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Blood transfusion
Cold storage of platelets in additive solution: the impact of residual plasma in apheresis platelet concentrates
Ferrata Storti Foundation
Haematologica 2018 Volume 103(2):207-214
Irene Marini,1* Konstanze Aurich,2* Rabie Jouni,1 Stefanie Nowak-Harnau,1 Oliver Hartwich,2 Andreas Greinacher,2 Thomas Thiele2,Ŧ and Tamam Bakchoul1,2,Ŧ
1Centre for Clinical Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen and 2Institute of Immunology and Transfusion Medicine, University of Greifswald, Germany
*Both authors shared first authorship. ŦBoth laboratories contributed equally to this work
ABSTRACT
Platelet transfusion has become essential therapy in modern medi- cine. Although the clinical advantage of platelet transfusion has been well established, adverse reactions upon transfusion, especial- ly transmission of bacterial infection, still represent a major challenge. While bacterial contamination is favored by the storage of platelets at room temperature, cold storage may represent a solution for this impor- tant clinical issue. In this study, we aimed to clarify whether plasma has protective or detrimental effects on cold-stored platelets. We investigat- ed the impact of different residual plasma contents in apheresis-derived platelet concentrates, stored at 4°C or room temperature, on platelet function and survival. We found that platelets stored at 4°C have higher expression of apoptosis marker compared to platelets stored at room temperature, leading to accelerated clearance from the circulation in a humanized animal model. While cold-induced apoptosis was independ- ent of the residual plasma concentration, cold storage was associated with better adhesive properties and higher response to activators. Interestingly, delta (δ) granule-related functions, such as ADP-mediated aggregation and CD63 release, were better preserved at 4°C, especially in 100% plasma. An extended study to assess cold-stored platelet con- centrates produced under standard care Good Manufacturing Practice conditions showed that platelet function, metabolism and integrity were better compared to those stored at room temperature. Taken together, our results show that residual plasma concentration does not have a car- dinal impact on the cold storage lesions of apheresis-derived platelet concentrates and indicate that the current generation of additive solu- tions represent suitable substitutes for plasma to store platelets at 4°C.
Introduction
Transfusion of platelet concentrates (PCs) is essential to reduce blood loss after traumatic injury or to maintain a safe platelet (PLT) count during chemotherapy. PCs are currently stored at room temperature (20-24°C) with constant agitation to ensure adequate PLT recovery, survival, and sufficient therapeutic efficacy. However, storage at room temperature (RT) not only compromises functionality both in vivo and in vitro (‘PLT storage lesions’), but also increases the potential risk of microbial growth in case of contamination.1-6 For these reasons, the shelf life of PLTs is limited to 4-7 days, depending on country specific guidelines.2 However, despite limited storage time, the incidence of bacterial contamination of PCs remains high, ranging from 1 to 10 per 50,000 units, which is a major drawback of PLTs stored at RT for clinical use.
Cold storage of PCs at 4°C could be an option to reduce the risk of bacterial growth.7,8 Recent studies reported that cold-stored PLTs are functionally and meta- bolically superior to those stored at RT.9-11 A potential limitation of cold storage is the poorer recovery and survival of PLTs after transfusion. However, this remains controversial. Some studies have shown a decrease in survival of cold-stored PLTs
Correspondence:
tamam.bakchoul@med.uni-tuebingen.de
Received: April 16, 2018. Accepted: August 9, 2018. Pre-published: August 16, 2018.
doi:10.3324/haematol.2018.195057
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/1/207
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