Impact of different pathogen reduction technologies on the biochemistry, function, and clinical effectiveness of platelet concentrates: An updated view during a pandemic

Abstract

Standard platelet concentrates (PCs) stored at 22°C have a limited shelf life of 5 days. Because of the storage temperature, bacterial contamination of PCs can result in life‐threatening infections in transfused patients. The potential of blood components to cause infections through contaminating pathogens or transmitting blood‐borne diseases has always been a concern. The current safety practice to prevent pathogen transmission through blood transfusion starts with a stringent screening of donors and regulated testing of blood samples to ensure that known infections cannot reach transfusion products. Pathogen reduction technologies (PRTs), initially implemented to ensure the safety of plasma products, have been adapted to treat platelet products. In addition to reducing bacterial contamination, PRT applied to PCs can extend their shelf life up to 7 days, alleviating the impact of their shortage, while providing an additional safety layer against emerging blood‐borne infectious diseases. While a deleterious action of PRTs in quantitative and qualitative aspects of plasma is accepted, the impact of PRTs on the quality, function, and clinical efficacy of PCs has been under constant examination. The potential of PRTs to prevent the possibility of new emerging diseases to reach cellular blood components has been considered more hypothetical than real. In 2019, a coronavirus‐related disease (COVID‐19) became a pandemic. This episode should help when reconsidering the possibility of future blood transmissible threats. The following text intends to evaluate the impact of different PRTs on the quality, function, and clinical effectiveness of platelets within the perspective of a developing pandemic.

In Vitro Comparative Study of Platelets Treated with Two Pathogen-Inactivation Methods to Extend Shelf Life to 7 Days

“…Pathogen inactivation (PI) of platelet (PLT) concentrates (PCs) increases the safety of blood products by reducing the risk of transfusion-transmitted infections [ 1 ] and by inactivating leukocytes for the prevention of transfusion-associated graft-versus-host disease (TA-GVHD) [ 2 , 3 ]. Two inactivation methods are commercially available.…”

Transfusion outcomes between regular and low yield pathogen reduced platelets across different patient populations in a single institution

“…3,4 This difference may be caused by the PRT process, which alters platelet morphology as well as increases anaerobic metabolism and expression of apoptotic markers in the PRT-treated platelets. 18 However, despite these biological consequences of the PRT process, our findings suggest that the potency of PRT-treated platelets appeared unaffected by the unit yield. Furthermore, previous studies with conventional platelets have only included hospitalized heme-onc patients with hypoproliferative thrombocytopenia and predominantly prophylactic transfusion needs; while this patient population often constitutes majority of the platelet transfusion recipients in a hospital transfusion service, their platelet transfusion needs are not necessarily reflective of other patient populations, where platelet transfusions tend to be therapeutic and occur during active bleeding.…”

“…This question is relevant especially given that PRT‐treated platelets are known to produce significantly lower count increment when compared with conventional platelets 3,4 . This difference may be caused by the PRT process, which alters platelet morphology as well as increases anaerobic metabolism and expression of apoptotic markers in the PRT‐treated platelets 18 . However, despite these biological consequences of the PRT process, our findings suggest that the potency of PRT‐treated platelets appeared unaffected by the unit yield.…”

Digital polymerase chain reaction to monitor platelet transfusions in cardiac surgery patients

“…Among surgery and trauma patients, cardiosurgical procedures may offer a relatively high degree of both standardization and monitoring. They may be ideally suited to differentially profile in haemato‐oncology and surgery patients the effects of novel approaches including pathogen reduction [20], major changes of storage conditions (e.g., in the cold [21] or for more than 5 days after preparation [22]) as well as products harvested from megakaryocyte culture [23].…”