1
|
Muret C, Crettaz D, Martin A, Aliotta A, Bertaggia Calderara D, Alberio L, Prudent M. Two novel platelet biotinylation methods and their impact on stored platelet concentrates in a blood bank environment. Transfusion 2022; 62:2324-2333. [PMID: 36190148 DOI: 10.1111/trf.17129] [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: 04/12/2022] [Revised: 07/08/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Storage of platelet concentrates (PCs) has an impact on platelet quality and possibly affects their functions after transfusion. The influence of processing and storage conditions of PCs on their in vivo function upon transfusion is unknown. One option for investigating this question is to implement an ex vivo labeling of human platelets, to analyze them after transfusion into heathy volunteers and/or patients. In this study, we developed two labeling methods employing biotin. METHODS Two methods of biotinylation were compared to a control (standard PC). The "Bio-Wash" process used washing steps to label all platelets within the PC; for the other method, "Bio-Direct," one fifth of the PC were directly labeled without washing steps. The control and the two biotinylated PCs were analyzed over 7 days of storage. Labeling efficiency, platelet counts, phenotypes, and functions, along with time and costs, were evaluated to select the best process. RESULTS Both methods achieved a stable labeling through the storage, with similar platelet counts and metabolism in comparison to control PCs. Bio-Wash showed higher activation phenotype and lower aggregation response in comparison to the Bio-Direct method. The Bio-Direct was performed within 1.5 h versus 3 h for the Bio-Wash. However, the Bio-Direct required 12 mg of biotin instead of 8 mg for the other process. CONCLUSION We set up two methods of biotinylation that can be easily implemented in a blood bank environment. The Bio-Direct process was preferred to the Bio-Wash because of its similarity, from a functional and phenotypic point of view, with standard PCs.
Collapse
Affiliation(s)
- Charlotte Muret
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, Epalinges, Switzerland.,Faculté de Biologie et de Médecine, Université de Lausanne (UNIL), Lausanne, Switzerland
| | - David Crettaz
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, Epalinges, Switzerland
| | - Agathe Martin
- Laboratoire de Préparation Cellulaire et d'Analyses, Transfusion Interrégionale CRS, Epalinges, Switzerland
| | - Alessandro Aliotta
- Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Debora Bertaggia Calderara
- Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Lorenzo Alberio
- Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Michel Prudent
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, Epalinges, Switzerland.,Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
2
|
Reichert L, Wallner S, Burkhardt R, Offner R, Ahrens N, Hähnel V. Triple apheresis platelet concentrate quality after pneumatic tube system, conveyor box, and courier transport: An observational study. Health Sci Rep 2022; 5:e596. [PMID: 35425867 PMCID: PMC8989271 DOI: 10.1002/hsr2.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lena Reichert
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Stefan Wallner
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Ralph Burkhardt
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Robert Offner
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
- MVZ for Laboratory Medicine Raubling, amedes Labor Raubling Germany
| | - Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| |
Collapse
|
3
|
Zhang Y, Jiang F, Chen Y, Ju LA. Platelet Mechanobiology Inspired Microdevices: From Hematological Function Tests to Disease and Drug Screening. Front Pharmacol 2022; 12:779753. [PMID: 35126120 PMCID: PMC8811026 DOI: 10.3389/fphar.2021.779753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/28/2021] [Indexed: 12/30/2022] Open
Abstract
Platelet function tests are essential to profile platelet dysfunction and dysregulation in hemostasis and thrombosis. Clinically they provide critical guidance to the patient management and therapeutic evaluation. Recently, the biomechanical effects induced by hemodynamic and contractile forces on platelet functions attracted increasing attention. Unfortunately, the existing platelet function tests on the market do not sufficiently incorporate the topical platelet mechanobiology at play. Besides, they are often expensive and bulky systems that require large sample volumes and long processing time. To this end, numerous novel microfluidic technologies emerge to mimic vascular anatomies, incorporate hemodynamic parameters and recapitulate platelet mechanobiology. These miniaturized and cost-efficient microfluidic devices shed light on high-throughput, rapid and scalable platelet function testing, hematological disorder profiling and antiplatelet drug screening. Moreover, the existing antiplatelet drugs often have suboptimal efficacy while incurring several adverse bleeding side effects on certain individuals. Encouraged by a few microfluidic systems that are successfully commercialized and applied to clinical practices, the microfluidics that incorporate platelet mechanobiology hold great potential as handy, efficient, and inexpensive point-of-care tools for patient monitoring and therapeutic evaluation. Hereby, we first summarize the conventional and commercially available platelet function tests. Then we highlight the recent advances of platelet mechanobiology inspired microfluidic technologies. Last but not least, we discuss their future potential of microfluidics as point-of-care tools for platelet function test and antiplatelet drug screening.
Collapse
Affiliation(s)
- Yingqi Zhang
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Heart Research Institute, Newtown, NSW, Australia
| | - Fengtao Jiang
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, NSW, Australia
| | - Yunfeng Chen
- The Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston, TX, United States
- The Department of Pathology, The University of Texas Medical Branch, Galveston, TX, United States
| | - Lining Arnold Ju
- School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Heart Research Institute, Newtown, NSW, Australia
- *Correspondence: Lining Arnold Ju,
| |
Collapse
|
4
|
Abstract
The supply of platelets for transfusion is a logistical challenge due to the physiology of platelets and current measures of transfusion performance dictating storage at 22°C and a short product shelf-life (<7 days). Demand for platelets has increased in recent years and changes in the demographics of the population may enhance this further. Many studies have been conducted to understand what the optimal dose and trigger for transfusion should be, mainly in hematology patients who are the largest cohort that receive platelets, mostly to prevent bleeding. Emerging data suggests that for bleeding patients, where immediate hemostasis is a key consideration, the current standard product may not be optimal. Alternative platelet preparation methods/storage options that may improve the hemostatic properties of platelets are under active development. In parallel with research into alternative platelet products that might enhance hemostasis, better measures for assessing bleeding risk and platelet efficacy are needed.
Collapse
|
5
|
Vinholt PJ. The role of platelets in bleeding in patients with thrombocytopenia and hematological disease. Clin Chem Lab Med 2020; 57:1808-1817. [PMID: 31465290 DOI: 10.1515/cclm-2019-0380] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/29/2019] [Indexed: 01/19/2023]
Abstract
This review evaluates the role of platelets in bleeding risk among patients with hematological disease and thrombocytopenia. Platelets are pivotal in primary hemostasis, and possess non-hemostatic properties involved in angiogenesis, tissue repair, inflammation and metastatis. Also, platelets safeguard vascular integrity in inflamed vessels. Overall, bleeding risk depends on the underlying disease, and patients with cancer and platelet count <6-10 × 109/L have a markedly increased bleeding risk, while the platelet count does not correlate with bleeding risk at higher platelet counts. Other factors might affect platelet properties and thus bleeding risk, for example, drugs, low hematocrit, coagulation system impairments or transfusion of dysfunctional donor platelets. For patients with leukemia and immune thrombocytopenia, reduced platelet activation, platelet aggregation, or thrombopoiesis, reflected by the reduced presence of reticulated platelets, are associated with bleeding phenotype. However, mechanistic insight into the cause of reduced platelet function in different thrombocytopenic conditions is sparse, except for some inherited platelet disorders. Promising tools for platelet function studies in thrombocytopenia are flow cytometry and biomarker studies on platelet constituents. An important message from this current paper is that bleeding risk assessment must be tailored to specific patient populations and cannot be applied broadly to all patients with thrombocytopenia.
Collapse
Affiliation(s)
- Pernille J Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, J.B. Winsløws vej 4B, 5000 Odense C, Denmark.,University of Southern Denmark, Odense, Denmark
| |
Collapse
|
6
|
Bogdanić D, Bogdanić N, Karanović N. Evaluation of platelet count and platelet function analyzer - 100 testing for prediction of platelet transfusion following coronary bypass surgery. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 80:296-302. [PMID: 32125177 DOI: 10.1080/00365513.2020.1731847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Platelet transfusions are commonly administered to treat bleeding in cardiac surgery. The aim of this study was to compare platelet (PLT) count and values of collagen adenosine diphosphate closure time (cADP-CT) measured by Platelet Function Analyzer (PFA) for prediction of PLT transfusion therapy following coronary bypass surgery. For this prospective observational study, 66 patients scheduled for coronary artery bypass grafting (CABG) who received early PLT transfusions (within 60 min after the operation) were enrolled. To assess changes in platelets, count and function, two time points were selected: 15 min before and 30 - 60 min after the end of PLT transfusion. The patients were divided into transfused and non-transfused with further PLT in the 48 h postoperatively. We used the receiver operating characteristics (ROC) curve to investigate whether the PLT count and cADP-CT values were predictors of PLT transfusion. The positive predictive values (PPV) of PLT count and cADP-CT after PLT transfusion for further PLT transfusion were 33% and 86% respectively, with a PLT count threshold of ≤200 × 109/L and cADP-CT threshold of ≥118 s. The comparison among the ROC curves showed a statistical difference (p = .0002). In multiple regression analysis, cADP-CT was the strongest predictor for the number of PLT transfusion doses in the 48 h postoperatively. In CABG patients, the results of cADP-CT after PLT transfusion have a better predictive capacity for further PLT transfusions than the PLT count.
Collapse
Affiliation(s)
- Dejana Bogdanić
- Department of Transfusion Medicine, University Hospital Center Split, Split, Croatia
| | - Nikolina Bogdanić
- University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Nenad Karanović
- Department of Anesthesiology and Intensive Care, University Hospital Center Split, Split, Croatia
| |
Collapse
|
7
|
Nair AB, Parker RI. Hemostatic Testing in Critically Ill Infants and Children. Front Pediatr 2020; 8:606643. [PMID: 33490001 PMCID: PMC7820389 DOI: 10.3389/fped.2020.606643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022] Open
Abstract
Children with critical illness frequently manifest imbalances in hemostasis with risk of consequent bleeding or pathologic thrombosis. Traditionally, plasma-based tests measuring clot formation by time to fibrin clot generation have been the "gold standard" in hemostasis testing. However, these tests are not sensitive to abnormalities in fibrinolysis or in conditions of enhanced clot formation that may lead to thrombosis. Additionally, they do not measure the critical roles played by platelets and endothelial cells. An added factor in the evaluation of these plasma-based tests is that in infants and young children plasma levels of many procoagulant and anticoagulant proteins are lower than in older children and adults resulting in prolonged clot generation times in spite of maintaining a normal hemostatic "balance." Consequently, newer assays directly measuring thrombin generation in plasma and others assessing the stages hemostasis including clot initiation, propagation, and fibrinolysis in whole blood by viscoelastic methods are now available and may allow for a global measurement of the hemostatic system. In this manuscript, we will review the processes by which clots are formed and by which hemostasis is regulated, and the rationale and limitations for the more commonly utilized tests. We will also discuss selected newer tests available for the assessment of hemostasis, their "pros" and "cons," and how they compare to the traditional tests of coagulation in the assessment and management of critically ill children.
Collapse
Affiliation(s)
- Alison B Nair
- Pediatric Critical Care Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Robert I Parker
- Pediatric Hematology/Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| |
Collapse
|
8
|
Napolitano M, Mancuso S, Raso S, LoCoco L, Arfò PS, De Francisci G, Dieli F, Caccamo N, Reina A, Dolce A, Agliastro R, Siragusa S. Buffy coat-derived platelets cryopreserved using a new method: Results from a pivotal clinical trial on thrombocytopenic patients with acute leukaemia. Transfus Apher Sci 2019; 58:102666. [PMID: 31753773 DOI: 10.1016/j.transci.2019.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
The administration of cryopreserved platelets (PLTs) may overcome the limits of platelet shortage and availability, especially during some seasons or in specific contexts like rural areas. After in vitro validation studies, ad hoc prepared buffy coat-derived pooled platelet concentrates (BC-PLTs), treated with dimethyl sulphoxide (DMSO) and cryopreserved (CRY BC-PLTs) at -80 °C with a modified Valeri method, were transfused in patients with severe thrombocytopenia secondary to chemotherapy for acute leukaemia (AL). Five inpatients were enrolled in the pivotal clinical trial NCT02032134: 4 males and 1 female with a mean age of 71 years (range: 65-80). Four patients were diagnosed with acute myeloid leukaemia and 1 had acute lymphoblastic leukaemia.Transfusion of one Unit of CRY BC-PLTs resulted effective in active bleeding control in two patients without any adverse reaction or concomitant antihaemorrhagic therapies. CRY BC-PLTs met the currently accepted criteria for cryopreserved PLTs, their transfusion in patients with AL was safe. (Clinical trial: NCT02032134).
Collapse
Affiliation(s)
- Mariasanta Napolitano
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (proMISE), University of Palermo, Palermo, Italy.
| | - Salvatrice Mancuso
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (proMISE), University of Palermo, Palermo, Italy
| | - Simona Raso
- Dipartiemnto di Discipline Chirurgiche, Oncologiche e Stomatologiche (DiChir.OnS), University of Palermo, Palermo, Italy
| | - Lucio LoCoco
- Laboratorio Centralizzato Policlinico "P.Giaccone", Sezione Emostasi e Trombosi, Palermo, Italy
| | - Piera Stefania Arfò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (proMISE), University of Palermo, Palermo, Italy
| | - Giovanni De Francisci
- Unità di Medicina Trasfusionale ed Immunoematologia, Ospedale "Civico" Palermo, Italy
| | - Francesco Dieli
- Laboratorio di Ricerca CLADIBIOR, Università di Palermo, Palermo, Italy
| | - Nadia Caccamo
- Laboratorio di Ricerca CLADIBIOR, Università di Palermo, Palermo, Italy
| | | | | | - Rosalia Agliastro
- Unità di Medicina Trasfusionale ed Immunoematologia, Ospedale "Civico" Palermo, Italy
| | - Sergio Siragusa
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (proMISE), University of Palermo, Palermo, Italy
| |
Collapse
|
9
|
Siddon AJ, Tormey CA, Snyder EL. Platelet Transfusion Medicine. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
10
|
Sperling S, Vinholt PJ, Sprogøe U, Yazer MH, Frederiksen H, Nielsen C. The effects of storage on platelet function in different blood products. ACTA ACUST UNITED AC 2018; 24:89-96. [PMID: 30170538 DOI: 10.1080/10245332.2018.1516599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Reduced platelet (PLT) function during storage has been shown for buffy-coat-derived platelet concentrates (BCP) and apheresis platelet units (AP), while for whole blood (WB) it has not been well studied. The aim of this study was to investigate PLT function in these blood products throughout storage using a novel flow cytometric assay. METHODS Flow cytometric measurement of agonist-induced platelet aggregation, CD62P expression and PAC-1 binding during storage in BCP, AP (1-9 days at 20°C) and WB (1-21 days at 2-6°C). RESULTS PLT-aggregation capacity decreased from day 1 to day 7 for almost all product-agonist combinations (P = .004 to P = .029) with aggregation capacity of WB being similar to that of AP and BCP. WB aggregation capacity remained relatively unchanged from day 7 to day 21. For all blood products, the fraction of agonist-induced CD62P-expression remained high and the fraction of PAC-1 binding decreased during storage. WB PLTs underwent only small changes in CD62P expression and PAC-1 binding from day 7 to day 21. CONCLUSION This study found PLT aggregation in WB stored at 4°C to be as least as good as for BCP and AP stored at 20°C. WB retained significant PLT-aggregation capacity to day 21.
Collapse
Affiliation(s)
- Signe Sperling
- a Department of Hematology , Odense University Hospital , Odense , Denmark.,b Department of Clinical Immunology , Odense University Hospital , Odense , Denmark.,c University of Southern Denmark , Odense , Denmark
| | - Pernille J Vinholt
- d Department of Clinical Biochemistry and Pharmacology , Odense University Hospital , Odense , Denmark
| | - Ulrik Sprogøe
- b Department of Clinical Immunology , Odense University Hospital , Odense , Denmark
| | - Mark H Yazer
- c University of Southern Denmark , Odense , Denmark.,e Department of Pathology , University of Pittsburgh , Pittsburgh , PA , USA
| | - Henrik Frederiksen
- a Department of Hematology , Odense University Hospital , Odense , Denmark
| | - Christian Nielsen
- b Department of Clinical Immunology , Odense University Hospital , Odense , Denmark
| |
Collapse
|
11
|
Jimenez-Marco T, Garcia-Recio M, Girona-Llobera E. Our experience in riboflavin and ultraviolet light pathogen reduction technology for platelets: from platelet production to patient care. Transfusion 2018; 58:1881-1889. [DOI: 10.1111/trf.14797] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
|
12
|
Napolitano M, Mancuso S, Lo Coco L, Arfò PS, Raso S, De Francisci G, Dieli F, Caccamo N, Reina A, Dolce A, Agliastro R, Siragusa S. Buffy coat-derived platelets cryopreserved using a new method: Results from in vitro studies. Transfus Apher Sci 2018; 57:578-581. [PMID: 30100202 DOI: 10.1016/j.transci.2018.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/08/2018] [Accepted: 07/23/2018] [Indexed: 01/07/2023]
Abstract
Cryopreservation for the long-term storage of platelets (PLTs) is a useful method to overcome the limits of platelet shortage. This is an in vitro prospective study to evaluate the count, viability, and function of buffy coat-derived pooled platelet concentrates (BC-PLTs), treated with dimethyl sulphoxide (DMSO) and cryopreserved (CRY BC-PLTs) at -80 °C with a modified Valeri method. PLTs were stored in 6% DMSO with a patented kit. Overall, 49 BC-PLTs from 245 healthy volunteer donors were prepared, cryopreserved, and analysed before and after 3, 6, and 9 months of storage. In flow cytometry, a statistically significant reduction in CD 42b (92.7 ± 4.29% at T0 vs. 23.6 ± 27.5% at T3, 16.38 ± 12.54% at T6, and 17.3 ± 9.6% at T9) and PAC-1 (1.9 ± 1.34% at T0 vs. 0.62 ± 0.4% at T3, 0.63 ± 0.83% at T6, and 0.49 ± 0.48% at T9) was observed after storage. CRY BC-PLTs showed a good and stable endogenous thrombin generation potential (nM min): 529.25 ± 98.64 at T0 vs. 533.04 ± 103.15 at T9 months. CRY BC-PLTs showed a good viability in vitro, according to currently accepted criteria for cryopreserved PLTs.
Collapse
Affiliation(s)
- Mariasanta Napolitano
- Dipartimento Biomedico di Medicina Interna e Specialistica, UOC Ematologia con Trapianto, Università di Palermo, Palermo, Italy.
| | - Salvatrice Mancuso
- Dipartimento Biomedico di Medicina Interna e Specialistica, UOC Ematologia con Trapianto, Università di Palermo, Palermo, Italy
| | - Lucio Lo Coco
- Laboratorio Centralizzato Policlinico "P.Giaccone", Sezione Emostasi e Trombosi, Palermo, Italy
| | - Piera Stefania Arfò
- Dipartimento Biomedico di Medicina Interna e Specialistica, UOC Ematologia con Trapianto, Università di Palermo, Palermo, Italy
| | - Simona Raso
- Dipartimento Biomedico di Medicina Interna e Specialistica, UOC Ematologia con Trapianto, Università di Palermo, Palermo, Italy
| | - Giovanni De Francisci
- Unità di Medicina Trasfusionale ed Immunoematologia, Ospedale "Civico" Palermo, Italy
| | - Francesco Dieli
- Laboratorio di Ricerca CLADIBIOR, Università di Palermo, Palermo, Italy
| | - Nadia Caccamo
- Laboratorio di Ricerca CLADIBIOR, Università di Palermo, Palermo, Italy
| | | | | | - Rosalia Agliastro
- Unità di Medicina Trasfusionale ed Immunoematologia, Ospedale "Civico" Palermo, Italy
| | - Sergio Siragusa
- Dipartimento Biomedico di Medicina Interna e Specialistica, UOC Ematologia con Trapianto, Università di Palermo, Palermo, Italy
| |
Collapse
|
13
|
Brazilek RJ, Tovar-Lopez FJ, Wong AKT, Tran H, Davis AS, McFadyen JD, Kaplan Z, Chunilal S, Jackson SP, Nandurkar H, Mitchell A, Nesbitt WS. Application of a strain rate gradient microfluidic device to von Willebrand's disease screening. LAB ON A CHIP 2017; 17:2595-2608. [PMID: 28660968 DOI: 10.1039/c7lc00498b] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Von Willebrand's disease (VWD) is the most common inherited bleeding disorder caused by either quantitative or qualitative defects of von Willebrand factor (VWF). Current tests for VWD require relatively large blood volumes, have low throughput, are time-consuming, and do not incorporate the physiologically relevant effects of haemodynamic forces. We developed a microfluidic device incorporating micro-contractions that harnesses well-defined haemodynamic strain gradients to initiate platelet aggregation in citrated whole blood. The microchannel architecture has been specifically designed to allow for continuous real-time imaging of platelet aggregation dynamics. Subjects aged ≥18 years with previously diagnosed VWD or who presented for evaluation of a bleeding disorder, where the possible diagnosis included VWD, were tested. Samples were obtained for device characterization as well as for pathology-based testing. Platelet aggregation in the microfluidic device is independent of platelet amplification loops but dependent on low-level platelet activation, GPIb/IX/V and integrin αIIbβ3 engagement. Microfluidic output directly correlates with VWF antigen levels and is able to sensitively detect aggregation defects associated with VWD subtypes. Testing demonstrated a strong correlation with standard clinical laboratory-based tests. Head-to-head comparison with PFA100® demonstrated equivalent, if not improved, sensitivity for screening aggregation defects associated with VWD. This strain rate gradient microfluidic prototype has the potential to be a clinically useful, rapid and high throughput-screening tool for VWD as well as other strain-dependent platelet disorders. In addition, the microfluidic device represents a novel approach to examine the effects of high magnitude/short duration (ms) strain rate gradients on platelet function.
Collapse
Affiliation(s)
- Rose J Brazilek
- The Australian Centre for Blood Diseases, Monash University, Alfred Medical Research and Educational Precinct, Melbourne, Victoria, Australia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
- Elissa M Milford
- Australian Defence Force, Australia.,University of Queensland, Australia
| | - Michael C Reade
- Australian Defence Force, Australia.,University of Queensland, Australia
| |
Collapse
|
15
|
Gremmel T, Panzer S. Oral antiplatelet therapy: impact for transfusion medicine. Vox Sang 2017; 112:511-517. [DOI: 10.1111/vox.12537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/15/2017] [Accepted: 04/25/2017] [Indexed: 01/03/2023]
Affiliation(s)
- T. Gremmel
- Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | - S. Panzer
- Department of Blood Group Serology and Transfusion Medicine; Medical University of Vienna; Vienna Austria
| |
Collapse
|
16
|
Application of an optimized flow cytometry-based quantification of Platelet Activation (PACT): Monitoring platelet activation in platelet concentrates. PLoS One 2017; 12:e0172265. [PMID: 28207883 PMCID: PMC5313179 DOI: 10.1371/journal.pone.0172265] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 02/02/2017] [Indexed: 11/19/2022] Open
Abstract
Background Previous studies have shown that flow cytometry is a reliable test to quantify platelet function in stored platelet concentrates (PC). It is thought that flow cytometry is laborious and hence expensive. We have optimized the flow cytometry-based quantification of agonist induced platelet activation (PACT) to a labor, time and more cost-efficient test. Currently the quality of PCs is only monitored by visual inspection, because available assays are unreliable or too laborious for use in a clinical transfusion laboratory. Therefore, the PACT was applied to monitor PC activation during storage. Study design and methods The optimized PACT was used to monitor 5 PCs during 10 days of storage. In brief, optimized PACT uses a ready-to-use reaction mix, which is stable at -20°C. When needed, a test strip is thawed and platelet activation is initiated by mixing PC with PACT. PACT was based on the following agonists: adenosine diphosphate (ADP), collagen-related peptide (CRP) and thrombin receptor-activating peptide (TRAP-6). Platelet activation was measured as P-selectin expression. Light transmission aggregometry (LTA) was performed as a reference. Results Both PACT and LTA showed platelet function decline during 10-day storage after stimulation with ADP and collagen/CRP; furthermore, PACT showed decreasing TRAP-induced activation. Major differences between the two tests are that PACT is able to measure the status of platelets in the absence of agonists, and it can differentiate between the number of activated platelets and the amount of activation, whereas LTA only measures aggregation in response to an agonist. Also, PACT is more time-efficient compared to LTA and allows high-throughput analysis. Conclusion PACT is an optimized platelet function test that can be used to monitor the activation of PCs. PACT has the same accuracy as LTA with regard to monitoring PCs, but it is superior to both LTA and conventional flow cytometry based tests with regard to labor-, time- and cost efficiency.
Collapse
|
17
|
Venkatesh K, Nair PS, Hoechter DJ, Buscher H. Current Limitations of the Assessment of Haemostasis in Adult Extracorporeal Membrane Oxygenation Patients and the Role of Point-of-Care Testing. Anaesth Intensive Care 2016; 44:669-680. [DOI: 10.1177/0310057x1604400601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Haemostatic perturbations are commonly seen in extracorporeal membrane oxygenation (ECMO) patients and remain a clinical challenge, contributing significantly to morbidity and mortality. The approach to anticoagulation monitoring and the management of bleeding varies considerably across ECMO centres. Routine laboratory tests have their limitations in terms of turnaround time and specificity of information provided. Newer point-of-care testing (POCT) for coagulation may overcome these issues, as it provides information about the entire coagulation pathway from clot initiation to lysis. It is also possible to obtain qualitative information on platelet function from these tests. Furthermore, the ability to incorporate these results into a goal-directed algorithm to manage bleeding with targeted transfusion strategies appears particularly attractive and cost effective. Further studies are required to evaluate the utility of POCT to optimise bleeding and anticoagulation management in these complex patients.
Collapse
Affiliation(s)
- K. Venkatesh
- Prince of Wales Hospital, Conjoint Associate Lecturer, University of New South Wales, Sydney, New South Wales
| | - P. S. Nair
- Intensive Care Unit, St Vincent's Hospital, Conjoint Senior Lecturer, University of New South Wales, Sydney, New South Wales
| | - D. J. Hoechter
- Department of Anaesthesiology, University of Munich (LMU), Munich, Germany
| | - H. Buscher
- Intensive Care Unit, St Vincent's Hospital, Conjoint Senior Lecturer, University of New South Wales, Sydney, New South Wales
| |
Collapse
|
18
|
Nielsen VG. The Contribution of Pin End-Cup Interactions to Clot Strength Assessed with Thrombelastography. Anesth Analg 2015; 122:43-5. [PMID: 26678469 DOI: 10.1213/ane.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Viscoelastic methods have been developed to assess the contribution of plasma proteins and platelets to coagulation in vitro to guide clinical transfusion therapy. One of the cardinal precepts of determining clot strength is making sure that the viscoelastic technique includes complete exposure of the plastic pin in the testing chamber with the fluid analyzed so as to assure maximal interaction of the cup wall with the pin surface. However, the various contributions of the pin surface area to final clot strength have not been investigated. That is, it is not clear what is more important in the in vitro determination of clot strength, the surface area shared between the cup and pin filled with fluid or the final viscoelastic resistance of the gel matrix formed. Thus, the purpose of this investigation was to determine the clot strength when only the tip of the pin was engaged with plasma thrombus and to compare these values with clot strength values obtained when the pin was completely in plasma. After determining the minimal amount of plasma required to cover a pin tip in a thrombelastographic system (30 μL), clot strength (elastic modulus, G) was determined in plasma samples of 30 or 360 μL final volume (n = 12 per condition) after tissue factor activation. The G value with 30 μL volume was 1057 ± 601 dynes/cm (mean ± SD; 95% confidence interval, 675-1439 dynes/cm), which was (P = 0.0015) smaller than the G value associated with 360-μL sample volumes, that was 1712 ± 48 dynes/cm (confidence interval, 1681-1742 dynes/cm). In conclusion, these data demonstrate that clot strength is not determined by a simple ratio of surface area of pin and cup to volume of sample, but rather strength is importantly influenced by the viscoelastic resistance of the fluid assessed.
Collapse
Affiliation(s)
- Vance G Nielsen
- From the Department of Anesthesiology, University of Arizona, Tucson, Arizona
| |
Collapse
|
19
|
Södergren AL, Tynngård N, Berlin G, Ramström S. Responsiveness of platelets during storage studied with flow cytometry--formation of platelet subpopulations and LAMP-1 as new markers for the platelet storage lesion. Vox Sang 2015; 110:116-25. [PMID: 26389538 DOI: 10.1111/vox.12324] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/17/2015] [Accepted: 07/22/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Storage lesions may prevent transfused platelets to respond to agonists and arrest bleeding. The aim of this study was to evaluate and quantify the capacity of platelet activation during storage using flow cytometry and new markers of platelet activation. MATERIALS AND METHODS Activation responses of platelets prepared by apheresis were measured on days 1, 5, 7 and 12. In addition, comparisons were made for platelet concentrates stored until swirling was affected. Lysosome-associated membrane protein-1 (LAMP-1), P-selectin and phosphatidylserine (PS) exposure were assessed by flow cytometry on platelets in different subpopulations in resting state or following stimulation with platelet agonists (cross-linked collagen-related peptide (CRP-XL), PAR1- and PAR4-activating peptides). RESULTS The ability to form subpopulations upon activation was significantly decreased already at day 5 for some agonist combinations. The agonist-induced exposure of PS and LAMP-1 also gradually decreased with time. Spontaneous exposure of P-selectin and PS increased with time, while spontaneous LAMP-1 exposure was unchanged. In addition, agonist-induced LAMP-1 expression clearly discriminated platelet concentrates with reduced swirling from those with retained swirling. This suggests that LAMP-1 could be a good marker to capture changes in activation capacity in stored platelets. CONCLUSION The platelet activation potential seen as LAMP-1 exposure and fragmentation into platelet subpopulations is potential sensitive markers for the platelet storage lesion.
Collapse
Affiliation(s)
- A L Södergren
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - N Tynngård
- Department of Clinical Immunology and Transfusion Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - G Berlin
- Department of Clinical Immunology and Transfusion Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - S Ramström
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
20
|
Kraemer L, Raczat T, Weiss DR, Strobel J, Eckstein R, Ringwald J. Correlation of the hypotonic shock response and extent of shape change with the new ThromboLUX ™. Vox Sang 2015; 109:194-6. [PMID: 25899969 DOI: 10.1111/vox.12268] [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: 12/02/2014] [Revised: 02/02/2015] [Accepted: 02/09/2015] [Indexed: 11/30/2022]
Abstract
ThromboLUX (TLX)-Score was compared with hypotonic shock response (HSR) and extent of shape change (ESC) in 99 samples from 42 platelet concentrates. Tests were performed in parallel and duplicate. Mean values for TLX Score, HSR and ESC were 30.3 ± 3.8%, 69.0 ± 12.2% and 23.2 ± 4.9%, respectively. We found no significant correlation between TLX Score and HSR or ESC (r = -0.158, P = 0.118 and r = -115, P = 0.255, respectively), whereas HSR and ESC correlated significantly (r = 0.351, P < 0.001). As TLX Score did not show significant correlation with HSR and ESC, the value of TLX for platelet quality testing remains unclear. Studies comparing these parameters with transfusion outcome are needed.
Collapse
Affiliation(s)
- L Kraemer
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany
| | - T Raczat
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany
| | - D R Weiss
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany
| | - J Strobel
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany
| | - R Eckstein
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany
| | - J Ringwald
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Erlangen, Germany
| |
Collapse
|
21
|
Kicken C, Van Poucke S, Marcus AE, Lancé MD, Henskens Y. Response of platelet concentrates to pressure and temperature changes without impairment of the in vitro function. Thromb Res 2015; 135:679-83. [DOI: 10.1016/j.thromres.2015.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/09/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
|
22
|
Tynngård N, Lindahl TL, Ramström S. Assays of different aspects of haemostasis - what do they measure? Thromb J 2015; 13:8. [PMID: 25688179 PMCID: PMC4329663 DOI: 10.1186/s12959-015-0036-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/12/2015] [Indexed: 12/25/2022] Open
Abstract
Haemostasis is a complex process affected by many factors including both cellular and plasma components. It is a multistep process starting with platelet adhesion to damaged endothelium and ending in clot fibrinolysis. There are several methods available to study different aspects of haemostasis including adhesion, aggregation, coagulation and fibrinolysis. This review describes the different methods, what aspects of haemostasis they measure and their limitations. Methods discussed include methods to study adhesion (e.g. PFA-100, cone and platelet(let) analyzer and perfusion chambers) and aggregation (e.g. Multiplate, VerifyNow and Plateletworks). Furthermore the principles behind viscoelastic haemostatic assays are presented as well as methods that can analyse aspects of haemostasis in plasma or platelet-rich-plasma samples (thrombin generation, overall haemostasis potential and Thrombodynamics Analyzer).
Collapse
Affiliation(s)
- Nahreen Tynngård
- Department of Clinical Chemistry, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden ; Department of Clinical Immunology and Transfusion Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Tomas L Lindahl
- Department of Clinical Chemistry, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Sofia Ramström
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
23
|
Feng Q, Shabrani N, Thon JN, Huo H, Thiel A, Machlus KR, Kim K, Brooks J, Li F, Luo C, Kimbrel EA, Wang J, Kim KS, Italiano J, Cho J, Lu SJ, Lanza R. Scalable generation of universal platelets from human induced pluripotent stem cells. Stem Cell Reports 2014; 3:817-31. [PMID: 25418726 PMCID: PMC4235139 DOI: 10.1016/j.stemcr.2014.09.010] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 12/23/2022] Open
Abstract
Human induced pluripotent stem cells (iPSCs) provide a potentially replenishable source for the production of transfusable platelets. Here, we describe a method to generate megakaryocytes (MKs) and functional platelets from iPSCs in a scalable manner under serum/feeder-free conditions. The method also permits the cryopreservation of MK progenitors, enabling a rapid “surge” capacity when large numbers of platelets are needed. Ultrastructural/morphological analyses show no major differences between iPSC platelets and human blood platelets. iPSC platelets form aggregates, lamellipodia, and filopodia after activation and circulate in macrophage-depleted animals and incorporate into developing mouse thrombi in a manner identical to human platelets. By knocking out the β2-microglobulin gene, we have generated platelets that are negative for the major histocompatibility antigens. The scalable generation of HLA-ABC-negative platelets from a renewable cell source represents an important step toward generating universal platelets for transfusion as well as a potential strategy for the management of platelet refractoriness. Large-scale production of platelets from human iPSCs under defined conditions iPSC platelets are functional both in vivo and in vitro Knockout of β2-microglobulin gene in iPSCs generates universal platelets
Collapse
Affiliation(s)
- Qiang Feng
- Advanced Cell Technology, Marlborough, MA 01752, USA
| | - Namrata Shabrani
- Department of Pharmacology, University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Jonathan N Thon
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115
| | - Hongguang Huo
- Advanced Cell Technology, Marlborough, MA 01752, USA
| | - Austin Thiel
- Advanced Cell Technology, Marlborough, MA 01752, USA
| | - Kellie R Machlus
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115
| | - Kyungho Kim
- Department of Pharmacology, University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Julie Brooks
- Advanced Cell Technology, Marlborough, MA 01752, USA
| | - Feng Li
- Advanced Cell Technology, Marlborough, MA 01752, USA
| | - Chenmei Luo
- Advanced Cell Technology, Marlborough, MA 01752, USA
| | | | - Jiwu Wang
- Allele Biotechnology, San Diego, CA 92121, USA
| | - Kwang-Soo Kim
- MacLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Joseph Italiano
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115; Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Boston, MA 02115, USA
| | - Jaehyung Cho
- Department of Pharmacology, University of Illinois College of Medicine, Chicago, IL 60612, USA
| | - Shi-Jiang Lu
- Advanced Cell Technology, Marlborough, MA 01752, USA
| | - Robert Lanza
- Advanced Cell Technology, Marlborough, MA 01752, USA.
| |
Collapse
|
24
|
Geraldo RB, Sathler PC, Lourenço AL, Saito MS, Cabral LM, Rampelotto PH, Castro HC. Platelets: still a therapeutical target for haemostatic disorders. Int J Mol Sci 2014; 15:17901-19. [PMID: 25295482 PMCID: PMC4227196 DOI: 10.3390/ijms151017901] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/26/2014] [Accepted: 09/23/2014] [Indexed: 11/16/2022] Open
Abstract
Platelets are cytoplasmatic fragments from bone marrow megakaryocytes present in blood. In this work, we review the basis of platelet mechanisms, their participation in syndromes and in arterial thrombosis, and their potential as a target for designing new antithrombotic agents. The option of new biotechnological sources is also explored.
Collapse
Affiliation(s)
- Reinaldo Barros Geraldo
- Programa de Pós-graduação em Ciências e Biotecnologia, Instituto de Biologia, Universidade Federal Fluminense (UFF), Niterói CEP 24210-130, RJ, Brazil.
| | - Plínio Cunha Sathler
- Programa de Pós-graduação em Patologia, Departamento de Patologia, Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense (UFF), Niterói CEP 24030-215, RJ, Brazil.
| | - André Luiz Lourenço
- Programa de Pós-graduação em Patologia, Departamento de Patologia, Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense (UFF), Niterói CEP 24030-215, RJ, Brazil.
| | - Max Seidy Saito
- Programa de Pós-graduação em Patologia, Departamento de Patologia, Hospital Universitário Antônio Pedro (HUAP), Universidade Federal Fluminense (UFF), Niterói CEP 24030-215, RJ, Brazil.
| | - Lucio M Cabral
- LabTIF, Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro CEP 21941-590, RJ, Brazil.
| | - Pabulo Henrique Rampelotto
- Interdisciplinary Center for Biotechnology Research, Federal University of Pampa, Antônio Trilha Avenue, P.O. Box 1847, São Gabriel/RS 97300-000, Brazil.
| | - Helena Carla Castro
- Programa de Pós-graduação em Ciências e Biotecnologia, Instituto de Biologia, Universidade Federal Fluminense (UFF), Niterói CEP 24210-130, RJ, Brazil.
| |
Collapse
|
25
|
Kaiser-Guignard J, Canellini G, Lion N, Abonnenc M, Osselaer JC, Tissot JD. The clinical and biological impact of new pathogen inactivation technologies on platelet concentrates. Blood Rev 2014; 28:235-41. [PMID: 25192602 DOI: 10.1016/j.blre.2014.07.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/14/2014] [Indexed: 01/01/2023]
Abstract
Since 1990, several techniques have been developed to photochemically inactivate pathogens in platelet concentrates, potentially leading to safer transfusion therapy. The three most common methods are amotosalen/UVA (INTERCEPT Blood System), riboflavin/UVA-UVB (MIRASOL PRT), and UVC (Theraflex-UV). We review the biology of pathogen inactivation methods, present their efficacy in reducing pathogens, discuss their impact on the functional aspects of treated platelets, and review clinical studies showing the clinical efficiency of the pathogen inactivation methods and their possible toxicity.
Collapse
Affiliation(s)
| | - Giorgia Canellini
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Niels Lion
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Mélanie Abonnenc
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Jean-Claude Osselaer
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Jean-Daniel Tissot
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| |
Collapse
|
26
|
Shams Hakimi C, Hesse C, Wallén H, Boulund F, Grahn A, Jeppsson A. In vitroassessment of platelet concentrates with multiple electrode aggregometry. Platelets 2014; 26:132-7. [DOI: 10.3109/09537104.2014.898141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
27
|
Faraoni D, Savan V, Levy JH, Theusinger OM. Goal-directed coagulation management in the perioperative period of cardiac surgery. J Cardiothorac Vasc Anesth 2013; 27:1347-54. [PMID: 24103717 DOI: 10.1053/j.jvca.2013.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Indexed: 01/15/2023]
Affiliation(s)
- David Faraoni
- Department of Anesthesiology, Queen Fabiola Children's University Hospital (QFCUH), Free University of Brussels, Brussels, Belgium.
| | | | | | | |
Collapse
|
28
|
Watson SP, Lowe GC, Lordkipanidzé M, Morgan NV. Genotyping and phenotyping of platelet function disorders. J Thromb Haemost 2013; 11 Suppl 1:351-63. [PMID: 23516995 DOI: 10.1111/jth.12199] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The majority of patients with platelet function disorders (PFDs) have normal platelet counts and mild day-to-day bleeding symptoms, but are at risk of major hemorrhage at times of trauma, surgery, or childbirth. This group is challenging to investigate, because the assays are often time-intensive and labour-intensive, and interpretation is difficult, especially in patients with mild disorders. In addition, interuser variability in performance of the assays, including the currently accepted gold standard, light transmission aggregometry, makes the results difficult to compare between laboratories. Furthermore, a similar pattern of mucocutaneous bleeding is seen in disorders in other components of the hemostatic pathway, including type 1 von Willebrand disease (VWD). We have undertaken an extensive investigation of patients with clinically diagnosed excessive bleeding, using a genotyping and platelet phenotyping approach based on lumi-aggregometry, and other specialist tests of platelet function, in combination with Sanger and next-generation sequencing (NGS). We found a functional defect in ~ 60% of patients, the majority being associated with feedback pathways of platelet activation. Function-disrupting mutations were identified in known and novel genes, and coinheritance with other genetic disorders of hemostasis, including type 1 VWD, was shown. A significant number of mutations are heterozygous and unlikely to cause extensive bleeding in isolation, consistent with incomplete penetrance of inheritance of bleeding disorders and a multifactorial etiology for excessive bleeding in many patients. Mucocutaneous bleeding is a complex trait, and this has important implications for NGS in the assessment of a PFD.
Collapse
Affiliation(s)
- S P Watson
- Centre for Cardiovascular Sciences, Institute of Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
| | | | | | | |
Collapse
|
29
|
Johnson L, Winter KM, Kwok M, Reid S, Marks DC. Evaluation of the quality of blood components prepared using the Reveos automated blood processing system. Vox Sang 2013; 105:225-35. [DOI: 10.1111/vox.12051] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/05/2013] [Accepted: 04/07/2013] [Indexed: 01/03/2023]
Affiliation(s)
- L. Johnson
- Applied and Developmental Research; Research and Development; Australian Red Cross Blood Service; Sydney; Australia
| | - K. M. Winter
- Applied and Developmental Research; Research and Development; Australian Red Cross Blood Service; Sydney; Australia
| | - M. Kwok
- Applied and Developmental Research; Research and Development; Australian Red Cross Blood Service; Sydney; Australia
| | - S. Reid
- Applied and Developmental Research; Research and Development; Australian Red Cross Blood Service; Sydney; Australia
| | - D. C. Marks
- Applied and Developmental Research; Research and Development; Australian Red Cross Blood Service; Sydney; Australia
| |
Collapse
|
30
|
Laloy J, Mullier F, Alpan L, Mejia J, Lucas S, Chatelain B, Toussaint O, Masereel B, Rolin S, Dogné JM. A comparison of six major platelet functional tests to assess the impact of carbon nanomaterials on platelet function: A practical guide. Nanotoxicology 2013; 8:220-32. [DOI: 10.3109/17435390.2013.788750] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
31
|
E. Kehrel B, F. Brodde M. State of the art in platelet function testing. Transfus Med Hemother 2013; 40:73-86. [PMID: 23653569 PMCID: PMC3638976 DOI: 10.1159/000350469] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/05/2013] [Indexed: 12/20/2022] Open
Abstract
Platelets perform many functions in hemostasis but also in other areas of physiology and pathology. Therefore, it is obvious that many different function tests have been developed, each one conceived and standardized for a special purpose. This review will summarize the different fields in which platelet function testing is currently in use; diagnostics of patients with bleeding disorders, monitoring patients' response to anti-platelet therapy, monitoring in transfusion medicine (blood donors, platelet concentrates, and after transfusion), and monitoring in perioperative medicine to predict bleeding tendency. The second part of the review outlines different methods for platelet function testing, spanning bleeding time, and platelet counting as well as determining platelet adhesion, platelet secretion, platelet aggregation, platelet morphology, platelet signal transduction, platelet procoagulant activity, platelet apoptosis, platelet proteomics, and molecular biology.
Collapse
Affiliation(s)
- Beate E. Kehrel
- Department of Anesthesiology, Intensive Care and Pain Medicine, Experimental and Clinical Hemostasis, University of Münster, Germany
| | - Martin F. Brodde
- Department of Anesthesiology, Intensive Care and Pain Medicine, Experimental and Clinical Hemostasis, University of Münster, Germany
- OxProtect GmbH, Münster, Germany
| |
Collapse
|
32
|
Roest M, van Holten TC, Fleurke GJ, Remijn JA. Platelet Activation Test in Unprocessed Blood (Pac-t-UB) to Monitor Platelet Concentrates and Whole Blood of Thrombocytopenic Patients. ACTA ACUST UNITED AC 2013; 40:117-25. [PMID: 23652405 DOI: 10.1159/000350688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 03/18/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Platelet concentrate transfusion is the standard treatment for hemato-oncology patients to compensate for thrombocytopenia. We have developed a novel platelet activation test in anticoagulated unprocessed blood (pac-t-UB) to determine platelet function in platelet concentrates and in blood of thrombocytopenic patients. METHODS We have measured platelet activity in a platelet concentrate and in anticoagulated unprocessed blood of a post-transfusion thrombocytopenic patient. RESULTS Our data show time-dependent platelet activation by GPVI agonist (collagen related peptide; CRP), PAR-1 agonist (SFLLRN), P2Y12 agonist (ADP), and thromboxane receptor agonist (U46619) in a platelet concentrate. Furthermore, pac-t-UB showed time-dependent platelet activation in unprocessed blood of a post-transfusion patient with thrombocytopenia. Testing platelet function by different agonists in relation to storage show that 3-day-old platelet concentrates are still reactive to the studied agonists. This reactivity rapidly drops for each agonists during longer storage. DISCUSSION Pac-t-UB is a novel tool to estimate platelet function by different agonists in platelet concentrates and in unprocessed blood of thrombocytopenic patients. In the near future, we will validate whether pac-t-UB is an adequate test to monitor the quality of platelet concentrates and whether pac-t-UB predicts the bleeding risk of transfused thrombocytopenic patients.
Collapse
Affiliation(s)
- Mark Roest
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Apeldoorn, The Netherlands
| | | | | | | |
Collapse
|
33
|
Neumüller J, Meisslitzer-Ruppitsch C, Ellinger A, Pavelka M, Jungbauer C, Renz R, Leitner G, Wagner T. Monitoring of platelet activation in platelet concentrates using transmission electron microscopy. ACTA ACUST UNITED AC 2013; 40:101-7. [PMID: 23652838 DOI: 10.1159/000350034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 01/18/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The quality of platelet concentrates (PC) is important for the in vivo recovery of thrombostasis in patients suffering from bleeding disorders and in tumor patients after chemotherapy. In this respect, activated platelets (PLT) cannot display their full functionality in the recipient and even can cause adverse effects. Therefore, we developed a transmission electron microscopy (TEM) method for quality assessment of PC. METHODS Score values taken from panorama TEM images describe the progress of PLT activation. To exemplify this method, i) 19 apheresis PC isolated with the Baxter Amicus system (BA) were compared with 14 PC obtained from pooled buffy coats (BC). ii) The score values of 33 PC derived from BA as well from BC were compared with flow-cytometric CD62P determinations by cross correlation. iii) Changes in the score value profiles during storage of a single pathogen-reduced BA PC were monitored over a period of 7 days. RESULTS The TEM evaluation described allows for demonstrating particular PLT activation stages. i) Significant differences between the percentages of the score values 0, 1 and 2 could be demonstrated in both processing groups. No significant differences were found comparing these two groups. ii) A weak correlation could be shown when comparing the percentages of score values 2 plus 3 with the percentage of CD62P-positive PLT. iii) The pathogen reduction affected slightly the score profiles during storage due to an increase of dead PLT. CONCLUSION Our investigations demonstrate the unique detailed quality information of PC obtained by the TEM method. This method can be performed in every routine electron microscopy laboratory.
Collapse
Affiliation(s)
- Josef Neumüller
- Medical University of Vienna, Center for Anatomy and Cell Biology, Department of Cell Biology and Ultrastructure Research, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Platelet Transfusion Medicine. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
35
|
Middelburg RA, Roest M, Ham J, Coccoris M, Zwaginga JJ, van der Meer PF. Flow cytometric assessment of agonist-induced P-selectin expression as a measure of platelet quality in stored platelet concentrates. Transfusion 2012; 53:1780-7. [PMID: 23216254 DOI: 10.1111/trf.12001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/24/2012] [Accepted: 09/25/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Platelet (PLT) function in PLT concentrates declines during storage and is further affected by pathogen reduction treatment. Flow cytometric assessment of agonist-induced P-selectin expression can be used to assess PLT function in patients with thrombocytopenia. The aim of this study was to evaluate how this functional test relates to established in vitro measures of PLT function. STUDY DESIGN AND METHODS Six units of PLTs in plasma and 6 units of riboflavin and ultraviolet (Mirasol, TerumoBCT)-treated PLTs in plasma were sampled on Days 2, 6, 8, and 10 after donation. PLT concentration, Annexin 5A staining, ThromboLUX (LightIntegra) thrombelastography, and P-selectin expression, both in unstimulated PLTs and in response to concentration series of adenosine diphosphate, collagen-related peptide, and thrombin receptor-activating peptide (TRAP), were measured. RESULTS For PLTs in plasma Annexin 5A expression increased by 0.60% (95% confidence interval [CI], 0.40%-0.80%) and P-selectin expression increased by 1.2% (95% CI, 0.80%-1.6%) per day. Responsiveness to TRAP simultaneously decreased by 1.3% (95% CI, 0.80%-1.8%) per day. After Mirasol treatment ThromboLUX scores decreased 3.3 points (95% CI, 0.2-6.4 points) from 22 to 19 points, Annexin 5A expression increased by 4.8% (95% CI, 3.3%-6.2%), and P-selectin expression increased by 13% (95% CI, 10%-16%), all averaged over the entire storage period. Responsiveness to TRAP simultaneously decreased by 19% (95% CI, 17%-21%). CONCLUSIONS Our results suggest flow cytometric measurement of agonist-induced P-selectin expression can measure PLT quality decline over the entire range encountered during 10-day storage of both standard PLTs and Mirasol-treated PLTs in plasma.
Collapse
Affiliation(s)
- Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, The Netherlands.
| | | | | | | | | | | |
Collapse
|
36
|
Thiele T, Iuga C, Janetzky S, Schwertz H, Gesell Salazar M, Fürll B, Völker U, Greinacher A, Steil L. Early storage lesions in apheresis platelets are induced by the activation of the integrin αIIbβ₃ and focal adhesion signaling pathways. J Proteomics 2012; 76 Spec No.:297-315. [PMID: 22634086 DOI: 10.1016/j.jprot.2012.04.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/25/2012] [Accepted: 04/26/2012] [Indexed: 12/22/2022]
Abstract
Production and storage of platelet concentrates (PC) induce protein changes in platelets leading to impaired platelet function. This study aimed to identify signaling pathways involved in the development of early platelet storage lesions in apheresis-PCs stored in plasma or additive solution (PAS). Apheresis-PCs from four donors were stored in plasma or in PAS at 22°C (n=4 each). Platelets were analyzed at day 0 (production day) and after 1, 6 and 9 days of storage. Platelet response to agonists (TRAP, collagen, ADP) and to hypotonic shock decreased, CD62P expression increased in both storage media over time. Using DIGE 1550 protein spots were monitored and compared to baseline values at day 0. Platelets in plasma displayed changes in 352 spots (166/day 1, 263/day 6 and 201/day 9); in PAS 325 spots changed (202/day 1, 221/day 6, 200/day 9). LC-ESI-MS/MS analysis of 405 platelet proteins revealed 32 proteins changed during storage in plasma (9/day 1, 15/day 6 and 26/day 9) and 28 in PAS (5/day 1, 20/day 6, 26/day 9). Ingenuity pathway analysis found integrin-αII(b)β(3) and focal adhesion signaling pathways involved in early alterations, being confirmed by Western blotting. Corresponding mRNAs in platelets were identified by next generation sequencing for 84 changed proteins. Integrin-αII(b)β(3) and focal adhesion signaling cause irreversible early storage lesions in apheresis platelets. This article is part of a Special Issue entitled: Integrated omics.
Collapse
Affiliation(s)
- Thomas Thiele
- Institut für Immunologie und Transfusionsmedizin, Universitätsmedizin Greifswald, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
PURPOSE OF REVIEW Coagulation management remains a challenge for anesthesiologists involved in cardiovascular surgery as the population undergoing surgery becomes older and presents with more comorbidities. These patients are frequently treated with one or more agents that directly affect coagulation. This review will discuss what is known and the treatments available to manage coagulation in the perioperative setting of cardiac surgery. RECENT FINDINGS New antithrombotics will be discussed as well as their proposed substitution in the preoperative period. The review will also describe the different products available in Europe for the treatment of bleeding and coagulopathy. Finally, the use of new monitoring devices will be discussed. SUMMARY The introduction of new drugs with different mechanisms of action adds to the complexity of coagulation management during cardiovascular surgery. Monitoring needs to be developed and improved, especially for evaluating platelet function.
Collapse
|
38
|
Brown TM, Horblyuk RV, Grotzinger KM, Matzdorff AC, Pashos CL. Patient-reported treatment burden of chronic immune thrombocytopenia therapies. BMC BLOOD DISORDERS 2012; 12:2. [PMID: 22436142 PMCID: PMC3350461 DOI: 10.1186/1471-2326-12-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 03/22/2012] [Indexed: 01/06/2023]
Abstract
Background Chronic immune thrombocytopenia (ITP) is a debilitating autoimmune disorder that causes a reduction in blood platelets and increased risk of bleeding. ITP is currently managed with various pharmacologic therapies and splenectomy. This study was conducted to assess patient perceived and reported treatment side effects, as well as the perceived burden or bother, and need to reduce or stop treatment, associated with these side effects among adult patients with chronic ITP. Methods A Web-enabled survey was administered to members of a US-based ITP patient support group. Patients reported demographic and clinical characteristics, ITP treatments' side effects for treatments received since diagnosed, level of bother (or distress), and need to reduce or stop treatment, associated with side effects. Current and past exposure was assessed for five specific treatment types: corticosteroids (CS), intravenous immunoglobulin (IVIg), anti-D immunoglobulin (anti-D), rituximab (RT), and splenectomy (SPL), as well as for other patient-referenced therapies (captured as "other"). Results The survey was completed by 589 patients; 78% female, 89% white, mean age 48 years (SD = 14.71), and 68% reported a typical low platelet count of < 50,000/μL. Current or past treatment with CS was reported by 92% (n = 542) of patients, 56% (n = 322) for IVIg, 36% (n = 209) for anti-D, 36% (n = 213) for RT, and 39% (n = 227) for SPL. A substantial proportion of CS-treated patients reported side effects (98%, P < 0.05), were highly bothered by their side effects (53.1%, P < 0.05), and reported the need to stop or reduce treatment due to side effects (37.8%, P < 0.05). Among patients reporting side effects of treatment, significant associations were noted for the number of side effects, aggregate bother of reported side effects, and the need to stop or reduce treatment (all P < 0.05). Conclusions Current ITP treatments, particularly corticosteroids, are associated with multiple bothersome side effects that may lead to patients stopping or reducing therapy. Open, informed and complete communication between clinician and patient regarding both the benefits and the side effects of ITP treatment may better prepare patients for their prescribed regimens.
Collapse
Affiliation(s)
| | | | | | - Axel C Matzdorff
- Department of Hematology and Oncology, Caritasklinikum Saarbruecken, St. Theresia, Saarbruecken, Germany
| | | |
Collapse
|
39
|
[Current coagulation diagnostics in intensive care medicine]. Med Klin Intensivmed Notfmed 2011; 106:171-6. [PMID: 22068755 DOI: 10.1007/s00063-011-0018-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Accepted: 09/12/2011] [Indexed: 10/15/2022]
Abstract
In the preoperative setting, a standardized questionnaire on bleeding history cannot be replaced by the Quick test or activated partial thromboplastin time (APTT) measurement. Thrombelastometry provides rapid measurement of coagulation in the intra- and postoperative settings. Besides the Quick test and APTT, thrombelastometry provides information about clot firmness and clot stability. This allows goal-directed management in coagulopathy, which results in a reduction of transfusion of blood products. Furthermore, this can lead to not only an overall reduced length of stay in the hospital, but also in the intensive care unit, thus, contributing to a significant cost reduction.
Collapse
|
40
|
Jilma-Stohlawetz P, Eichelberger B, List J, Jilma B, Panzer S, Leitner G. The effect of plasma removal from apheresis platelet concentrates on platelet function. Vox Sang 2011; 102:258-60. [PMID: 21923859 DOI: 10.1111/j.1423-0410.2011.01548.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effect of plasma removal on platelet function has scarcely been investigated. Plasma removal from apheresis platelet concentrates was achieved by centrifugation at 5000 g for 6 min or 2000 g for 10 min. After resting for 1 h, platelet concentrates were resuspended in 0·9% NaCl. Platelet function was tested before centrifugation and after resuspension by multiple electrode impedance aggregometry (MEA) and light transmission aggregometry (LTA). Plasma removal resulted in 10-14% lower response to TRAP-6 by MEA using both washing procedures, whereas TRAP-6-inducible aggregation by LTA increased slightly (2-5%). Neither plasma removal method affected collagen-induced aggregation. Thus, platelet function did not deteriorate significantly by either method.
Collapse
Affiliation(s)
- P Jilma-Stohlawetz
- Clinical Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
*Romiplostim is an Fc-peptide fusion protein (or 'peptibody') that stimulates megakaryopoiesis and thrombopoiesis by binding to, and activating, the thrombopoietin receptor. *Because it has no sequence homology to thrombopoietin, romiplostim theoretically avoids the risk of eliciting cross-reacting, neutralizing antibodies to thrombopoietin. *In well designed, 24-week, phase III trials, subcutaneous romiplostim was significantly more effective than placebo in achieving the primary endpoint of a protocol-defined durable platelet response in nonsplenectomized (61% vs 5%) or splenectomized (38% vs 0%) adults with chronic immune (idiopathic) thrombocytopenic purpura (ITP). *Romiplostim was also significantly more effective than placebo with regard to a number of secondary endpoints, including the proportions of patients with an overall (durable plus transient) platelet response or who required ITP rescue medications. The majority of romiplostim-treated patients receiving concurrent ITP drugs were able to reduce or discontinue these therapies. *Platelet response was maintained by most patients during longer-term treatment with romiplostim for up to 3 or 4 years in an open-label extension study. *Romiplostim was generally well tolerated. Almost all adverse events in the phase III studies were of mild-to-moderate intensity; most were unrelated to treatment. Longer-term treatment with romiplostim had an adverse event profile consistent with that observed in the phase III studies.
Collapse
|
42
|
Lohoff FW, Weller AE, Bloch PJ, Buono RJ, Doyle GA, Ferraro TN, Berrettini WH. Association between polymorphisms in the vesicular monoamine transporter 1 gene (VMAT1/SLC18A1) on chromosome 8p and schizophrenia. Neuropsychobiology 2008; 57:55-60. [PMID: 18451639 DOI: 10.1159/000129668] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 02/02/2008] [Indexed: 11/19/2022]
Abstract
Linkage studies have suggested a susceptibility locus for schizophrenia (SZ) exists on chromosome 8p21-22. The vesicular monoamine transporter 1 gene (VMAT1), also known as SLC18A1, maps to this SZ susceptibility locus. Vesicular monoamine transporters are involved in the presynaptic vesicular packaging of monoamine neurotransmitters, which have been postulated to play a role in the etiology of SZ. Variations in the VMAT1 gene might affect transporter function and/or expression, and might be involved in the etiology of SZ. Genotypes of 62 patients with SZ and 188 control subjects were obtained for 4 missense single nucleotide polymorphisms (Thr4Pro, Thr98Ser, Thr136Ile, Val392Leu) and 2 noncoding single nucleotide polymorphisms (rs988713, rs2279709). All cases and controls were of European descent. The frequency of the minor allele of the Thr4Pro polymorphism was significantly increased in SZ patients when compared to controls (p = 0.0140; d.f. = 1; OR = 1.69; 95% CI = 1.11-2.57). Assuming a recessive mode of inheritance, the frequency of homozygote 4Pro carriers was significantly increased in the SZ patients when compared to controls (24 vs. 8%, respectively; p = 0.0006; d.f. = 1; OR = 3.74; 95% CI = 1.703-8.21). Haplotype analysis showed nominal significance for an individual risk haplotype (p = 0.013); however, after permutation correction, the global p value did not attain a statistically significant level (p = 0.07). Results suggest that variations in the VMAT1 gene may confer susceptibility to SZ in patients of European descent. Further studies are necessary to confirm this effect, and to elucidate the role of VMAT1 in central nervous system physiology and possible involvement in the genetic origins of SZ.
Collapse
Affiliation(s)
- Falk W Lohoff
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | |
Collapse
|