Storage of platelets in a novel additive solution (M-sol), which is prepared by mixing solutions approved for clinical use that are not especially for platelet storage

Improvement of platelet preservation by inhibition of TRPC6

BACKGROUND

The preservation of platelets (PLTs) by room temperature (RT) oscillation limits their shelf life to between 4 and 7 days because of the decrease in PLT function. TRPC6 is a non-selective mechanically sensitive cation channel that has been shown to mediate Ca²⁺ signalling, implying a role in PLT activation during preservation by RT oscillation.

OBJECTIVES

This study was designed to investigate whether inhibition of TRPC6 can improve the RT preservation of PLTs and the possible underlying mechanism.

METHODS

Human PLTs from whole blood were stored at 22 ± 2°C with oscillation in plasma or M-sol (mixture of solutions). BI-749327, a specific TRPC6 inhibitor, was administered throughout the preservation period. PLT distribution width (PDW), mean platelet volume (MPV), maximum platelet aggregation rate (MAR) and average aggregation rate (AAR) were measured. The MTT method was used to assess the relative viability of PLTs. Flow cytometry was used to measure the changes of Ca²⁺ concentration in PLTs and phosphatidylserine (PS) exposure on the PLT surface, and western blotting was used to assess the expression changes of platelet TRPC6 and CD62P proteins.

RESULTS

Compared with the control group, inhibition of TRPC6 with BI-749327 significantly reduced the PDW, MPV and Ca²⁺ concentration, the MAR and AAR were significantly increased, the expression of TRPC6 and CD62P protein was significantly down-regulated in PLTs, and the PS exposure was significantly reduced on the PLT surface. However, these effects were all reversed by activation of TRPC6.

CONCLUSION

Inhibition of TRPC6 improves the quality of PLT preservation by inhibiting the Ca²⁺ signal mediated by TRPC6.

Platelet storage: Progress so far

There is a crucial need for platelet transfusion during an emergency-surgery and treatment of platelet disorders. The unavailability of donors has furthermore increased the demand for platelet storage. Platelets have limited shelf life due to bacterial contamination and storage lesions. Temperature, materials, oxygen availability, media, platelet processing and manufacturing methods influence the platelet quality and viability during storage. The conception of various platelet additive solutions along with the advent of plastic storage during the 1980s led to enormous developments in platelet storage strategies. Cold storage of platelets gained attention despite its inability to contribute to platelet survival post-transfusion as it offers faster haemostasis. Several developments in platelet storage strategies over the years have improved the quality and shelf-life of stored platelets. Despite the progress, the efficacy of platelets during storage beyond a week has not been achieved. Antioxidants as additives have been explored in platelet storage and have proven to enhance the efficacy of platelets during prolonged storage. However, the molecular interactions of antioxidants in platelets can provide a better understanding of their mechanism of action. Optimization of dosage concentrations of antioxidants is also a critical parameter to be considered as they tend to exhibit toxicity at certain levels. This review provides comprehensive insights into the critical factors affecting platelet storage and the evolution of platelet storage. It also emphasizes the role of antioxidants as additives in platelet storage solutions and their future prospects towards better platelet banking.

Preventing adverse reactions in pediatric transfusions using washed platelet concentrate

Blood transfusion is an important form of supportive care in children; however, transfusion-associated adverse reactions (TARs) are a problem. As with adults, allergic transfusion reactions (ATRs) and febrile non-hemolytic transfusion reactions (FNHTRs) are major TARs, and the frequency of ATRs caused by platelet concentrate (PC) tends to be particularly high. The plasma component of the blood product is thought to be a major factor in the onset of TARs such as ATR and FNHTR. By contrast, in children, age, underlying disease, and number of blood transfusions may be relevant patient-related factors. Although acetaminophen or diphenhydramine may be used prophylactically to prevent TARs, there is no clear evidence of their effectiveness. Volume-reduced PC is used to prevent TARs; however, it may be difficult to maintain the quality of platelets. Plasma-replaced PC stored with platelet additive solution raises the concern that TARs cannot be completely prevented by residual plasma. Washed PC removes most of the plasma, so it can effectively prevent ATR and FNHTR. The recent development of platelet additive solution [M-sol, bicarbonate Ringer's solution supplemented with acid-citrate-dextrose formula A (BRS-A)] in Japan has enabled the maintenance of the quality of platelets for long periods. The clinical use of washed PC in Japan has therefore progressed. Washed PC with M-sol or BRS-A for pediatric patients can effectively prevent TARs without diminishing the transfusion effect. The supply of washed PC has begun from the Japanese Red Cross Society, and it has become possible to use washed PC at all medical institutions in Japan.

Transfusion outcome for volume- and plasma-reduced platelet concentrates for pediatric patients

BACKGROUND AND OBJECTIVES

Plasma reduction in platelet concentrate (PC) products has been reported to prevent large volume load and transfusion-related adverse reactions (TRARs). However, volume reduction might be associated with a poor transfusion response because of a deterioration in platelet (PLT) quality. Because PLT quality control and transfusion responses for recently washed PCs using PLT additive solutions are superior, we investigated the clinical safety and transfusion efficacy of volume-reduced washed PCs in pediatric patients.

MATERIALS AND METHODS

We prepared a simplified resuspended PC product (RPC) as a washed PC. Regular RPC (R-RPC) included equivalent volumes of bicarbonate Ringer's solution and anticoagulant citrate dextrose solution A (BRS-A) as the resuspension solution. Half RPC (H-RPC) was prepared by adding a half volume of BRS-A. Twenty-four pediatric patients were scheduled for transfusions with R-RPC and H-RPC up to 4 times. R-RPC was transfused 42 times into 24 patients. H-RPC was transfused 41 times into 23 patients.

RESULTS

Neither product was observed to cause TRARs. Although the calculated PLT recovery for H-RPC was significantly reduced, the posttransfusion corrected count increment (24 h) did not differ. Moreover, similar results were observed for vital signs during transfusion.

CONCLUSION

Volume-reduced washed PC can be transfused without causing TRARs, differences in vital signs, or inferior transfusion responses. Volume-reduced washed PC also provides the advantages of shortened transfusion times and reduced volume loads. Although a standard technique for stable resuspension is necessary, volume-reduced washed PC may be a beneficial option for children, including neonates, or individuals with cardiovascular or renal problems.

Evaluation of in vitro storage properties of apheresis platelets suspended in a bicarbonate-containing additive solution with low levels of plasma and stored with a 24-hour interruption of agitation

BACKGROUND AND OBJECTIVES

PLT additive solutions (PAS) are useful for reducing the frequency and/or severity of plasma-associated transfusion reactions. A new PAS solution, PAS-5, containing 5% plasma, maintains in vitro PLT properties during 7-day storage. Periods with interruption of agitation (IA) ≤24 h routinely occur during PLT shipment and do not usually compromise platelet quality. The aim of the study was to evaluate the properties of PLTs stored for 7 days in 95% PAS-5/5% plasma subjected to a 24-h IA.

MATERIALS AND METHODS

Double apheresis Amicus units (n = 12) were collected using a manual PAS-5 addition to hyperconcentrated PLTs. PLT units were equally divided in two containers. Control and test PLTs were stored with continuous agitation at 20-24°C except for 24-h IA period for test units between days 2-3.

RESULTS

During storage, levels of glucose, lactate, mitochondrial membrane potential and aggregation significantly differed in test units compared to those of control. The pH levels of test PLTs were less than those of control units with 7/12 test units having pHs <6·2 on Day 7 compared to 1/12 control units. Morphology score, GP1bα expression, ESC values, superoxide production were also less, and activation was greater in test PLTs than those of control. All other parameters were similar between test and control units.

CONCLUSION

PLTs stored in PAS-5 solution containing 5% plasma with a 24-h IA results in marked decrements in many in vitro PLT quality parameters during 7-day storage.

Current understanding of allergic transfusion reactions: incidence, pathogenesis, laboratory tests, prevention and treatment

Non-haemolytic transfusion reactions are the most common type of transfusion reaction and include transfusion-related acute lung injury, transfusion-associated circulatory overload, allergic reactions, febrile reactions, post-transfusion purpura and graft-versus- host disease. Although life-threatening anaphylaxis occurs rarely, allergic reactions occur most frequently. If possible, even mild transfusion reactions should be avoided because they add to patients' existing suffering. During the last decade, several new discoveries have been made in the field of allergic diseases and transfusion medicine. First, mast cells are not the only cells that are key players in allergic diseases, particularly in the murine immune system. Second, it has been suggested that immunologically active undigested or digested food allergens in a donor's blood may be transferred to a recipient who is allergic to these antigens, causing anaphylaxis. Third, washed platelets have been shown to be effective for preventing allergic transfusion reactions, although substantial numbers of platelets are lost during washing procedures, and platelet recovery after transfusion may not be equivalent to that with unwashed platelets. This review describes allergic transfusion reactions, including the above-mentioned points, and focusses on their incidence, pathogenesis, laboratory tests, prevention and treatment.

Current status of additive solutions for platelets

The storage of platelets in additive solution (PAS) had lagged behind red cell concentrates, especially in North America. The partial or complete removal of anticoagulated plasma and storage of platelet concentrates in AS presents many advantages. The PAS can be formulated to optimize aerobic metabolism or decrease platelet activation, thus abrogating the platelet storage lesion and potentially improving in vivo viability. Plasma removal has been shown to reduce allergic reactions and the plasma harvested could contribute to the available plasma pool for transfusion or fractionation. PAS coupled to pathogen reduction technology results in a platelet product of equivalent hemostatic efficacy to conventionally stored platelets. Given the above, the likely future direction of platelet storage will be in new generation designer PAS with an extended shelf life and a superior safety profile to plasma stored platelets. J. Clin. Apheresis, 2012. © 2012 Wiley Periodicals, Inc.

In vitro variables of apheresis platelets are stably maintained for 7 days with 5% residual plasma in a glucose and bicarbonate salt solution, PAS-5

BACKGROUND

Platelet additive solutions (PASs) facilitate improved recovery of plasma and may reduce the severity and/or frequency of plasma-associated transfusion reactions. Current apheresis platelet (PLT) PAS products contain approximately 30 to 40% residual plasma. In an effort to further decrease the residual plasma, two in vitro studies were conducted with PLTs suspended in 5% plasma and a reformulated PAS-3, named PAS-5, that contains additional salts, glucose, and bicarbonate.

STUDY DESIGN AND METHODS

In Study 1, PLTs suspended in 5% plasma/95% PAS-5 were prepared directly on a separator (Amicus, Fenwal, Inc.) without additional centrifugation or washing. In Study 2, a double unit of hyperconcentrated Amicus PLTs in plasma was collected, divided, and centrifuged to prepare a control unit in 100% plasma and a paired test unit in 5% plasma/95% PAS-5. The in vitro properties of PLTs were assessed in both studies during 7-day storage at 20 to 24°C with continuous agitation.

RESULTS

In Study 1, PLT concentration, pH, mean PLT volume (MPV), HCO(3)(-), pCO(2), pO(2), lactate dehydrogenase, and hypotonic shock response (HSR) did not significantly change during storage. By Day 7, glucose levels and morphology scores modestly decreased (17.6 and 14.4%, respectively) and lactate levels modestly increased (to 7.2 mmol/L). In Study 2, MPV, pH, glucose, pO(2), HSR, and morphology were comparable in control and test PLTs during 7-day storage. Glucose consumption and lactate production were significantly less in test versus control PLTs (p≤0.0015). Extent of shape change and %CD62P-positive test PLTs were less than those of controls (p<0.001).

CONCLUSION

Apheresis PLTs suspended in 5% plasma/95% PAS-5 maintained in vitro properties during 7-day storage.

Overview on platelet preservation: better controls over storage lesion

Platelet storage lesion (PSL), correlating with reduced in vivo recovery/survival and hemostatic capacity after transfusion, is characterized essentially by morphological and molecular evidence of platelet activation and energy consumption in the medium. Processes that limit shelf-life are multifactorial, and include both necrosis and apoptosis. PSL is greatly influenced by factors including duration of storage, temperature, ratio of platelet number to media volume, solution composition with respect to energy content and buffering capacity, and gas permeability of the container. Recent progress for slowing PSL has been made with storage media that more effectively fuel ATP production and buffer the inevitable effects of metabolism. Improved oxygen-permeability of containers also helps to maintain aerobic-dominant glycolysis. Patients stand to benefit from platelet products of higher intrinsic quality that store well until the moment of transfusion.

Platelet additive solution - electrolytes

Recent attention to solutions that replace most or all plasma in platelet concentrates, while maintaining satisfactory platelet function, is motivated by the potential of plasma reduction or depletion to mitigate various transfusion-related adverse events. This report considers the electrolytic composition of previously described platelet additive solutions, in order to draw general conclusions about what is required for platelet function and longevity. The optimal concentrations of Na(+) and Cl(-) are 69-115 mM. The presence of both K(+) and Mg(2+) in platelet suspension at nearly physiological concentrations (3-5mM and 1.5-3mM, respectively) is indispensable for good preservation capacity because both electrolytes are required to prevent platelet activation. In contrast to K(+) and Mg(2+), Ca(2+) may not be important because no free Ca(2+) is available in M-sol, which showed excellent platelet preservation capacity at less than 5% plasma concentration. The importance of bicarbonate (approximately 40 mM) can be recognized when the platelets are suspended in additive solution under less than 5% residual plasma concentration.

Cryopreservation of buffy-coat-derived platelet concentrates in dimethyl sulfoxide and platelet additive solution

Platelets prepared in plasma can be frozen in 6% dimethyl sulfoxide (Me(2)SO) and stored for extended periods at -80°C. The aim of this study was to reduce the plasma present in the cryopreserved product, by substituting plasma with platelet additive solution (PAS; SSP+), whilst maintaining in vitro platelet quality. Buffy coat-derived pooled leukoreduced platelet concentrates were frozen in a mixture of SSP+, plasma and 6% Me(2)SO. The platelets were concentrated, to avoid post-thaw washing, and frozen at -80°C. The cryopreserved platelet units (n=9) were rapidly thawed at 37°C, reconstituted in 50% SSP+/plasma and stored at 22°C. Platelet recovery and quality were examined 1 and 24h post-thaw and compared to the pre-freeze samples. Upon thawing, platelet recovery ranged from 60% to 80%. However, there were differences between frozen and liquid-stored platelets, including a reduction in aggregation in response to ADP and collagen; increased CD62P expression; decreased viability; increased apoptosis and some loss of mitochondrial membrane integrity. Some recovery of these parameters was detected at 24h post-thaw, indicating an extended shelf-life may be possible. The data suggests that freezing platelets in 6% Me(2)SO and additive solution produces acceptable in vitro platelet quality.