Haematology and Medical Oncology Service, Morales Meseguer University Hospital, Regional Blood Donation Centre, University of Murcia, IMIB-Arrixaca, CIBERER, Murcia, Spain.
Haematology and Blood Therapy Service, "Rafael Méndez" University Hospital, Lorca, Spain.
Blood Transfus. 2018 May;16(3):273-278. doi: 10.2450/2017.0277-16. Epub 2017 Apr 13.
Transfusion of washed platelet concentrates (W-PC) is recommended for some patients, such as those who have had previous severe allergic transfusion reactions. However, we still lack a standardised method for preparing these products. Here, we assessed the effect of a manual washing procedure on in vitro platelet quality and on the transfusion efficacy of W-PCs.
Buffy coat-derived W-PC in Composol solution were prepared by one-step centrifugation. Platelet activation and function were evaluated before and after washing by means of: (i) CD62 expression by flow cytometry; (ii) platelet aggregation (LTA); and (iii) the VerifyNow P2Y12 test. A pilot prospective transfusion study was carried out in 11 onco-hematology patients receiving, in a short time, two consecutive transfusions: one with standard PC (S-PC) and one with W-PC. The post-transfusion platelet increment, the 1 h and 24 h corrected count increment (CCI) and occurrence of bleeding events were used as indices of transfusion efficacy.
Platelet recovery in W-PC was 84.8±5.4%. Washing slightly increased platelet activation in W-PC vs pre-washed samples (% CD62+ platelets 23.6±7 vs 14.8±1; p=0.03). As compared to prewash samples, platelet reactivity of W-PC as measured by VerifyNow P2Y12 was significantly lower with ADP (PRU 32.2±37.7 vs 4.2±2.4, p=0.027), but similar using TRAP. Platelet aggregation responses to TRAP, collagen, ristocetin and arachidonic acid were maintained in W-PC. The pilot transfusion trial showed similar 1 h (13.5±5.6 vs 11.5±7.3, p=0.49) and 24 h (11±7.2 vs 9±6.5, p=0.48) CCI for S-PC and W-PC. Transfusion of W-PC was not associated with an increased number of bleeding events.
We have set up a simple method to obtain buffy-coat-derived W-PC, which has minor effects on in vitro platelet quality and transfusion effectiveness. This procedure can be easily implemented in transfusion centres for on-demand preparation of washed platelets.
对于某些患者，如曾发生过严重过敏输血反应的患者，推荐输注洗涤血小板浓缩物（W-PC）。然而，我们仍然缺乏标准化的制备这些产品的方法。在这里，我们评估了手动洗涤程序对体外血小板质量和 W-PC 输血效果的影响。
使用 Composol 溶液从富含血小板的白细胞层中制备一步离心法制备 W-PC。通过以下方法评估洗涤前后的血小板活化和功能：（i）流式细胞术测定 CD62 表达；（ii）血小板聚集（LTA）；和（iii）VerifyNow P2Y12 检测。对 11 名肿瘤血液病患者进行了一项前瞻性输血研究，他们在短时间内接受了两次连续输血：一次为标准血小板浓缩物（S-PC），一次为 W-PC。将输血后的血小板增加量、1 小时和 24 小时校正计数增加量（CCI）以及出血事件的发生作为输血效果的指标。
W-PC 中的血小板回收率为 84.8±5.4%。洗涤后，W-PC 中的血小板活化较洗涤前样本略有增加（% CD62+血小板 23.6±7 vs 14.8±1；p=0.03）。与洗涤前样本相比，W-PC 通过 VerifyNow P2Y12 测定的血小板反应性使用 ADP 明显降低（PRU 32.2±37.7 vs 4.2±2.4，p=0.027），但使用 TRAP 则相似。W-PC 对 TRAP、胶原、瑞斯托霉素和花生四烯酸的血小板聚集反应保持不变。初步输血试验表明，S-PC 和 W-PC 的 1 小时（13.5±5.6 vs 11.5±7.3，p=0.49）和 24 小时（11±7.2 vs 9±6.5，p=0.48）CCI 相似。W-PC 输血与出血事件的增加无关。
我们已经建立了一种简单的方法来获得富含血小板的白细胞层衍生的 W-PC，它对体外血小板质量和输血效果的影响较小。该程序可在输血中心轻松实施，以便按需制备洗涤后的血小板。
