Residual aggregates in platelet products: what do we know?

Ringwald, Juergen; Antoon, M.; Eckstein, Reinhold; Cardoso, Marcia

doi:10.1111/vox.12089

Cited by 18 publications

(27 citation statements)

References 57 publications

(78 reference statements)

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“…The primary interaction between platelets and the damaged vessel wall is highly dependent on the prevailing fluid shear forces and strengthens in proportion to the impacting drag . Apheresis involves fluid aspiration and centrifugation of blood or its components, and this process equally evokes fluid shear and drag forces that may facilitate platelet–platelet binding through GPIbα and sheared soluble plasma VWF . Furthermore, our previous work on this topic indicated that certain donors are more likely to routinely donate concentrates with PA .…”

Section: Discussionmentioning

confidence: 99%

“…Apheresis has specific advantages and disadvantages compared to other modalities of platelet concentrate production . One practical problem in apheresis is the presence of platelet aggregates in the final product . These structures are poorly defined but manifest as macroscopic hyaline structures that are clearly visible to the naked eye, with or without backlighting.…”

Section: Introductionmentioning

confidence: 99%

“…Depending on the institution's directives , products with PA may be distributed for transfusion, quarantined until free of aggregates or immediately destroyed. There are no clinical studies investigating these products, and the aetiology of PA in apheresis concentrates is not known .…”

Section: Introductionmentioning

confidence: 99%

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The contribution of von Willebrand factor–GPIbα interactions to persistent aggregate formation in apheresis platelet concentrates

Feys¹,

Aelst²,

Devloo³

et al. 2015

Vox Sanguinis

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Background and Objectives Apheresis platelet concentrates sometimes contain persistent aggregates (PA). Because apheresis involves extracorporeal circulation, we hypothesized that interactions between GPIba and von Willebrand factor (VWF) underlie their origin. Materials and MethodsPlatelets in donations with PA were compared to aggregate-free (AF) controls. Flow cytometry was used to determine platelet bound VWF. Degranulation was measured using P-selectin expression in flow cytometry and cytokine release using immunosorbent assays. Platelet adhesion to VWF was assessed in hydrodynamic flow and real-time video microscopy.Results Platelets in PA concentrates had significantly more (P = 0Á009, n ≥ 8) bound VWF compared to AF platelets, but differences in VWF concentration, VWF collagen binding, activated VWF or GPIba expression were not found. Degranulation was higher (P = 0Á030, n = 7) in PA than AF concentrates on day 1 of storage, but adhesion to immobilized VWF under hydrodynamic flow conditions was normal at that moment. On day 6, however, significantly less VWF adhesion (P = 0Á009, n ≥ 6) was found for PA platelets compared to AF, indicating accelerated storage lesion in PA products. In a model that mimicks PA formation by chemically induced binding of VWF to platelets, we found that degranulation, phosphatidylserine expression and metabolism did not differ with paired controls at any time during subsequent storage.Conclusion Accelerated storage lesion is found in concentrates with PA, but this cannot be explained solely by increased platelet bound VWF following apheresis. Therefore, additional stressors are probably responsible for the increases observed in platelet degranulation and storage lesion in products with PA.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The contribution of von Willebrand factor–GPIbα interactions to persistent aggregate formation in apheresis platelet concentrates

Feys¹,

Aelst²,

Devloo³

et al. 2015

Vox Sanguinis

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“…Apheresis procedures may cause platelet aggregation. These generally dissipate, but some persist throughout the entire storage period . Products with persisting aggregates (PA) may be quarantined, destroyed or distributed in which case an evaluation procedure can be used as a guideline .…”

Section: Introductionmentioning

confidence: 99%

“…A practical consequence of the higher platelet concentration in PA donor's whole blood is the larger products these donors provide, but it is unclear whether collection of smaller products from such donors would help driving back PA incidence. To mitigate PA incidence, previous reports have suggested to increase the anticoagulant to inlet ratio, but additional research is required to confirm utility and investigate the consequences for donor and operators . With the adoption of Intercept pathogen inactivation, PA have disappeared in our blood institution.…”

Section: Introductionmentioning

confidence: 99%

Persistent aggregates in apheresis platelet concentrates are commonly collected from donors with a history of aggregate donation

Feys¹,

Pottel

Coene³

et al. 2016

Vox Sanguinis

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Platelet apheresis sometimes causes persistent aggregates (PA). This study (n = 211) shows that changing the apheresis settings to reach fixed product volumes instead of yields does not influence PA incidence, even though PA products on average contain more platelets than controls. Furthermore, logistic regression was used to model if PA can be predicted on the basis of certain predonation parameters. PA donation history was the only parameter retained, proving a strong determinant of predictability [AUC = 0.735 (SE = 0.022)]. Consequently, donations from a donor with previous PA history are 7.8 times more likely to contain PA than from a donor without preceding history.

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Recurrent clumping in the extracorporeal photopheresis circuit using acid citrate dextrose solution A

Castillo‐Aleman,

Lumame,

Castelo

et al. 2024

J of Clinical Apheresis

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A 32-year-old male patient with multiple sclerosis underwent extracorporeal photopheresis (ECP) (Therakos Cel-lEx Photopheresis System; Therakos Inc., Mallinckrodt Pharmaceuticals, Ireland-USA) as a participant in the PHOMS study (NCT05168384). The patient was administered two ECP procedures performed weekly according to the approved protocol through peripheral venous accesses using the double-needle mode.The initial four ECPs were completed uneventfully; however, during his fifth ECP procedure, the apheresis staff reported clumping within the internal blood filter (Figure 1), using an anticoagulant (AC) to whole blood (WB) ratio of 1:12. The AC used during the procedures was exclusively acid citrate dextrose solution A (ACD-A), as approved by the local regulatory

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Residual aggregates in platelet products: what do we know?

Cited by 18 publications

References 57 publications

The contribution of von Willebrand factor–GPIbα interactions to persistent aggregate formation in apheresis platelet concentrates

The contribution of von Willebrand factor–GPIbα interactions to persistent aggregate formation in apheresis platelet concentrates

Persistent aggregates in apheresis platelet concentrates are commonly collected from donors with a history of aggregate donation

Recurrent clumping in the extracorporeal photopheresis circuit using acid citrate dextrose solution A

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