Bloodworks Northwest Research Institute, Seattle, Washington, USA.
Department of Medicine, Division of Hematology, University of Washington Medical Center, Seattle, WA, USA.
Transfusion. 2022 Jan;62(1):22-27. doi: 10.1111/trf.16741. Epub 2021 Nov 15.
The current approach to manufacture cold-stored platelets (CSP) replicates that of room temperature-stored platelets (RSP). However, this production method is associated with aggregate formation in CSP, a major pitfall that leads to significant wastage. We hypothesized that isolating platelets from whole blood as platelet-rich plasma (PRP) and storing them at a lower concentration reduces aggregates and that conventional bedside transfusion filtration removes CSP aggregates.
We collected platelets from healthy humans by apheresis (AP) and by phlebotomy, from which we generated platelet-rich plasma (PRP). We split each AP and PRP platelets into two equal aliquots, storing one at 22°C (RT-PRP and RT-AP) and the other at 4°C (4C-PRP and 4C-AP). We evaluated platelets on day 0 and day 7 of storage. After storage, we measured platelet counts, aggregates, and other key characteristics before and after filtration by a bedside filter.
After storage, the 4C-AP platelet counts decreased significantly. 4C-PRP preserved glucose better and prevented a significant increase in lactate contrary to 4C-AP. Filtration led to significantly lower platelet counts in both 4C-PRP and 4C-AP but not in their RT counterparts. Post filtration, we observed 50% fewer aggregates only in 4C-AP, whereas 4C-PRP showed an unexpected but significant increase in aggregates. Testing confirmed activation during storage but filtration did not further activate platelets.
We provide evidence that 4C-PRP is an alternative to 4C-AP and that bedside filters reduce aggregates from 4C-AP. Further studies are needed to evaluate the hemostatic potential of 4C-PRP and the management of aggregates.
目前制造冷藏血小板（CSP）的方法复制了室温储存血小板（RSP）的方法。然而，这种生产方法与 CSP 中的聚集物形成有关，这是导致大量浪费的主要缺陷。我们假设从全血中分离富含血小板的血浆（PRP）并以较低的浓度储存可以减少聚集物，并且常规床边输血过滤可以去除 CSP 聚集物。
我们通过单采（AP）和静脉穿刺从健康人采集血小板，从中生成富含血小板的血浆（PRP）。我们将每个 AP 和 PRP 血小板分成两份相等的等分，一份储存在 22°C（RT-PRP 和 RT-AP），另一份储存在 4°C（4C-PRP 和 4C-AP）。我们在储存的第 0 天和第 7 天评估血小板。储存后，我们在床边过滤器过滤前后测量血小板计数、聚集物和其他关键特征。
储存后，4C-AP 血小板计数显著下降。4C-PRP 更好地保存葡萄糖，并且与 4C-AP 相反，防止乳酸盐显著增加。过滤导致 4C-PRP 和 4C-AP 的血小板计数显著降低，但不会降低 RT 对应物的血小板计数。过滤后，我们仅在 4C-AP 中观察到聚集物减少 50%，而 4C-PRP 显示出意想不到但显著增加的聚集物。测试证实储存过程中血小板被激活，但过滤不会进一步激活血小板。
我们提供的证据表明，4C-PRP 是 4C-AP 的替代方法，床边过滤器可减少 4C-AP 中的聚集物。需要进一步研究来评估 4C-PRP 的止血潜力和聚集物的管理。
