Metabolic energy reduction by glucose deprivation and low gas exchange preserves platelet function after 48 h storage at 4 °C

Metabolic phenotypes of standard and cold-stored platelets

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.

Aging of platelets stored for transfusion

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.

The effect of 24 h resting of old PCs at 22-24°С in permeable bags on in vitro platelet parameters

BACKGROUND

During transporting periods, platelet (PLT) concentrates (PCs) usually undergo a long period without agitation. Whether this interruption, improves quality and viability, or has deleterious effect at 72 h stored PCs, is here investigated. The aim of our study is to investigate effect of metabolic resting (24 h interruption of agitation) versus continue agitation of 72 h-stored PCs (old), prior to transfusion in the blood bank of Tehran.

STUDY DESIGN AND METHODS

PCs were prepared using the platelet-rich plasma (PRP) method and stored in the permeable bags in the shaker/incubator, for 72 h at 20-24°C. Then by simply stopping the agitator, PCs remained at stationary condition without agitation for 24 h (WA24h) before sampling. In vitro measurements of PLT quality were carried out just after the termination of interruption period, and the results were compared with continuously agitated platelet within the same day (designated as control group, CA). In vitro variables which are measured were pH, Platelet count, swirling, Ristocetin-induced aggregation (GPIb-related function), LDH, PF4 release and P-selectin expression (activation marker).

RESULTS

Compared with control group, the mean platelets PF4 release and P-selectin expression showed no significant differences (p=0.101, p=0.739 respectively). The mean level of pH was not significant (p=0.156); WA24h (7.12±0.14) and CA (7.17±0.11). Also Ristocetin-induced aggregation study showed significant differences (p=0.0281) between CA (76.6±3.2) and WA24h (62.69±21.43). Other in vitro variables between CA and WA groups including swirling, Platelet count and LDH showed no significant differences after 72 h of storage.

CONCLUSIONS

We observed that 24 h resting of old PCs (WA24h) at 22-24°С in permeable bags preserved pH, swirling, LDH, Ristocetin-induced aggregation and platelet's activation as good as control group after 72 h of storage.

Increased platelet storage time is associated with mitochondrial dysfunction and impaired platelet function

BACKGROUND

Hemorrhagic shock is a leading cause of death following severe trauma, and platelet transfusions are frequently necessary to achieve hemostasis. Platelets, however, require special storage conditions, and storage time has been associated with loss of platelet quality. We hypothesized that standard storage conditions have a deleterious effect on platelet mitochondrial function and platelet activation.

MATERIALS AND METHODS

Platelet donations were collected from healthy donors (n = 5) and stored in gas-permeable collection bags according to American Association of Blood Bank recommendations. Platelet units were sampled from day of collection (day 0) until day 7. High-resolution respirometry was used to assess baseline mitochondrial respiration, maximal oxygen utilization, and individual mitochondrial complex-dependent respiration. Fluorescence-activated cell sorting was performed to analyze mitochondrial content, mitochondrial reactive oxygen species, the expression of P-selectin (both before and after challenge with thrombin receptor-activating peptide), and apoptosis. Data were analyzed using analysis of variance and Pearson correlation (P < 0.05 significant).

RESULTS

Mitochondrial respiration decreased significantly in platelets stored longer than 2 d (P < 0.05). Platelets also demonstrated a persistent decrease in response to stimulation with thrombin receptor-activating peptide by the third day of storage (P < 0.05) as well as an increase in mitochondrial reactive oxygen species and apoptosis (P < 0.05). Mitochondrial respiration significantly correlated with platelet capacity to activate (r = 0.8, P < 0.05).

CONCLUSIONS

Platelet mitochondrial respiratory function and activation response decrease significantly in platelets stored for 3 d or more. Because platelet transfusions almost universally occur between the third and fifth day of storage, our findings may have significant clinical importance and warrant further in vivo analysis.

Glucose ameliorates the metabolic profile and mitochondrial function of platelet concentrates during storage in autologous plasma

BACKGROUND

It is essential that the quality of platelet metabolism and function remains high during storage in order to ensure the clinical effectiveness of a platelet transfusion. New storage conditions and additives are constantly evaluated in order to achieve this. Using glucose as a substrate is controversial because of its potential connection with increased lactate production and decreased pH, both parameters triggering the platelet lesion during storage.

MATERIALS AND METHODS

In this study, we analysed the morphological status and metabolic profile of platelets stored for various periods in autologous plasma enriched with increasing glucose concentrations (13.75, 27.5 and 55 mM). After 0, 2, 4, 6 and 8 days, high energy phosphates (ATP, GTP, ADP, AMP), oxypurines (hypoxanthine, xanthine, uric acid), lactate, pH, mitochondrial function, cell lysis and morphology, were evaluated.

RESULTS

The data showed a significant dose-dependent improvement of the different parameters in platelets stored with increasing glucose, compared to what detected in controls. Interestingly, this phenomenon was more marked at the highest level of glucose tested and in the period of time generally used for platelet transfusion (0-6 days).

CONCLUSION

These results indicate that the addition of glucose during platelet storage ameliorates, in a dose-dependent manner, the biochemical parameters related to energy metabolism and mitochondrial function. Since there was no correspondence between glucose addition, lactate increase and pH decrease in our experiments, it is conceivable that platelet derangement during storage is not directly caused by glucose through an increase of anaerobic glycolysis, but rather to a loss of mitochondrial functions caused by reduced substrate availability.

pH value promotes growth of Staphylococcus epidermidis in platelet concentrates

BACKGROUND

The platelet (PLT) storage lesion is characterized metabolically by a pH value associated with lactic acid generation. PLT storage conditions support the growth of Staphylococcus epidermidis, the most common organism implicated in bacterial contamination of PLT concentrates (PCs). Here, different factors that influence bacterial growth in PCs are discussed and the relation between pH values of PCs and citrate plasma (CP) is studied, with emphasis on bacterial proliferation.

STUDY DESIGN AND METHODS

The PLT lesion with regard to pH decrease and lactic acid production was monitored during storage and correlated to bacterial proliferation properties. A total of 115 coagulase-negative staphylococci, especially S. epidermidis isolates, were characterized for their proliferation in different blood components (CP, buffy coat-derived, and apheresis PCs). Furthermore, the influence of donor-specific, product-specific, species-specific, and strain-specific factors on bacterial proliferation was investigated.

RESULTS

PCs showed a lower pH value in comparison to plasma during storage. Bacterial proliferation in PCs and the failure to grow in CP were determined with all organisms tested. No correlation to donor-specific, species-specific, or strain-specific factors was observed. Lowering the pH of CP resulted in bacterial proliferation, whereas a pH increase in the PC unit inhibited the proliferation of S. epidermidis.

CONCLUSION

With emphasis on bacterial proliferation, the significant difference between PC and CP is the presence of metabolizing PLTs. The pH values of stored PLTs, but not those of stored plasma, support the growth of S. epidermidis.