Reduction of the volume of stored platelet concentrates for use in neonatal patients

Abstract

Premature infants and neonatal patients who require platelet transfusions may develop circulatory overload when administered a 50-ml unit of platelet concentrate. We evaluated the influence of centrifugation and resuspension steps used to reduce the volume of stored platelet concentrates on platelet properties by in vitro methods and by determining post-transfusion increments in neonatal patients. In vitro studies were conducted with platelet concentrates stored at 20 to 24 degrees C for 1 and 5 days in CLX (Cutter) and PL732 (Fenwal) containers and for 1 and 2 days in PL146 containers (Fenwal). With platelets stored in any of the three containers, platelet morphology, mean platelet volume, hypotonic stress response, synergistic aggregation, and platelet factor 3 activity were not affected by the processing steps. The centrifugation and resuspension steps did not cause an enhanced discharge of lactate dehydrogenase from platelets. Similar results were obtained when the platelet concentrates were stored on either a flatbed or an end-over-end tumbler agitator. The in vitro platelet recovery following volume reduction was at least 85 percent. In vivo studies were conducted with platelets stored in the PL732 and PL146 containers. Infusion of platelet concentrates after volume reduction produced a mean corrected increment of 18,947 +/- 14,824 when platelets were stored in the PL146 container and 16,178 +/- 15,699 when platelets were stored in the PL732 container. These results indicate that the volume of stored platelet concentrates can be reduced in a manner which maintains platelet properties.

The Effect on Apheresis Platelet Quality During Shipment with Continued Interruption of Agitation for 24 and 48 Hours

“…Under no test conditions did discontinuous agitation affect a change great enough to result in any value outside the range expected for stored PCs on the basis of previous studies. 12,13 The results from this study confirm and extend the results of Simon and Sierra, 6 who showed that PCs could be transported to distant locations early in the PC's shelf life. We found that an interruption of continuous agitation for a 1 or 2 day period did not excessively accelerate the production of lactic acid, so that it did not result in a drop of pH levels to less than 7.0 on Day 5 of storage; contradicting the data presented by Hunter et al 5 They concluded that the increase in production of lactic acid occurs while agitation is interrupted.…”

Does Hyperconcentration Result in Platelet Activation?

“…This additional activation is small in comparison to the activation that results from platelet collection, preparation and storage. These results differ from the earlier reports of platelet activation during platelet centrifugation as measured by β-thromboglobulin release [5], but support the findings of Moroff and colleagues [19]who reported no change in platelet factor 3 activity following reduction in the volume of stored platelet concentrates. This discrepancy in the results appears to reflect the current use of slower centrifugation speeds in the production of platelet products which results in less platelet activation.…”

Multicenter Analysis of Platelet Transfusion Usage Among Neonates on Extracorporeal Membrane Oxygenation

“…11 Usually, this practice requires the use of volume reduction, a process associated with platelet activation, clumping, and dysfunction. The administration of dysfunctional platelets to neonates who already have evidence of platelet dysfunction (eg, patients on ECMO) is counterintuitive, although Moroff et al 12 showed the number and function of platelets to be acceptable when volume-reduced platelet components were used.…”