Platelet Transfusion Research Laboratory, Bloodworks Northwest Research Institute, Seattle, Washington.
Department of Medicine, Division of Hematology, University of Washington School of Medicine, Seattle, Washington.
Transfusion. 2020 Mar;60(3):613-621. doi: 10.1111/trf.15669. Epub 2020 Feb 4.
Cold (4°C)-stored platelets are currently under investigation for transfusion in bleeding patients. It is currently unknown how long cold-stored platelets can be stored for clinical applications.
Twenty three subjects were recruited. Twenty-one subjects were available for in vivo assessment and received indium-111 radiolabeled, cold-stored platelets. We investigated 5- (n = 5), 10- (n = 6), 15- (n = 5), and 20-day-stored (n = 5) platelets and obtained samples for in vitro testing at baseline and after the designated storage time. Twenty three units were available for in vitro testing. Five- and 7-day (n = 5 each), room temperature (RT)-stored platelets served as the current clinical standard control.
In vivo, we found a continuous decline in platelet recovery from 5 to 20 days. Platelet survival reached a low nadir after 10 days of storage. Ex vivo, we observed the maximum platelet αIIbβ3 integrin response to collagen at 5 days of cold storage, and we saw a continuous decline thereafter. However, platelet integrin activation and mitochondrial membrane integrity were better preserved after 20 days at 4°C, compared to 5 days at RT. Platelet metabolic parameters suggest comparable results between 20-day cold-stored platelets and 5- or 7-day RT-stored platelets.
In summary, we performed the first studies with extended, cold-stored, apheresis platelets in plasma for up to 20 days with a fresh comparator. Storing cold-stored platelets up to 20 days yields better results in vitro, but further studies in actively bleeding patients are needed to determine the best compromise between hemostatic efficacy and storage prolongation.
目前正在研究冷藏（4°C）保存的血小板用于出血患者的输血。目前尚不清楚冷藏保存的血小板可以储存多长时间用于临床应用。
共招募了 23 名受试者。21 名受试者可进行体内评估，并接受铟-111 标记的冷藏血小板。我们研究了 5 天（n=5）、10 天（n=6）、15 天（n=5）和 20 天储存（n=5）的血小板，并在基线和指定储存时间后获得了用于体外测试的样本。共有 23 个单位可用于体外测试。5 天和 7 天（n=5）的室温（RT）储存血小板作为当前临床标准对照。
在体内，我们发现血小板回收率从 5 天持续下降到 20 天。血小板存活在储存 10 天后达到最低点。在体外，我们观察到在冷藏 5 天时，血小板 αIIbβ3 整合素对胶原蛋白的最大反应，此后反应持续下降。然而，与 5 天 RT 相比，在 4°C 下储存 20 天后，血小板整合素激活和线粒体膜完整性得到更好的保存。血小板代谢参数表明，20 天冷藏保存的血小板与 5 天或 7 天 RT 保存的血小板具有相似的结果。
总之，我们首次进行了长达 20 天的新鲜对照下在血浆中延长冷藏、单采血小板的研究。将冷藏保存的血小板储存长达 20 天，在体外产生了更好的结果，但需要在积极出血的患者中进行进一步研究，以确定止血效果和储存延长之间的最佳折衷。
