Statewide support of thrombocytopenic patients with ABO matched single donor platelets

Utility of thromboelastography with platelet mapping for monitoring platelet transfusion in qualitative platelet disorders

BACKGROUND

Patients with pathogenic variants in RASGRP2 (inherited platelet disorder (IPD)-18) exhibit normal platelet counts but impaired platelet aggregation and αIIbβ3 activation. Moderate-to-severe bleeding episodes require patients to be transfused with platelets and/or pro-hemostatic agents. We recently demonstrated that hemostatic efficacy of transfused platelets is limited by dysfunctional endogenous platelets in a mouse model of IPD-18 (Rasgrp2-/- mice), as dysfunctional platelets were recruited to the forming hemostatic plug but did not participate in clot contraction. Thus, higher amounts of transfused platelets were required to outcompete these dysfunctional cells and to reverse bleeding.

OBJECTIVE

We here studied the usefulness of thromboelastography with platelet mapping (TEG-PM) for ex vivo monitoring of the hemostatic potential in Rasgrp2-/- mice transfused with various amounts of wild-type (WT) platelets.

METHODS

Whole blood (WB) samples from WT and Rasgrp2-/- mice were tested in TEG-PM and parameters for clot formation and contraction (K time, α-angle, maximum amplitude [MA]) were measured.

RESULTS

Rasgrp2-/- WB samples did not contract in TEG-PM, consistent with a critical role of this protein in αIIbβ3 activation. Addition of WT platelets improved TEG parameters in a ratio-dependent manner, consistent with our recent in vivo studies showing impaired hemostasis at a 5:1, but not at a 2:1 ratio of mutant to WT platelets. K and α values were identified as better predictors of transfusion efficacy than MA, the most platelet-dependent TEG parameter.

CONCLUSION

This proof-of-concept study supports the use of TEG-PM to monitor platelet transfusion ratios and hemostatic potential in IPD-18 and potentially other platelet disorders.

Utility of thromboelastography with platelet mapping (TEG-PM) for monitoring platelet transfusion in qualitative platelet disorders

Patients with pathogenic variants in RASGRP2 (inherited platelet disorder (IPD)-18) have normal platelet counts but show impaired platelet aggregation due to diminished activation of αIIbβ3 integrin. This defect results in moderate to severe bleeding episodes, especially following surgical procedures, which require patients to be transfused with platelets and/or pro-hemostatic agents. We recently demonstrated that the hemostatic efficacy of transfused platelets is limited by dysfunctional endogenous platelets in a mouse model of IPD-18 ( Rasgrp2 -/- mice), as dysfunctional platelets were recruited to the forming hemostatic plug but did not participate in clot contraction. Consequently, higher amounts of transfused platelets were required to outcompete these dysfunctional cells and to reverse bleeding. We here studied the usefulness of thromboelastography with platelet mapping (TEG-PM), a method to evaluate platelet-dependent clot contraction, for ex vivo monitoring of the hemostatic potential in Rasgrp2 -/- mice transfused with various amounts of wild-type (WT) platelets. Rasgrp2 -/- whole blood samples did not contract in TEG-PM, consistent with a critical role of this protein in αIIbβ3 activation. Addition of WT platelets improved TEG parameters (K time, α-angle, MA) in a ratio dependent manner, consistent with our recent in vivo studies showing impaired hemostasis at a 5:1, but not at a 2:1 ratio of mutant to WT platelets. Interestingly, K and α values were identified as better predictors of transfusion efficacy than MA, the most platelet-dependent TEG parameter. In conclusion, this proof-of-concept study supports the use of TEG-PM to monitor platelet transfusion ratios and hemostatic potential in IPD-18 and potentially other platelet disorders.

Plateletapheresis with “Haemonetics 30” through a new three-way reinfusion set®

The main disadvantages of the discontinuous flow cell separator Haemonetics 30 (Haemonetics Corp. Natick, Mass.) compared to continuous flow separators are that there is a longer course procedure and a larger amount of donor's blood in extracorporeal circulation. These drawbacks can be reduced by means of a simple technical set-up.

Since plasma reinfusion may commence as soon as the bowl filling stage is completed, the amount of blood in extracorporeal circulation can be greatly reduced simply by substituting a three-way setfor the two-way reinfusion set (BT 293).

Platelet collection using the IBM 2997 cell separator

Platelets were collected using the dual-channel module on the IBM 2997 Blood Fraction Separator. We carried out 320 procedures to harvest platelets for therapeutic purposes and yielded 5.1 +/- 1.5 X 10(11) platelets (mean +/- SD). Infusion into previously unsensitized recipients with hypomegakaryocytic thrombocytopenia achieved increments at 1 hr of 19 +/- 7.3 X 10(9)/liter/m2 (mean +/- SD) and at 24 hr of 15 +/- 6.3 X 10(9)/liter/m2. The only consistent donor reaction was mild hypocalcaemia, easily corrected by calcium gluconate infusion. Changes in donor packed-cell volume and white cell count were not statistically altered (p greater than 0.05) but donor platelet counts fell from 216 +/- 43.1 X 10(9)/liter to 162.5 +2- 41.7 X 10(9)/liter (mean +/- SD) (p less than 0.01). Additional plateletphereses were carried out in seven normal volunteers, using the same technique, in order that the function of the harvested platelets could be studied. Following radiochromium labelling and reinfusion into the same donors, normal in vivo recoveries were obtained at 10 min (59.4 +/- 3.4%; mean +/- SD) and platelet mean life span was also normal (218 +/- 12 hr; mean +/- SD). Furthermore, in vitro platelet factor III availability and aggregation patterns of the harvested platelets did not differ from control values and their ultrastructural appearance was normal.

Long-term support of a patient with aplastic anemia by platelets and granulocytes from donors of a HLA-A,B identical family

The case of an 18-year-old male patient with aplastic anemia is reported who was successfully treated by platelets from his father, mother and uncle over a period 8 months because of the very rare constellation of HLA-A,B identity in the family. The patient deceased from uncontrollable septicemia.

Redistribution of platelets during discontinous flow platelet pheresis

Greater numbers of platelets are recovered during discontinuous flow centrifugation than can be simply accounted for by the decrease in total circulating platelets in the donor. There is a linear relationship between the logarithm of the circulating platelet count and the number of plateletpheresis bowls filled. The disappearance of platelets from the peripheral circulation occurs at a greater rate in splenectomized donors than in normal donors, and the rate of platelet disappearance in normal donors is less than what would be expected if there were no in vivo platelet storage pools. The data suggest the redistribution of platelets from the spleen in normal donors during the time course of the procedure.