Extended storage of platelets in an artificial medium with the platelet activation inhibitors prostaglandin E1 and theophylline

Evaluation of a lyophilized platelet-derived hemostatic product

BACKGROUND

Current limitations of platelet shelf life to 5 days have led to an increasingly greater demand for hemostatic agents with greater longevity. The objective of this study was to evaluate the function of a lyophilized platelet-derived hemostatic product (thrombosome [TS]) as a potential alternative to fresh platelets.

METHODS

Platelets were collected from whole blood from healthy donors. TSs were reconstituted with water and added to various configurations of reassembled whole blood (platelets, plasma, and RBCs); measures included rotational thromboelastometry (ROTEM), optical aggregometry, mitochondrial function, calibrated automated thrombogram, collagen adhesion under flow (shear flow assay), and flow cytometry.

RESULTS

In ROTEM, no differences were observed between maximum clot formation values for contact pathway activation thromboelastometry tests with TSs or platelet samples. Significantly decreased aggregation was observed in the TSs versus platelets (p < 0.001 for all agonists). Flow cytometry measures demonstrated significant decreases in glycoprotein Ib expression and increases in phosphatidylserine expression in the TS group (p < 0.01). The calibrated automated thrombogram assay was suggestive (lag time and peak thrombin) that the TSs might have some thrombogenic properties. Measurements of mitochondrial function revealed that TSs had no functional mitochondria.

CONCLUSION

In this study, TSs were shown to have nonfunctional mitochondria. ROTEM measures revealed that the TSs had no impact on clot strength. Likewise, compared to platelets, the TSs displayed minimal aggregation, had significantly more phosphatidylserine (measure of activation status), but had the ability to adhere to a collagen surface under flow conditions and contribute to clot formation and induced greater thrombin generation.

Increased in vitro Aggregation of Stored Platelets at Room Temperature in Contrast to 37°C

Platelet concentrates were stored at room temperature and the reactivity of platelets to aggregating agents was studied at temperatures between 23 and 39°C. Fresh platelets showed increased reactivity at higher temperatures. When stored platelets were considered, maximal aggregation was not statistically different when compared with fresh platelets in the temperature range of 23-29°C (5 μM ADP). In addition, platelets stored either in Terumo or Baxter (PL 146 and PL 732) plastic bags at room temperature, showed an increased ADP-induced aggregation (10 μM) when studied at room temperature compared to 37°C. This pattern was confirmed by the difference in released ATP during aggregation. Collagen, although not resulting in detectable aggregation at 25°C, caused a similar release of ATP as that observed at 37°C. Since the observed differences in platelet reactivity seem to be similar using different types of plastic bags, the increased aggregation observed at room temperature is unlikely to be due to a special effect of a storage bag. Since the recovery of ADP aggregability is better at room temperature than at 37°C, ADP-induced aggregation determined at room temperature might be a better index of the clinical results expected when using stored platelets.

The role of bicarbonate in platelet additive solution for apheresis platelet concentrates stored with low residual plasma

BACKGROUND

Complex platelet additive solutions (PASs) are required to store platelet (PLT) concentrates with plasma levels below 30%. Previously, apheresis PLTs stored with 5% plasma in acetate- and bicarbonate-containing PAS maintained stable pH and bicarbonate levels during 7-day storage. Due to this observation, the necessity of added bicarbonate in PAS was investigated and whether the concurrent increase in PAS pH after bicarbonate addition had any effect on PLT storage.

STUDY DESIGN AND METHODS

Apheresis PLTs were stored in 5% plasma-95% high- or low-pH PAS, with or without bicarbonate (n=10 per arm). Bicarbonate PAS PLTs were paired and nonbicarbonate PAS PLTs were paired (split from same double-dose collection). PLTs were evaluated for in vitro variables on Days 1 and 7 and up to Day 14 if the Day 7 pH was higher than 6.2.

RESULTS

PLT pH was maintained above 7.3 to Day 14 in bicarbonate PAS PLTs while pH failures below 6.2 were observed in 4 of 10 and 2 of 10 units on Day 7 in low- and high-pH nonbicarbonate PAS arms, respectively. Day 7 in vitro variables in nonbicarbonate PAS PLTs with pH values of higher than 6.2 were comparable to Day 7 variables in bicarbonate PAS PLTs. The pH of bicarbonate PAS did have a small effect on pH and bicarbonate levels in PLT units, but did not have an effect on functional variables and metabolism.

CONCLUSION

Bicarbonate was not required to maintain in vitro PLT function in 5% plasma-95% PAS, but was required as a pH buffer and increased PAS pH did not significantly contribute to this effect.

Effects of blood product storage protectants on blood coagulation1 1The opinions expressed herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense

The ever-increasing demand for blood products challenges scientists to develop new and more effective techniques for their preservation. The progress of these novel preservation technologies uses a wide variety of cryoprotectant, lyoprotectant, and other preservatives, which will need to be explored and assessed for their biological effects during blood product formulation. The leading factor in protectant selection is for their ability to provide superior preservation for a particular blood product. We believe that such protectants used in blood product development should also be evaluated for their ability to preserve normal hemostasic mechanisms. In this review, high-molecular-weight cryoprotectants, lyoprotectants, polyols, amino acids, antioxidants, and surfactants, used because of their protective properties, were evaluated for their possible role in relation to their effect on normal hemostatic mechanisms.

In vitro analysis of platelet concentrates stored in the presence of modulators of 3',5' adenosine monophosphate, and organic anions

The storage of conventional platelet concentrates (PCs) under standard blood bank conditions is limited to five days, in part because longer storage periods lead to increasing damage in platelet integrity and functionality. The growing demand of PCs for clinical use, raises the interest to develop agents that would potentially permit a more extended period of storage. We have evaluated and compared the in vitro quality of PCs treated with: (1) Modulators of levels of cAMP (PGE1, foskolin, theophylline and isobutyl-methyl-xanthine [IBMX]); and (2) organic anions that function as alternative substrates of platelets (pyruvate and acetate). Platelet rich plasma (PRP) from pools (n = 6) of PCs was distributed into storage bags, and the agents to be tested were added, using saline as a control substance. PCs were stored at 22 degrees C with continuous agitation for up to 10 days. At 0, 5 and 10 days of storage, samples were analyzed for platelet counts, mean platelet volume (MPV), metabolic markers, and expression of glycoproteins (GPs). The addition of modulators of levels of cAMP, at the concentration used in the study, did not lead to substantial improvement in the parameters being evaluated, with respect to those in control units. The supplementation with organic anions, while not affecting the surface levels of GPs, favored the maintenance of metabolic values, such as pH, PCO2, and bicarbonate concentrations, as well as the preservation of MPV (p values < 0.05 respect to control units both at 5 and 10 days of storage). Our results indicate that while the use of modulators of levels of cAMP do not provide substantial benefit in the prevention of platelet storage lesions, organic anions have some advantageous effect in the storage promoted metabolic changes of PCs. These data might be considered when designing strategies to improve PC storage.

Apyrase, ascorbic acid and aprotinin ameliorate the storage lesion in pelleted platelet preparations

To evaluate the effect of apyrase, ascorbic acid and aprotinin (AAA) in preventing platelet activation during storage, 12 sets of platelet concentrates (PCs), were treated with AAA and evaluated at days 1, 3, and 5 utilizing platelet functional and morphological assays. Platelets treated with AAA demonstrated significantly enhanced response to ADP-induced platelet aggregation, higher morphology scores, and evaluated ATP levels compared to control samples after 5 days of storage. Similarly, platelet specimens treated with AAA had significantly reduced PF4 secretion and P-selectin expression compared to controls. Finally, Western blots of aggregated platelets at day 5 demonstrated that AAA-treated PCs continue to express the platelet membrane GPIb whereas specimens from control PCs do not. These results show that PCs treated with AAA have reduced platelet activation and enhanced functional platelet activity.

Platelet storage: efforts to extend the shelf life of platelet concentrates

In transfusion medicine, platelets cannot be replaced by blood substitutes. Circulating platelets must respond quickly to changes in normal blood flow and blood-vessel injury to promote normal hemostasis. Adhesion of platelets at the site of vessel endothelial rupture is mediated through platelet membrane glycoprotein receptors. The integrity of these surface adhesion receptors and the signal-transduction pathways of activation will determine, in large part, how well a platelet functions in hemostasis. The deterioration of these systems during storage leads to a compromise of function known as the 'platelet-storage lesion'.

Preservation of hemostatic and structural properties of rehydrated lyophilized platelets: potential for long-term storage of dried platelets for transfusion

Currently, therapeutic platelet concentrates can be stored for only 5 days. We have developed a procedure that permits long-term storage of fixed and lyophilized platelets that retain hemostatic properties after rehydration. These rehydrated lyophilized platelets (RL platelets) restore hemostasis in thrombocytopenic rats and become incorporated in the hemostatic plug of bleeding time wounds of normal dogs as well as von Willebrand disease dogs with partially replenished plasma von Willebrand factor. Ultrastructurally, these platelets are well preserved and are comparable to control normal washed platelets. Flow cytometry analysis shows that RL platelets react with antibodies to the major surface receptors, glycoprotein (GP)Ib and GPIIb/IIIa. These receptors are involved in platelet agglutination, aggregation, and adhesion. In vitro functional tests document the ability of RL platelets to adhere to denuded subendothelium and to spread on a foreign surface. Circulating RL platelets participated in carotid arterial thrombus formation induced in normal canine subjects. The participation of RL platelets in these vital hemostatic properties suggests that with further development they could become a stable platelet product for transfusion.