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The functional integrity of platelets in volume-reduced platelet concentrates
Helge Schoenfeld1, Manfred Muhm, Ulrich R Doepfmer
1*Department of Anesthesiology, Inselspital, University Hospital of Bern, Bern, Switzerland; †Department of Anesthesiology and Intensive Care Medicine, Charité, University Medicine Berlin, Campus Charité Mitte, Berlin, Germany; ‡Department of Cardiothoracic Anesthesia and Intensive Care Medicine, University of Vienna, and Department of Anesthesiology and Intensive Care Medicine, Hospital of Oberpullendorf, Austria; and §Institute of Transfusion Medicine, Charité, University Medicine Berlin, Campus Charité Mitte, Berlin, Germany.
Insights
Volume reduction of platelet concentrates (PCs) effectively increases platelet counts for infants needing transfusions. While spontaneous platelet activation slightly increases, this method remains a viable alternative for patients at risk of excessive intravascular volume.
Area of Science:
- Hematology
- Transfusion Medicine
- Neonatal Care
Background:
- Premature and low-birth-weight infants often require small-volume platelet transfusions for thrombocytopenia.
- Infants undergoing cardiac surgery with extracorporeal circulation are at risk for excessive intravascular volume.
- Small-volume platelet transfusions can be achieved by dispensing aliquots from standard platelet concentrates (PCs) or by volume reduction of PCs.
Purpose of the Study:
- To evaluate the spontaneous and induced activation of platelets before and after volume reduction in single-donor apheresis PCs.
- To compare the efficacy of volume-reduced PCs versus standard PCs for maximizing platelet transfusion in minimal volume.
Main Methods:
- Twenty consecutive single-donor apheresis PCs were analyzed after a mean storage of 2 days.
- Platelet concentrates underwent plasma depletion via centrifugation for volume reduction.
- Spontaneous, adenosine diphosphate (ADP)-induced, and collagen-induced platelet activation were assessed using flow cytometry.
- ADP- and collagen-induced platelet aggregation were measured.
Main Results:
- A baseline of 33.8% spontaneous platelet activation was observed in standard PCs.
- Volume reduction led to a significant increase in spontaneous platelet activation to 43.2%.
- Platelet aggregability was impaired following ADP induction but unaffected by collagen induction after volume reduction.
Conclusions:
- Volume reduction of PCs is an effective strategy for transfusing higher platelet counts in smaller volumes.
- This method offers an alternative to standard PCs for patients at risk of excessive intravascular volume.
- Volume-reduced PCs can increase the platelet count more effectively per unit volume transfused.
Abstract:
Premature and low-birth-weight infants usually require small-volume platelet transfusions to treat thrombocytopenia. Also, infants undergoing open-heart surgery with extracorporeal circulation and with compromised cardiac function are at risk for excessive intravascular volume. The small-volume platelet substitution can be achieved by dispensing an aliquot from the unit of a standard single-donor platelet concentrate (PC). Alternatively, there is an indication for volume reduction of PCs to maximize the number of platelets transfused in the smallest possible volume. We determined the spontaneous and induced activation of platelets before and after volume reduction in 20 consecutive single-donor-apheresis PCs. After a mean storage time of 2 days, the PCs were plasma-depleted by centrifugation. Spontaneous, adenosine diphosphate (ADP)-induced, and collagen-induced activation were determined by flow cytometry. Furthermore, ADP- and collagen-induced aggregation were measured. A total of 33.8% of platelets in standard PCs were activated spontaneously. Volume reduction of PCs led to a mild but significant increase of spontaneous activation of platelets (43.2%). Additionally, volume reduction resulted in an impaired ADP-induced aggregability of platelets, whereas collagen induction was unaffected. Transfusion of volume-reduced PCs is an effective alternative to use of standard PCs in patients at frequent risk for excessive intravascular volume, because equal volumes increase the platelet count twice as effectively.
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