Eriksson L, Eriksson G, Högman C F
Department of Clinical Immunology and Transfusion Medicine, University Hospital, Uppsala, Sweden.
Vox Sang. 1997;73(2):74-80. doi: 10.1046/j.1423-0410.1997.7320074.x.
Buffy coats (BCs) are used as an alternative to platelet-rich plasma in the preparation of platelet concentrates (PCs). For this purpose the BCs have to be stored for same time at 20-24 degrees C which implies cellular metabolic activity. However, little information is available concerning the effects of a number of factors which may influence the suitability of the preparation as the source of PC.
We studied the effects on BCs of a high and low gas permeability of the wall of the plastic containers, PL2209 and PL146, respectively, mixing versus non-mixing during storage for 48 h at 22 degrees C, and two types of anticoagulant solutions, CPD and half strength citrate CPD (0.5CPD). The buffy coats were prepared by the bottom and top technique. The median values of volume and haematrocrit were 58-64 ml and 39-45%, respectively. A total of 48 BCs were tested. Blood gases, pH, bicarbonate concentration and haemolysis were determined in the blood mixtures and beta-thromboglobulin (beta-TG), lactate dehydrogenase (LDH), complement factor 3a, and elastase in the extracellular fluid.
The pH decreased in all units but to a lesser extent in PL2209 containers than in PL146 units. In the former the pCO2 decreased slowly in contrast to the latter where it increased by about 50%. Mixing during storage increased the pH and decreased the pCO2 in 0.5CPD-PL146 and CPD-PL2209 units, as compared to resting, while no effects of mixing were observed in the other groups. The pO2 decreased to low levels in PL146 units. The haemolysis and LDH release were higher in mixed than in unmixed units. The initial beta-TG levels were lowest in 0.5CPD-PL146 units which also had the lowest 24-hour levels. The release of beta-TG during storage was smallest in CPD resting units. The elastase release was significantly higher in 0.5CPD than in CPD units already from the beginning of storage and increased during storage at about the same rate irrespective of mixing. The C3a levels were higher in 0.5CPD-PL2209 units than in the other units at 2 h. Storage for 24 h caused an increase by 2-3 times of the original level without any clear relation to storage conditions.
In BC units accumulation of CO2 occurs in containers with low gas permeability. These also show the most rapid pH decrease during storage. Prolonged holding of BCs puts extra emphasis on the need of satisfactory gas permeability of the container for platelet storage in BC-derived PCs. Continuous mixing causes red cell damage and does not seem to have any clear benefit. The release of granulocyte elastase was higher in 0.5CPD than in CPD units but there was no indication of an associated increase in platelet activation.
Study of buffy coats stored in various media and containers at 22 degrees C suggests that it is better to restrict storage to 24 h or less to avoid activation or other deleterious effects on the platelets.
在制备血小板浓缩物(PCs)时,血沉棕黄层(BCs)被用作富血小板血浆的替代品。为此,BCs必须在20 - 24摄氏度下储存一段时间,这意味着细胞具有代谢活性。然而,关于许多可能影响该制剂作为PC来源适用性的因素的影响,目前可用信息较少。
我们研究了塑料容器PL2209和PL146壁的高、低气体渗透性、在22摄氏度下储存48小时期间混合与不混合以及两种抗凝剂溶液(CPD和半强度枸橼酸盐CPD(0.5CPD))对BCs的影响。血沉棕黄层采用底部和顶部技术制备。体积和血细胞比容的中位数分别为58 - 64毫升和39 - 45%。共测试了48个BCs。测定血液混合物中的血气、pH值、碳酸氢盐浓度和溶血情况,以及细胞外液中的β - 血小板球蛋白(β - TG)、乳酸脱氢酶(LDH)、补体因子3a和弹性蛋白酶。
所有单位的pH值均下降,但PL2209容器中的下降程度小于PL146单位。在前者中,pCO2缓慢下降,而在后者中则增加了约50%。与静置相比,储存期间混合使0.5CPD - PL146和CPD - PL2209单位的pH值升高,pCO2降低,而在其他组中未观察到混合的影响。PL146单位中的pO2降至低水平。混合组的溶血和LDH释放高于未混合组。初始β - TG水平在0.5CPD - PL146单位中最低,其24小时水平也最低。储存期间β - TG的释放在CPD静置单位中最小。从储存开始,0.5CPD单位中的弹性蛋白酶释放就显著高于CPD单位,并且在储存期间以大致相同的速率增加,与混合无关。在2小时时,0.5CPD - PL2209单位中的C3a水平高于其他单位。储存24小时导致其水平比原始水平增加2 - 3倍,与储存条件无明显关系。
在BC单位中,气体渗透性低的容器会出现CO2积聚。这些容器在储存期间pH值下降也最快。长时间保存BCs特别强调了容器对于在源自BC的PCs中储存血小板具有良好气体渗透性的必要性。持续混合会导致红细胞损伤,似乎没有任何明显益处。0.5CPD单位中的粒细胞弹性蛋白酶释放高于CPD单位,但没有迹象表明血小板活化相应增加。
对在22摄氏度下储存在各种介质和容器中的血沉棕黄层的研究表明,最好将储存时间限制在24小时或更短,以避免对血小板的激活或其他有害影响。