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Platelet activity in washed platelet concentrates.
Helge Schoenfeld1, Manfred Muhm, Ulrich Doepfmer
1* Department of Anesthesiology, University Hospital of Bern, Inselspital, Switzerland, the †Department of Anesthesiology and Intensive Care Medicine, University Hospital Charité, Berlin, Germany, the ‡ Department of Anesthesiology and Intensive Care Medicine, Hospital of Oberpullendorf and Department of Cardiothoracic Anesthesia and Intensive Care Medicine, University of Vienna, Austria, and the § Institute of Transfusion Medicine, University Hospital Charité Berlin, Germany.
Washing platelet concentrates (PCs) significantly increases spontaneous platelet activation and impairs induced activation and aggregation. This suggests reducing PC washing frequency for most patients, reserving it for those with severe transfusion reactions.
Area of Science:
- Hematology
- Transfusion Medicine
Background:
- Platelet concentrates (PCs) can cause severe transfusion reactions like anaphylaxis or febrile nonhemolytic reactions.
- Washing PCs is considered for thrombocytopenic patients to remove sensitizing plasma components or cytokines.
- Platelet function, specifically activation after physiological stimulation, is crucial for transfusion efficacy.
Purpose of the Study:
- To evaluate the impact of washing on spontaneous and induced platelet activation.
- To assess changes in platelet aggregation after washing.
- To inform clinical decisions regarding the necessity of washing platelet concentrates.
Main Methods:
- Analyzed 11 single-donor-apheresis platelet concentrates.
- Determined spontaneous and induced (ADP, collagen) platelet activation via flow cytometry before and after washing.
- Measured ADP- and collagen-induced platelet aggregation.
Main Results:
- Washing tripled spontaneous platelet activation (16.1% to 47.4%).
- Washed platelets showed reduced induced activation and impaired ADP-induced aggregation.
- Increased spontaneous activation after washing suggests a loss of platelet responsiveness.
Conclusions:
- Platelet concentrate washing significantly compromises platelet quality by increasing spontaneous activation and reducing responsiveness to stimuli.
- The findings support a more judicious approach to washing PCs, limiting its use to specific clinical indications like severe transfusion reactions.
- Reducing PC washing may preserve platelet function and improve transfusion outcomes for many patients.