血小板体外浓缩物的促凝潜能降低，但在输血后似乎得到恢复。

Platelet procoagulant potential is reduced in platelet concentrates ex vivo but appears restored following transfusion.

机构信息

ANZAC Research Institute, University of Sydney, Sydney, Australia.

Haematology Department, Concord Repatriation General Hospital, Sydney, Australia.

出版信息

Transfusion. 2021 Dec;61(12):3420-3431. doi: 10.1111/trf.16695. Epub 2021 Oct 5.

DOI:10.1111/trf.16695

PMID:34611925

Abstract

BACKGROUND

The procoagulant profile of platelet concentrates (PCs) following transfusion has been difficult to evaluate due to lack of specific markers. This study aimed to characterize procoagulant platelets in PCs and the effect of transfusion.

STUDY DESIGN AND METHODS

Buffy coat-derived PCs from 12 donors were pooled, split, then stored conventionally, cold (2-6°C) or cryopreserved (-80°C). Procoagulant platelet profiles were assessed by flow cytometry (GSAO /P-selectin ), lactadherin-binding, and calibrated automated thrombogram, during storage, unstimulated, or after thrombin and collagen stimulation and compared with blood from healthy volunteers. Platelet activation (P-selectin) and procoagulant platelet formation potential were measured (flow cytometry) in patients receiving clinically indicated conventional PC transfusion.

RESULTS

Independent of significant increases with storage, procoagulant platelet proportions with and without agonist stimulation were significantly blunted in conventionally stored PCs (stimulated day 5 conventional PC 4.2 ± 1.3%, healthy volunteer blood 11.1 ± 2.9%; p < .0001). Cryopreserved PCs contained the highest proportion of procoagulant platelets (unstimulated: cryopreserved 25.6 ± 1.8% vs. day 5 conventional 0.5 ± 0.1% vs. day 14 cold-stored 5.8 ± 1.0%, p < .0001), but demonstrated minimal increase with agonist. Transfusion of PCs was associated with an increase in procoagulant platelets (2.2 ± 1.4% vs. 0.6 ± 0.2%; p = .004) and reversal of the blunted agonist response (15.8 ± 5.9% vs. 4.0 ± 1.6%; p < .0001). Procoagulant responses post-transfusion were significantly higher than healthy controls, suggesting a priming effect. The P-selectin agonist response was not restored upon transfusion (79.4 ± 13.9% vs. 82.0 ± 2.5%).

CONCLUSION

Storage blunts the procoagulant platelet response to agonist stimulation in PCs. Despite this, conventionally stored PCs have high procoagulant potential following transfusion, with a discordant, persistent reduction in P-selectin response.

摘要

背景

由于缺乏特异性标志物，血小板浓缩物（PCs）输注后的促凝状态一直难以评估。本研究旨在描述 PCs 中的促凝血小板以及输注对其的影响。

研究设计与方法

将 12 位供者的富血小板血浆分离，混合后分为常规储存、冷藏（2-6°C）或冷冻（-80°C）三组。通过流式细胞术（GSAO/P-选择素）、乳凝集素结合试验和校准自动血栓图评估储存过程中、未刺激时以及经凝血酶和胶原刺激后的促凝血小板谱，并与健康志愿者的血液进行比较。对接受临床常规 PC 输注的患者进行血小板激活（P-选择素）和促凝血小板形成潜能（流式细胞术）的检测。

结果

无论储存时间如何，与未刺激时相比，常规储存的 PCs 经刺激后的促凝血小板比例显著降低（第 5 天常规储存组 4.2±1.3%，健康志愿者血液组 11.1±2.9%；p<0.0001）。冷冻保存的 PCs 中促凝血小板比例最高（未刺激：冷冻组 25.6±1.8% vs. 第 5 天常规储存组 0.5±0.1% vs. 第 14 天冷藏组 5.8±1.0%；p<0.0001），但经刺激后其增加幅度较小。PC 输注后促凝血小板增加（2.2±1.4% vs. 0.6±0.2%；p=0.004），并逆转了促凝反应减弱（15.8±5.9% vs. 4.0±1.6%；p<0.0001）。输注后的促凝反应明显高于健康对照组，提示存在预激效应。但 P-选择素激动剂反应在输注后并未恢复（79.4±13.9% vs. 82.0±2.5%）。