Sodium citrate contributes to the platelet storage lesion

Area of Science:

• Hematology
• Transfusion Medicine
• Biochemistry

Background:

• Sodium citrate is a standard anticoagulant in apheresis collection and platelet additive solutions (PASs).
• Concerns exist that citrate at 10 mM in PAS formulations may induce apoptosis in platelets.
• This study investigates the impact of removing citrate from PAS-III on platelet storage quality.

Purpose of the Study:

• To evaluate the effect of citrate removal from PAS-III on apheresis platelet storage.
• To compare platelet quality and function when stored in citrate-free PAS-III versus citrate-containing PAS-III.

Main Methods:

• Study 1: Assessed citrate dose-response effects on platelet storage in a PAS formulation.
• Study 2: Compared platelet storage in citrate-free PAS-III versus PAS-III with 10 mM citrate.
• Analyses included cell count, blood gases, flow cytometry for activation markers (P-selectin, phosphatidylserine), and aggregation assays.

Main Results:

• Citrate inclusion in PAS led to increased glucose utilization, lactate, P-selectin, phosphatidylserine (PS) exposure, and reactive oxygen species (ROS) formation.
• Platelets stored in citrate-free PAS-III showed better maintenance of glucose utilization and reduced lactate, P-selectin, PS exposure, and ROS formation.
• Platelet aggregation responses were notably higher (at least 10%) in citrate-free PAS-III compared to citrate-containing PAS-III.

Conclusions:

• Storage of apheresis platelets in citrate-free PAS-III significantly improves key storage parameters.
• Citrate removal enhances platelet quality by reducing metabolic stress and activation markers.
• This modification leads to a modest but significant improvement in platelet aggregation capacity.