Platelets: Testing, Dosing and the Storage Lesion—Recent Advances

Abstract

The demand for platelet transfusions continues to grow. Several complementary approaches that may help meet this demand in the future are reviewed. First, platelet bacterial testing is beginning to allow the extension of platelet storage beyond 5 days. Studies are also underway aimed at better preserving viability and function during ex vivo platelet storage: additive solutions and other approaches are being developed to try to negate the "platelet storage lesion." Finally, new approaches to dosing platelets may help extend the limited supply.

Desialylation accelerates platelet clearance after refrigeration and initiates GPIbα metalloproteinase-mediated cleavage in mice

“…1 Methods of pathogen inactivation may extend platelet shelf life to 7 days 2 but will unfortunately not prevent modifications associated with platelet storage that alter the functional integrity and structure of platelets, a process termed as platelet storage lesion. 3 One characteristic of platelet storage lesion is metalloproteinase (MP)-dependent loss of surface GPIb␣ and GPV subunits of the VWF receptor (VWFR) complex. 4,5 The membrane-bound MP ADAM17, also known as TACE (TNF-␣-converting enzyme), is the MP most intimately involved in agonist-induced shedding of GPIb␣ 6 and GPV, 7 generating 130 and 80 kDa of soluble subfragments of these subunits, respectively.…”

Assessment of a dimethyl sulfoxide–stabilized frozen canine platelet concentrate

“…36 Loss of cellular function associated with room temperature platelet storage lesions has been reported in the human literature. 33 Increased amounts of phosphatidylserine or P-selectin on the platelet surface, decreased aggregometry response to agonist, or decreased recovery after hypotonic stress reaction are all evidence of a loss of platelet function. 33 In our experiment, the platelets in the frozen concentrate already had maximal amounts of phosphatidylserine at rest, compared with fresh platelets.…”

“…33 Increased amounts of phosphatidylserine or P-selectin on the platelet surface, decreased aggregometry response to agonist, or decreased recovery after hypotonic stress reaction are all evidence of a loss of platelet function. 33 In our experiment, the platelets in the frozen concentrate already had maximal amounts of phosphatidylserine at rest, compared with fresh platelets. Moreover, platelets in the frozen concentrate are not able to translocate additional phosphatidylserine to the outer leaflet of the plasma membrane when stimulated with thrombin, whereas the fresh platelets and the fresh platelets in 6% DMSO could.…”

“…8,22,33 Aging of the PC is associated with decreased Pco 2 and glucose content in both human 34 and veterinary d studies. The acid-base status of the studied PCs is consistent with the use of citrate-phosphate-dextrose-adenine as the anticoagulant and storage agent.…”

Glycans and glycosylation of platelets: current concepts and implications for transfusion

“…The risk of transfusion-mediated bacteremia is predicted to be greatly reduced if platelets are refrigerated, allowing for extended storage time and reducing the number of outdated products. Recently, bacterial testing and pathogen inactivation methodologies have been implemented to reduce contamination [11][12][13][14]. Bacterial detection, however, prolongs platelet storage time causing functional deterioration [9 ], and although pathogen inactivation is performed without any significant delay in platelet product release, this method reduces platelet recovery and circulation and raises toxicological concerns, including possible immunomodulatory effects [15,16].…”