols or aliquoted into 2 mL tubes. Platelets were hyperconcentrated to 25 mL (standard CPPs) or 200 μL (tubes) before freezing at -80°C (n = 8). Six insulators/controlled rate freezing containers were used to vary the freezing rate of platelets in tubes. Platelets were thawed, resuspended in plasma, and then assessed by flow cytometry and thromboelastography. RESULTS The use of different insulators for tubes changed the freezing rate of platelets compared to platelets frozen using the standard protocol (p < .001). However, this had no impact on the recovery of the platelets (p = .87) or the proportion of platelets expressing GPIbα (p = .46) or GPVI (p = .07), which remained similar between groups. A lower proportion of platelets frozen in tubes externalized phosphatidylserine compared to standard CPPs (p < .001). The clot-forming ability (thromboelastography) of platelets was similar between groups (p > .05). CONCLUSION Freezing platelets in tubes modified the freezing rate and altered some platelet characteristics. However, the functional characteristics remained comparable, demonstrating the feasibility of downscaling platelet cryopreservation for high-throughput exploratory investigations.
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Affiliation(s)
- Lauren Waters
- Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Denese C Marks
- Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lacey Johnson
- Research and Development, Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
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Ehn K, Wikman A, Uhlin M, Sandgren P. Cryopreserved Platelets in a Non-Toxic DMSO-Free Solution Maintain Hemostatic Function In Vitro. Int J Mol Sci 2023; 24:13097. [PMID: 37685902 PMCID: PMC10488190 DOI: 10.3390/ijms241713097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Dimethyl sulfoxide (DMSO) is regularly used as a cryoprotectant agent for the cryopreservation of platelets. However, DMSO is considered toxic. We therefore hypothesized that saline could be used as a non-toxic medium for the cryopreservation of platelets. Double-dose buffy coat platelets (n = 10) were divided and cryopreserved at -80 °C using 5-6% dimethyl sulfoxide (DMSO) or in NaCl (9 mg/mL). Paired testing was conducted pre-freeze, post-thaw (PT 1 h). Upon analysis, each bag was thawed and reconstituted in fresh plasma. Analyses included cell counts and the metabolic, phenotypic, and functional properties of the platelets together with thromboelastometry. The cryopreserved platelets showed several biochemical and ultrastructural changes compared to pre-freezing. Platelet recovery was approximately 17% higher in DMSO-free units (p < 0.001), but the platelet viability was reduced (p < 0.001). However, using controlled freezing (n = 6), the platelet viability was improved. The clot formation time (CFT) was comparable, but DMSO-free platelets showed slightly decreased maximum clot firmness (MCF) (p = 0.034). By reducing the reconstituted plasma volume, a reduced CFT and increased MCF were obtained (p < 0.001). This study demonstrates that platelets can be cryopreserved in saline without the addition of DMSO, with high recovery and maintained hemostatic function. However, controlled freezing is required to optimize platelet quality.
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Affiliation(s)
- Kristina Ehn
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, 141 86 Stockholm, Sweden; (A.W.); (M.U.); (P.S.)
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141 52 Huddinge, Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, 141 86 Stockholm, Sweden; (A.W.); (M.U.); (P.S.)
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141 52 Huddinge, Sweden
| | - Michael Uhlin
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, 141 86 Stockholm, Sweden; (A.W.); (M.U.); (P.S.)
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141 52 Huddinge, Sweden
| | - Per Sandgren
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, 141 86 Stockholm, Sweden; (A.W.); (M.U.); (P.S.)
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, 141 52 Huddinge, Sweden
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Wikman A, Diedrich B, Björling K, Forsberg PO, Harstad AM, Henningsson R, Höglund P, Sköld H, Östman L, Sandgren P. Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden. Front Public Health 2023; 10:1073318. [PMID: 36743180 PMCID: PMC9894868 DOI: 10.3389/fpubh.2022.1073318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/27/2022] [Indexed: 01/21/2023] Open
Abstract
Background Balanced transfusions, including platelets, are critical for bleeding patients to maintain hemostasis. Many rural hospitals have no or limited platelet inventory, with several hours of transport time from larger hospitals. This study aimed to evaluate the feasibility of using cryopreserved platelets that can be stored for years, in remote hospitals with no or limited platelet inventory. Material and methods Three remote hospitals participated in a prospective study including adult bleeding patients where platelet transfusions were indicated. Cryopreserved platelets were prepared in a university hospital, concentrated in 10 ml, transported on dry ice, and stored at -80°C at the receiving hospital. At request, the concentrated platelet units were thawed and diluted in fresh frozen plasma. The indications, blood transfusion needs, and laboratory parameters pre- and post-transfusion, as well as logistics, such as time from request to transfusion and work efforts in preparing cryopreserved platelets, were evaluated. Results Twenty-three bleeding patients were included. Nine patients (39%) were treated for gastrointestinal bleeding, five (22%) for perioperative bleeding, and four (17%) for trauma bleeding. The transfusion needs were 4.9 ± 3.3 red blood cell units, 3.2 ± 2.3 plasma units, and 1.9 ± 2.2 platelet units, whereof cryopreserved were 1.5 ± 1.1 (mean ± SD). One patient had a mild allergic reaction. We could not show the difference in laboratory results between pre- and post-transfusion of the cryopreserved units in the bleeding patients. The mean time from the order of cryopreserved platelets to transfusion was 64 min, with a range from 25 to 180 min. Conclusion Cryopreserved platelets in remote hospitals are logistically feasible in the treatment of bleeding. The ability to have platelets in stock reduces the time to platelet transfusion in bleeding patients where the alternative often is many hours delay. Clinical effectiveness and safety previously shown in other studies are supported in this small feasibility study.
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Affiliation(s)
- Agneta Wikman
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden,*Correspondence: Agneta Wikman ✉
| | - Beatrice Diedrich
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Karl Björling
- Department of Anaesthesiology and Intensive Care, Visby Hospital, Visby, Sweden
| | - Per-Olof Forsberg
- Department Laboratory Medicine, Central Hospital of Karlstad, Karlstad, Sweden
| | - Anna-Maria Harstad
- Department of Anaesthesiology and Intensive Care, Central Hospital of Karlstad, Karlstad, Sweden
| | - Ragnar Henningsson
- Department of Anaesthesiology and Intensive Care, Central Hospital of Karlstad, Karlstad, Sweden
| | - Petter Höglund
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Center for Hematology and Regenerative Medicine, Department of Medicine, Huddinge Karolinska Institutet, Stockholm, Sweden
| | - Hans Sköld
- Department of Anaesthesiology and Intensive Care, Torsby Hospital, Torsby, Sweden
| | - Lars Östman
- Department of Anaesthesiology and Intensive Care, Visby Hospital, Visby, Sweden
| | - Per Sandgren
- Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Tynngård N, Bell A, Gryfelt G, Cvetkovic S, Wikman A, Uhlin M, Sandgren P. Cryopreservation of buffy coat derived platelets: Paired in vitro characterization using uncontrolled versus controlled freezing rate protocols. Transfusion 2020; 61:546-556. [PMID: 33345368 PMCID: PMC7898315 DOI: 10.1111/trf.16227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/21/2020] [Accepted: 10/09/2020] [Indexed: 12/21/2022]
Abstract
Background Cryopreserved platelets show a reduced recovery and viability after freezing and thawing including several ultrastructural and phenotypic deteriorations compared with liquid‐stored platelets. It is suggested that using Controlled‐Rate Freezing (CRF) can reduce variability and optimize the functionality profile for cells. The objective of the study is to compare cellular, metabolic, phenotypic and functional effects on platelets after cryopreservation using different freezing rate protocols. Study Design and Methods To evaluate the possible effects of different freezing rate protocols a two‐experimental study comparing diverse combinations was tested with a pool and split design. Uncontrolled freezing of platelets in materials with different thermal conductivity (metal vs cardboard) was evaluated in experiment 1. Experiment 2 evaluated uncontrolled vs a controlled‐rate freezing protocol in metal boxes. All variables were assessed pre and post cryopreservation. Results Directly after thawing, no major differences in platelet recovery, LDH, ATP, Δψ, CD62P, CD42b, platelet endothelial cell adhesion molecule and sCD40L were seen between units frozen with different thermal conductivity for temperature. In contrast, we observed signs of increased activation after freezing using the CRF protocol, reflected by increased cell surface expression of CD62P, PAC‐1 binding and increased concentration of LDH. Agonist induced expression of a conformational epitope on the GPIIb/IIIa complex and contribution to blood coagulation in an experimental rotational thromboelastometry setup were not statistically different between the groups. Conclusion The use of a uncontrolled freezing rate protocol is feasible, creating a platelet product comparable to using a controlled rate freezing equipment during cryopreservation of platelets.
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Affiliation(s)
- Nahreen Tynngård
- Research and Development Unit in Region Östergötland and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Alice Bell
- Department of Laboratory Medicine, Karolinska Institutet, Solna, Sweden
| | - Gunilla Gryfelt
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, Stockholm, Huddinge, Sweden
| | - Stefan Cvetkovic
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, Stockholm, Huddinge, Sweden
| | - Agneta Wikman
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, Stockholm, Huddinge, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Huddinge, Sweden
| | - Michael Uhlin
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, Stockholm, Huddinge, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Huddinge, Sweden
| | - Per Sandgren
- Department of Clinical Immunology and Transfusion Medicine (KITM), Karolinska University Hospital, Stockholm, Huddinge, Sweden.,Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Huddinge, Sweden
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