1
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Bontekoe IJ, van der Meer PF, Tanis BC, de Korte D, Verhoeven AJ, Raat NJH, Specht PAC, Mik EG, Klei TRL. Donor variation in stored platelets: Higher metabolic rates of platelets are associated with mean platelet volume, activation and donor health. Transfusion 2022; 62:2609-2620. [PMID: 36278429 DOI: 10.1111/trf.17160] [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: 06/09/2022] [Revised: 08/16/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Platelets (PLTs) differ in glycolytic activity, resulting in rapid acidification of 'poor' storing PLT concentrates (PCs) in plasma, or depletion of glucose when stored in PLT additive solution (PAS). We aimed to understand why PLT glycolysis rates vary between donors and how this affects storage performance. STUDY DESIGN AND METHODS Buffy coats from donors <45, 45-70 and >70 years were selected and single-donor PCs in plasma or PAS-E were prepared. PCs were stored for 8 days at 22 ± 2°C and sampled regularly for analysis. Mitochondrial activity was analyzed with an Oroboros oxygraph. Age groups, or subgroups divided into quartiles based on glucose consumption, were analyzed with ANOVA. RESULTS In each comparison, PCs of the different groups were not different in volume and cellular composition. PLTs with the highest glucose consumption had a higher initial mean platelet volume (MPV) and developed higher CD62P expression and Annexin A5 binding during storage. Higher glycolytic activity in these PLTs was not a compensation for lower mitochondrial ATP production, because mitochondrial ATP-linked respiration of fresh PLTs correlated positively with MPV (R2 = 0.71). Donors of high glucose-consuming PLTs had more health-related issues. Storage properties of PCs from donors over 70 were not significantly different compared to PCs from donors younger than 45 years. CONCLUSIONS High glucose-consuming PCs developing higher activation levels, not only displayed enhanced mitochondrial activity but were also found to contain larger PLTs, as determined by MPV. Storage performance of PLTs was found to be associated with donor health, but not with donor age.
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Affiliation(s)
- Ido J Bontekoe
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Pieter F van der Meer
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands.,Department of Hematology, Haga Teaching Hospital, the Hague, the Netherlands
| | - Bea C Tanis
- Department of Medical Donor Affairs, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Dirk de Korte
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands.,Department Blood Cell Research, Sanquin Research, Amsterdam, the Netherlands
| | - Arthur J Verhoeven
- Tytgat Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Nicolaas J H Raat
- Department of Anesthesiology, Laboratory of Experimental Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Patricia A C Specht
- Department of Anesthesiology, Laboratory of Experimental Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Egbert G Mik
- Department of Anesthesiology, Laboratory of Experimental Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Thomas R L Klei
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands
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2
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Hegde S, Zheng Y, Cancelas JA. Novel blood derived hemostatic agents for bleeding therapy and prophylaxis. Curr Opin Hematol 2022; 29:281-289. [PMID: 35942861 PMCID: PMC9547927 DOI: 10.1097/moh.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Hemorrhage is a major cause of preventable death in trauma and cancer. Trauma induced coagulopathy and cancer-associated endotheliopathy remain major therapeutic challenges. Early, aggressive administration of blood-derived products with hypothesized increased clotting potency has been proposed. A series of early- and late-phase clinical trials testing the safety and/or efficacy of lyophilized plasma and new forms of platelet products in humans have provided light on the future of alternative blood component therapies. This review intends to contextualize and provide a critical review of the information provided by these trials. RECENT FINDINGS The beneficial effect of existing freeze-dried plasma products may not be as high as initially anticipated when tested in randomized, multicenter clinical trials. A next-generation freeze dried plasma product has shown safety in an early phase clinical trial and other freeze-dried plasma and spray-dried plasma with promising preclinical profiles are embarking in first-in-human trials. New platelet additive solutions and forms of cryopreservation or lyophilization of platelets with long-term shelf-life have demonstrated feasibility and logistical advantages. SUMMARY Recent trials have confirmed logistical advantages of modified plasma and platelet products in the treatment or prophylaxis of bleeding. However, their postulated increased potency profile remains unconfirmed.
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Affiliation(s)
- Shailaja Hegde
- Hoxworth Blood Center, University of Cincinnati Academic Health Center
| | - Yi Zheng
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jose A Cancelas
- Hoxworth Blood Center, University of Cincinnati Academic Health Center
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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3
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Cancelas JA, Genthe JR, Stolla M, Rugg N, Bailey SL, Nestheide S, Shaz B, Mack S, Schroeder K, Anani W, Szczepiorkowski ZM, Dumont LJ, Yegneswaran S, Corash L, Mufti N, Benjamin RJ, Erickson AC. Evaluation of amotosalen and UVA pathogen-reduced apheresis platelets after 7-day storage. Transfusion 2022; 62:1619-1629. [PMID: 35808974 PMCID: PMC9546462 DOI: 10.1111/trf.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Amotosalen/UVA pathogen-reduced platelet components (PRPCs) with storage up to 7 days are standard of care in France, Switzerland, and Austria. PRPCs provide effective hemostasis with reduced risk of transfusion-transmitted infections and transfusion-associated graft versus host disease, reduced wastage and improved availability compared with 5-day-stored PCs. This study evaluated the potency of 7-day PRPCs by in vitro characterization and in vivo pharmacokinetic analysis of autologous PCs. STUDY DESIGN AND METHODS The in vitro characteristics of 7-day-stored apheresis PRPCs suspended in 100% plasma or 65% platelet additive solution (PAS-3)/35% plasma, thrombin generation, and in vivo radiolabeled post-transfusion recovery and survival of 7-day-stored PRPCs suspended in 100% plasma were compared with either 7-day-stored or fresh autologous conventional platelets. RESULTS PRPCs after 7 days of storage maintained pH, platelet dose, in vitro physiologic characteristics, and thrombin generation when compared to conventional 7-day PCs. In vivo, the mean post-transfusion survival was 151.4 ± 20.1 h for 7-day PRPCs in 100% plasma (Test) versus 209.6 ± 13.9 h for the fresh autologous platelets (Control), (T-ΔC: 72.3 ± 8.8%: 95% confidence interval [CI]: 68.5, 76.1) and mean 24-h post-transfusion recovery 37.6 ± 8.4% for Test versus 56.8 ± 9.2% for Control (T-ΔC: 66.2 ± 11.2%; 95% CI: 61.3, 71.1). DISCUSSION PRPCs collected in both 100% plasma as well as 65% PAS-3/35% plasma and stored for 7 days retained in vitro physiologic characteristics. PRPCs stored in 100% plasma for 7 days retained in vivo survival. Lower in vivo post-radiolabeled autologous platelet recovery is consistent with reported reduced count increments for allogenic transfusion.
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Affiliation(s)
| | | | - Moritz Stolla
- Bloodworks Northwest, Seattle, Washington, USA.,Division of Hematology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Neeta Rugg
- Hoxworth Blood Center, Cincinnati, Ohio, USA
| | | | | | - Beth Shaz
- Duke University, Durham, North Carolina, USA
| | | | | | | | - Zbigniew M Szczepiorkowski
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | | | - Nina Mufti
- Cerus Corporation, Concord, California, USA
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4
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Hegde S, Wellendorf AM, Zheng Y, Cancelas JA. Antioxidant prevents clearance of hemostatically competent platelets after long-term cold storage. Transfusion 2020; 61:557-567. [PMID: 33247486 DOI: 10.1111/trf.16200] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/27/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cold storage of platelets (PLTs) has the potential advantage of prolonging storage time while reducing posttransfusion infection given the decreased likelihood of bacterial outgrowth during storage and possibly beneficial effects in treating bleeding patients. However, cold storage reduces PLT survival through the induction of complex storage lesions, which are more accentuated when storage is prolonged. STUDY DESIGN AND METHODS Whole blood-derived PLT-rich plasma concentrates from seven PLT pools (n = 5 donors per pool). PLT additive solution was added (67%/33% plasma) and the product was split into 50-mL bags. Split units were stored in the presence or absence of 1 mM of N-acetylcysteine (NAC) under agitation for up to 14 days at room temperature or in the cold and were analyzed for PLT activation, fibrinogen-dependent spreading, microparticle formation, mitochondrial respiratory activity, reactive oxygen species (ROS) generation, as well as in vivo survival and bleeding time correction in immunodeficient mice. RESULTS Cold storage of PLTs for 7 days or longer induces significant PLT activation, cytoskeletal damage, impaired fibrinogen spreading, enhances mitochondrial metabolic decoupling and ROS generation, and increases macrophage-dependent phagocytosis and macrophage-independent clearance. Addition of NAC prevents PLT clearance and allows a correction of the prolonged bleeding time in thrombocytopenic, aspirin-treated, immunodeficient mice. CONCLUSIONS Long-term cold storage induces mitochondrial uncoupling and increased proton leak and ROS generation. The resulting ROS is a crucial contributor to the increased macrophage-dependent and -independent clearance of functional PLTs and can be prevented by the antioxidant NAC in a magnesium-containing additive solution.
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Affiliation(s)
- Shailaja Hegde
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Ashley M Wellendorf
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Yi Zheng
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jose A Cancelas
- Hoxworth Blood Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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5
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Cancelas JA. Future of platelet formulations with improved clotting profile: a short review on human safety and efficacy data. Transfusion 2019; 59:1467-1473. [DOI: 10.1111/trf.15163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Jose A. Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati Academic Health Center Cincinnati Ohio
- Division of Experimental Hematology and Cancer BiologyCincinnati Children's Hospital Medical Center Cincinnati Ohio
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6
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Hegde S, Akbar H, Zheng Y, Cancelas JA. Towards increasing shelf life and haemostatic potency of stored platelet concentrates. Curr Opin Hematol 2018; 25:500-508. [PMID: 30281037 PMCID: PMC6532779 DOI: 10.1097/moh.0000000000000456] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Platelet transfusion is a widely used therapy in treating or preventing bleeding and haemorrhage in patients with thrombocytopenia or trauma. Compared with the relative ease of platelet transfusion, current practice for the storage of platelets is inefficient, costly and relatively unsafe, with platelets stored at room temperature (RT) for upto 5-7 days. RECENT FINDINGS During storage, especially at cold temperatures, platelets undergo progressive and deleterious changes, collectively termed the 'platelet storage lesion', which decrease their haemostatic function and posttransfusion survival. Recent progress in understanding platelet activation and host clearance mechanisms is leading to the consideration of both old and novel storage conditions that use refrigeration and/or cryopreservation to overcome various storage lesions and significantly extend platelet shelf-life with a reduced risk of pathogen contamination. SUMMARY A review of the advantages and disadvantages of alternative methods for platelet storage is presented from both a clinical and biological perspective. It is anticipated that future platelet preservation involving cold, frozen and/or pathogen reduction strategies in a proper platelet additive solution will enable longer term and safer platelet storage.
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Affiliation(s)
- Shailaja Hegde
- Hoxworth Blood Center, University of Cincinnati Academic Health Center
| | - Huzoor Akbar
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati
- Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Yi Zheng
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati
| | - Jose A. Cancelas
- Hoxworth Blood Center, University of Cincinnati Academic Health Center
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati
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7
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Jain P, Tendulkar A, Gupta A. First Indian initiative for preparation of low-titer group "O" single-donor platelets with platelet additive solution. Asian J Transfus Sci 2018; 12:10-16. [PMID: 29563669 PMCID: PMC5850691 DOI: 10.4103/ajts.ajts_2_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Guidelines recommend ABO-identical platelet (PLT) transfusions. Hemolytic reactions after a minor ABO-incompatible PLT transfusion have escalated due to single-donor platelets (SDP) containing ABO-incompatible plasma. Avoiding such events by examining titers or performing plasma reduction is cumbersome. The introduction of platelet additive solutions (PAS) has enabled to reduce these reactions by avoiding passive transfer of isoagglutinin. Our aim was to study antibody titers (anti-A, anti-B) in "O" SDP by adding PAS at source and the quality parameters with reference to viability, morphology, and metabolism. MATERIALS AND METHODS Group "O" SDP (n = 50) were prepared on a standard cell separator. PAS in a ratio of 70:30 (PAS: plasma) was added at source under sterile conditions (study arm). The units were studied on day of collection (day 0) and day 4 and compared with SDP containing 100% plasma (control arm). A titer study was performed after PAS addition. RESULTS In the study group, the median antibody titers (anti-A, anti-B) reduced from 128 to16, post-PAS addition (P < 0.001). Morphology scores were superior in PAS platelet concentrates (P < 0.001). Metabolic parameters pO2 and pCO2 were similar in the two arms signifying good unit storage and stable oxygen consumption (P > 0.05). Lactate levels, glucose consumption rate, and lactate production rates were significantly low in study arm showing the advantage of PAS. CONCLUSION O group SDPs can be prepared with PAS and the beneficial effects were significant with respect to antibody titers. Quality parameters were well maintained. Availability of PAS units has benefitted patients.
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Affiliation(s)
- Puneet Jain
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anita Tendulkar
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhaykumar Gupta
- Department of Transfusion Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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8
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Bontekoe IJ, van der Meer PF, van den Hurk K, Verhoeven AJ, de Korte D. Platelet storage performance is consistent by donor: a pilot study comparing "good" and "poor" storing platelets. Transfusion 2017; 57:2373-2380. [PMID: 28703861 DOI: 10.1111/trf.14238] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 05/03/2017] [Accepted: 05/17/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND In retrospective studies, it has been shown that differences in storage variables of platelet (PLT) concentrates (PCs) are partially donor dependent. It was our aim to prospectively determine the donor effect on PLT quality. STUDY DESIGN AND METHODS Based on quality control data of outdated apheresis PCs, male donors were selected with at least one PC with a pH value of more than 7.0 ("good," n = 6) or one PC with a pH value of less than 6.7 ("poor," n = 6) on Day 8. These donors donated a PC (Trima Accel, Terumo) and completed a short questionnaire about their health and lifestyle. PCs were stored for 12 days and analyzed at regular intervals for in vitro quality. RESULTS Donor characteristics were comparable, except that zero of six good and four of six poor donors reported high blood pressure and/or high cholesterol/fat and/or use of medicines. Lactate production in good PCs was lower than that in poor PCs (0.09 ± 0.03 mmol/day/1011 PLTs vs. 0.13 ± 0.04 mmol/day/1011 PLTs, p < 0.05) resulting in a higher pH from Day 5 onward. At the end of storage, the good PCs showed lower CD62P expression, lower phosphatidylserine exposure, and higher mitochondrial membrane potential. PLT functional properties were only slightly different. Despite having lower pH, the poor PCs also fulfilled European Guidelines during 7-day storage. CONCLUSION Platelet storage performance is consistent when donors are dichotomized as having good or poor storing PLTs. Metabolic differences are perhaps due to different functionality of the mitochondria. More research is needed to establish the underlying causes and the implications for donors and blood products.
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Affiliation(s)
- Ido J Bontekoe
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Pieter F van der Meer
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Blood Supply, Leiden, the Netherlands
| | | | - Arthur J Verhoeven
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, the Netherlands
| | - Dirk de Korte
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands.,Department of Blood Cell Research, Sanquin Research
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9
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Skripchenko A, Turgeon A, Thompson-Montgomery D, Awatefe H, Wagner SJ. Value of calcium and phosphate in a bicarbonate-containing platelet additive solution with low plasma levels in maintaining key in vitro platelet storage parameters. Transfusion 2016; 57:349-356. [PMID: 27859382 DOI: 10.1111/trf.13894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Use of recently developed platelet (PLT) additive solutions (PAS) with 5% plasma levels may reduce the frequency and/or severity of transfusion reactions attributed to plasma. PLTs suspended in bicarbonate-containing PAS-5 with 5% plasma levels can maintain key PLT parameters during 7-day storage. This study evaluates the role of calcium and phosphate, as constituents of PAS-5, in maintaining PLT parameters. STUDY DESIGN AND METHODS An Amicus apheresis PLT unit (n = 13) was equally divided into four 60-mL aliquots in CF-250 polyolefin bags. Four different formulations of PAS-5 were prepared: PAS-5, PAS-5 without phosphate (-PO4 ), PAS-5 without calcium (-Ca), and PAS-5 without Ca and phosphate (-Ca/-PO4 ). PLTs were centrifuged, and the supernatant was expressed and replaced with the respective PAS, yielding PLTs suspended in 95% PAS and 5% plasma. PLTs were stored at 20 to 24ºC with agitation for 7 days. PLT in vitro parameters were evaluated on Days 1, 5, and 7. RESULTS In PLT PAS-5 aliquots, pH levels were maintained better compared with those in -Ca and -Ca/-PO4 aliquots. Glycolysis was greater in -Ca and -Ca/-PO4 PLT aliquots compared with PAS-5 aliquots. Hypotonic stress response and morphology were less and p-selectin (CD62P) binding was greater in -Ca/-PO4 PLT aliquots. The accumulation of reactive oxygen species was greater in -Ca/-PO4 PLTs. Phosphorylation of p38 mitogen-activated protein kinase (MAPK) was greater in -Ca and -Ca/-PO4 PLT aliquots during storage. CONCLUSION The removal of calcium and phosphate from PAS-5 leads to the activation of p38 MAPK and deterioration of key PLT storage parameters.
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Affiliation(s)
- Andrey Skripchenko
- American Red Cross Biomedical Services, Holland Laboratory, Rockville, Maryland
| | - Annette Turgeon
- American Red Cross Biomedical Services, Holland Laboratory, Rockville, Maryland
| | | | - Helen Awatefe
- American Red Cross Biomedical Services, Holland Laboratory, Rockville, Maryland
| | - Stephen J Wagner
- American Red Cross Biomedical Services, Holland Laboratory, Rockville, Maryland
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10
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Begue S, Morel P, Djoudi R. [Innovative technology and blood safety]. Transfus Clin Biol 2016; 23:245-252. [PMID: 27616610 DOI: 10.1016/j.tracli.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 07/19/2016] [Indexed: 11/17/2022]
Abstract
If technological innovations are not enough alone to improve blood safety, their contributions for several decades in blood transfusion are major. The improvement of blood donation (new apheresis devices, RFID) or blood components (additive solutions, pathogen reduction technology, automated processing of platelets concentrates) or manufacturing process of these products (by automated processing of whole blood), all these steps where technological innovations were implemented, lead us to better traceability, more efficient processes, quality improvement of blood products and therefore increased blood safety for blood donors and patients. If we are on the threshold of a great change with the progress of pathogen reduction technology (for whole blood and red blood cells), we hope to see production of ex vivo red blood cells or platelets who are real and who open new conceptual paths on blood safety.
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Affiliation(s)
- S Begue
- Direction médicale, établissement français du sang, 20, avenue du Stade-de-France, 93218 La Plaine-Stade-de-France, France
| | - P Morel
- Établissement français du sang - Bourgogne-Franche Comté, 8, rue du Docteur-Jean-François-Xavier-Girod, 25000 Besançon, France
| | - R Djoudi
- Établissement français du sang - Île-de-France, 122/130, rue Marcel-Hartmann, LEAPARK bâtiment A, 94200 Ivry-sur-Seine, France.
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11
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Hegde S, Cancelas JA. Dissecting the metabolic pathways controlling platelet survival in vivo: are our platelets what they eat? Transfusion 2016; 56:1928-31. [PMID: 27500916 DOI: 10.1111/trf.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Shailaja Hegde
- Hoxworth Blood Center, University of Cincinnati College of Medicine.,Division of Experimental Hematology, Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jose A Cancelas
- Hoxworth Blood Center, University of Cincinnati College of Medicine.,Division of Experimental Hematology, Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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12
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Affiliation(s)
- W.-C. Tsoi
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong China
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13
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Improving platelet transfusion safety: biomedical and technical considerations. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 14:109-22. [PMID: 26674828 DOI: 10.2450/2015.0042-15] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/16/2015] [Indexed: 12/25/2022]
Abstract
Platelet concentrates account for near 10% of all labile blood components but are responsible for more than 25% of the reported adverse events. Besides factors related to patients themselves, who may be particularly at risk of side effects because of their underlying illness, there are aspects of platelet collection and storage that predispose to adverse events. Platelets for transfusion are strongly activated by collection through disposal equipment, which can stress the cells, and by preservation at 22 °C with rotation or rocking, which likewise leads to platelet activation, perhaps more so than storage at 4 °C. Lastly, platelets constitutively possess a very large number of bioactive components that may elicit pro-inflammatory reactions when infused into a patient. This review aims to describe approaches that may be crucial to minimising side effects while optimising safety and quality. We suggest that platelet transfusion is complex, in part because of the complexity of the "material" itself: platelets are highly versatile cells and the transfusion process adds a myriad of variables that present many challenges for preserving basal platelet function and preventing dysfunctional activation of the platelets. The review also presents information showing--after years of exhaustive haemovigilance--that whole blood buffy coat pooled platelet components are extremely safe compared to the gold standard (i.e. apheresis platelet components), both in terms of acquired infections and of immunological/inflammatory hazards.
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14
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Abstract
PURPOSE OF REVIEW Platelets are a frequently requested blood product today and are often in limited supply because of a shelf life of 5-7 days, depending on the country. Room temperature storage is associated with an increased risk of transfusion-transmitted infection. Plasma used for platelet storage is unavailable for other uses, and allogeneic plasma carries with it risks for adverse transfusion reactions. This review looks at recent activities evaluating alternative conditions for the storage of platelets. RECENT FINDINGS New-generation platelet additive solutions are being evaluated and applied as a strategy to reduce the volume of allogeneic plasma transfused and to support storage following pathogen reduction treatments. There is a renewed interest in refrigerator temperature and frozen storage of platelets to improve availability, to reduce septic transfusion risk, and to enhance hemostatic efficacy in the bleeding patient. SUMMARY Use of platelet additive solutions has been shown to reduce the incidence of allergic and nonhemolytic febrile transfusion reactions in two large studies. Results of ongoing research and new clinical trials in cold storage methods will be forthcoming and may present solutions for platelet availability problems and new choices for therapeutic transfusion of the bleeding patient.
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15
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Leitner GC, List J, Horvath M, Eichelberger B, Panzer S, Jilma-Stohlawetz P. Additive solutions differentially affect metabolic and functional parameters of platelet concentrates. Vox Sang 2015; 110:20-6. [DOI: 10.1111/vox.12317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 06/14/2015] [Accepted: 06/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- G. C. Leitner
- Department of Blood Group Serology and Transfusion Medicine; Medical University; Vienna Austria
| | - J. List
- Department of Hematology; Hanuschkrankenhaus; Vienna Austria
| | - M. Horvath
- Department of Blood Group Serology and Transfusion Medicine; Medical University; Vienna Austria
| | - B. Eichelberger
- Department of Blood Group Serology and Transfusion Medicine; Medical University; Vienna Austria
| | - S. Panzer
- Department of Blood Group Serology and Transfusion Medicine; Medical University; Vienna Austria
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16
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Gravemann U, Volgmann T, Min K, Philipp R, Lambrecht B, Müller TH, Seltsam A. In vitro variables of buffy coat-derived platelet concentrates with residual plasma of down to 10% are stably maintained in new-generation platelet additive solutions. Transfusion 2015; 55:1700-9. [DOI: 10.1111/trf.13000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/04/2014] [Accepted: 12/04/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Ute Gravemann
- German Red Cross Blood Service NSTOB, Institute Springe; Springe Germany
| | - Thorsten Volgmann
- German Red Cross Blood Service NSTOB, Institute Springe; Springe Germany
| | | | | | - Bernd Lambrecht
- German Red Cross Blood Service NSTOB, Institute Springe; Springe Germany
| | - Thomas H. Müller
- German Red Cross Blood Service NSTOB, Institute Springe; Springe Germany
| | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Institute Springe; Springe Germany
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17
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Abstract
The last 20 years have seen many advances in transfusion therapy and safety. Blood products are biological products engendering complex interactions with the immune system. Prestorage leukoreduction results in a reduced risk of febrile reactions, CMV transmission, and immune modulation, proving to be safer for patients than non-leuko reduced products. Simple patient identification issues and clerical error continue to be the primary causes of ABO-incompatible transfusions. Rigorous donor screening as well as serologic and nucleic acid testing for transfusion transmitted infection have brought the blood supply to a very safe level, although transmission of these agents continues to be a problem in underdeveloped countries. Emerging infectious diseases, beyond current laboratory detection capabilities, combined with global travel, pose unknown imminent risks everywhere. We also briefly discuss the current risks of transfusion-transmitted infections. We review currently available hemostatic blood products, their compositions, and their clinical indications; we mention product modifications currently in development; and we touch upon the hemostatic properties and drawbacks of whole blood, which is currently gaining popularity as an alternative to split blood products. We conclude with an in-depth overview of the risks associated with transfusion, including incompatibility, hemolytic transfusion reactions, transfusion-associated circulatory overload (TACO), and transfusion-related acute lung injury (TRALI).
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Affiliation(s)
| | - Patrick Schoettker
- Department of Anesthesiology, University Hospital of Lausanne, Lausanne, Switzerland
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18
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Heaton WA. Costs and benefits of PAS platelets: a mix of science, quality, and value. Transfusion 2014; 53:2597-602. [PMID: 24580646 DOI: 10.1111/trf.12438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Wm Andrew Heaton
- Transfusion Medicine, Hofstra School of Medicine, NSLIJ Health System, Manhasset, NY.
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Katus MC, Szczepiorkowski ZM, Dumont LJ, Dunbar NM. Safety of platelet transfusion: past, present and future. Vox Sang 2014; 107:103-13. [PMID: 24650183 DOI: 10.1111/vox.12146] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/31/2014] [Accepted: 02/13/2014] [Indexed: 12/18/2022]
Abstract
Platelet components became routinely available to many institutions in the late 1960s and since then utilization has steadily increased. Platelets are produced by three principal methods and their manufacturing process is regulated by multiple agencies. As the field of platelet transfusion has evolved, a broad array of strategies to improve platelet safety has developed. This review will explore the evolution of modern platelet component therapy, highlight the various risks associated with platelet transfusion and describe risk reduction strategies that have been implemented to improve platelet transfusion safety. In closing, the reader will be briefly introduced to select investigational platelet and platelet-mimetic products that have the potential to enhance platelet transfusion safety in the near future.
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Affiliation(s)
- M C Katus
- Department of Pathology, Transfusion Medicine Service, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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20
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Skripchenko A, Turgeon A, Thompson-Montgomery D, Awatefe H, Wagner SJ. 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. Vox Sang 2013; 106:337-43. [PMID: 24330192 DOI: 10.1111/vox.12113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/17/2013] [Accepted: 10/17/2013] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- A Skripchenko
- American Red Cross Biomedical Services, Holland Laboratory, Rockville, MD, USA
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21
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Exploratory studies of extended storage of apheresis platelets in a platelet additive solution (PAS). Blood 2013; 123:271-80. [PMID: 24258816 DOI: 10.1182/blood-2013-05-501247] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To evaluate the poststorage viability of apheresis platelets stored for up to 18 days in 80% platelet additive solution (PAS)/20% plasma, 117 healthy subjects donated platelets using the Haemonetics MCS+, COBE Spectra (Spectra), or Trima Accel (Trima) systems. Control platelets from the same subjects were compared with their stored test PAS platelets by radiolabeling their stored and control platelets with either (51)chromium or (111)indium. Trima platelets met Food and Drug Administration poststorage platelet viability criteria for only 7 days vs almost 13 days for Haemonetics platelets; ie, platelet recoveries after these storage times averaged 44 ± 3% vs 49 ± 3% and survivals were 5.4 ± 0.3 vs 4.6 ± 0.3 days, respectively. The differences in storage duration are likely related to both the collection system and the storage bag. The Spectra and Trima platelets were hyperconcentrated during collection, and PAS was added, whereas the Haemonetics platelets were elutriated with PAS, which may have resulted in less collection injury. When Spectra and Trima platelets were stored in Haemonetics' bags, poststorage viability was significantly improved. Platelet viability is better maintained in vitro than in vivo, allowing substantial increases in platelet storage times. However, implementation will require resolution of potential bacterial overgrowth during storage.
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22
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Weiss DR, Franke D, Strasser EF, Ringwald J, Zimmermann R, Eckstein R. von Willebrand factor, clotting factors, and clotting inhibitors in apheresis platelet concentrates. Transfusion 2013; 54:633-9. [DOI: 10.1111/trf.12304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/02/2013] [Accepted: 05/05/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Dominik R. Weiss
- Department of Transfusion Medicine and Haemostaseology; University Hospital Erlangen; Erlangen Germany
| | - D. Franke
- Department of Transfusion Medicine and Haemostaseology; University Hospital Erlangen; Erlangen Germany
| | - Erwin F. Strasser
- Department of Transfusion Medicine and Haemostaseology; University Hospital Erlangen; Erlangen Germany
| | - Juergen Ringwald
- Department of Transfusion Medicine and Haemostaseology; University Hospital Erlangen; Erlangen Germany
| | - Robert Zimmermann
- Department of Transfusion Medicine and Haemostaseology; University Hospital Erlangen; Erlangen Germany
| | - Reinhold Eckstein
- Department of Transfusion Medicine and Haemostaseology; University Hospital Erlangen; Erlangen Germany
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