Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada.
Transfusion. 2022 Aug;62 Suppl 1:S53-S62. doi: 10.1111/trf.16974. Epub 2022 Jun 24.
Platelets are a key component of massive transfusion in treating actively bleeding patients. While optimized for prophylactic transfusions, the effectiveness of the current standard room temperature stored platelets (RPs) in treating actively bleeding patients is not clear. Cold-stored platelets (CPs) have been shown to have superior hemostatic functions and the potential to extend shelf life. In this study, we explored the effect of using CPs versus RPs in an in vitro transfusion model based on the massive transfusion protocol.
RPs or CPs were combined with RBCs and plasma in a 1:1:1 volume ratio to make transfusion packages. Whole blood was collected and then either diluted to 20% hematocrit or mixed with tPA (8.8 μg/ml). By volume, 70% of transfusion package was mixed with 30% whole blood to simulate massive transfusions and analyzed by rotational thromboelastometry. Transfusion package supernatant was analyzed for PAI-1 activity as well.
Both transfusion packages restored the clot characteristics of hemodiluted or hyperfibrinolytic whole blood. Specifically, only transfusion packages made with CPs significantly reduced the maximum clot lysis of hyperfibrinolytic whole blood. PAI-1 activity in CPs transfusion packages were also significantly higher.
Transfusion packages containing cold-stored platelets may be able to restore the blood hemostatic profile of bleeding patients. In addition, transfusion packages made from CPs may provide additional benefit of resisting hyperfibrinolysis in bleeding patients. In trauma where post-transfusion platelet recovery is less of a concern, CPs are a viable option to restore hemostasis.
血小板是治疗活动性出血患者大量输血的关键组成部分。虽然目前的室温保存血小板（RPs）在预防性输血方面得到了优化，但在治疗活动性出血患者方面的效果尚不清楚。冷储血小板（CPs）已被证明具有更好的止血功能，并有可能延长保质期。在这项研究中，我们根据大量输血方案，在体外输血模型中探索了使用 CPs 与 RPs 的效果。
将 RPs 或 CPs 与 RBCs 和血浆以 1:1:1 的体积比混合制成输血包。采集全血，然后稀释至 20%的红细胞压积或与 tPA（8.8 μg/ml）混合。按体积计，70%的输血包与 30%的全血混合，模拟大量输血，并通过旋转血栓弹性描记术进行分析。还分析了输血包上清液中 PAI-1 的活性。
两种输血包均恢复了血液稀释或高纤维蛋白溶解全血的凝血特征。具体来说，只有含有 CPs 的输血包才能显著降低高纤维蛋白溶解全血的最大血块溶解。CPs 输血包中的 PAI-1 活性也明显更高。
含有冷储血小板的输血包可能能够恢复出血患者的血液止血谱。此外，来自 CPs 的输血包可能提供抵抗出血患者高纤维蛋白溶解的额外益处。在创伤中，输注后血小板恢复不太重要的情况下，CPs 是恢复止血的可行选择。
