Safety and efficacy of cryopreserved platelets in bleeding patients with thrombocytopenia

Slichter, Sherrill J.; Dumont, Larry J.; Cancelas, José A.; Jones, MeLinh; Gernsheimer, Terry; Szczepiórkowski, Zbigniew M.; Dunbar, Nancy M.; Prakash, Gautham; Medlin, Stephen; Rugg, Neeta; Kinne, Bridget; Macdonald, Victor W.; Housler, Greggory; Valiyaveettil, Manoj; Hmel, Peter J.; Ransom, Janet H.

doi:10.1111/trf.14780

Cited by 58 publications

(61 citation statements)

References 12 publications

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“…There has been a resurgence in interest in cryopreservation of platelets over the past decade . Although CPPs have been transfused for prophylactic purposes, the most prevalent indication for CPPs has been the treatment of active bleeding . In the future, CPPs could represent one component in a multiproduct inventory where the choice of product is dictated by individual patient requirements.…”

Section: Discussionmentioning

confidence: 99%

Freezing expired platelets does not compromise in vitro quality: An opportunity to maximize inventory potential

et al. 2019

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BACKGROUND AND OBJECTIVES Cryopreservation provides an option for long‐term storage of platelet concentrates. While platelets are usually frozen as soon as practical after collection (within 2 days), the ability to freeze units at a later stage of the shelf life may improve inventory management. As such, the aim of this study was to determine the impact of freezing platelets approaching expiry (Day 5/6). MATERIALS AND METHODS Two ABO‐matched buffy coat–derived platelets (30% plasma/70% platelet additive solution) were pooled and split to produce matched pairs (n = 8 pairs). Platelets were frozen on Day 1 after collection (cryopreserved platelets [CPPs]) or Day 5 or 6 (expired‐CPPs) at −80°C with 5% to 6% dimethyl sulfoxide. In vitro platelet quality was tested before freezing and after thawing and reconstitution in plasma. RESULTS The majority of prefreeze parameters were equivalent for all platelet units (Day 1 vs. Day 5 or 6). Expired‐CPPs had a higher mean postthaw platelet recovery (82 ± 4%) compared to CPPs (75 ± 4%; p = 0.0021). Cryopreservation resulted in a loss of surface glycoproteins (glycoprotein (GP) Ibα, GPIIb, GPVI), an increase in activation markers (phosphatidylserine and P‐selectin) and microparticle release, compared to unfrozen platelets. However, the cryopreservation‐induced changes were equivalent in CPPs and expired‐CPPs. Functionality was measured by thromboelastography and was similar between expired‐CPPs (R‐time: 5.3 ± 0.3) and CPPs (R‐time: 5.4 ± 0.5; p = 0.7094). CONCLUSION The phenotype and functional profile of platelets frozen at expiry were similar to platelets frozen 1 day following collection. These data suggest that expired platelets may represent a suitable starting material for cryopreservation.

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Section: Discussionmentioning

confidence: 99%

Freezing expired platelets does not compromise in vitro quality: An opportunity to maximize inventory potential

et al. 2019

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“…Platelet transfusion is generally used either prophylactically to reduce the risk of bleeding or therapeutically to control active bleeding in many clinical settings . Liquid‐preserved platelets kept under standard blood banking conditions, at 20 to 24 °C with constant agitation, can be stored for only 5 to 7 days, which severely limits their availability at far‐forward combat facilities and remote civilian locations …”

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confidence: 99%

Cryopreserved platelets augment the inflammatory response: role of phosphatidylserine‐ and P‐selectin–mediated platelet phagocytosis in macrophages

Zhao

Gan

et al. 2019

Transfusion

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BACKGROUND Cryopreservation in dimethyl sulfoxide and storage at −80 °C extends the shelf life of platelets to at least 2 years, allowing greater availability in rural and military areas. While cryopreserved platelets (CPPs) have been extensively characterized for coagulation and thrombin generation, reports on the mechanism of adverse reactions to CPPs transfusion are scarce. Here, we tested the hypothesis that CPPs facilitate phagocytosis by Kupffer cells and subsequently promote the inflammatory response in Kupffer cells. STUDY DESIGN AND METHODS P‐selectin expression, glycoprotein Ibα clustering and phosphatidylserine (PS) surface exposure on platelets stored at 22 °C, 4 °C and − 80 °C for 3 days were examined by flow cytometry. The phagocytosis of mepacrine‐labeled platelets coincubated with THP‐1 cells was examined by flow cytometry and confocal microscopy, and the release of cytokines from THP‐1 cells was measured by enzyme‐linked immunosorbent assay. RESULTS CPPs showed a marked enhancement of exposed PS but dramatically reduced glycoprotein Ibα expression and clustering compared with platelets stored at 4 °C. Activation of THP‐1 cells was stronger by CPPs than by platelets stored at 22 °C and 4 °C. CPP interference tests using annexin V and anti–P‐selectin showed that CPPs induced increases in PS‐ and P‐selectin–mediated phagocytosis, as well as secretion of the proinflammatory cytokine tumor necrosis factor‐α, and interleukins IL‐1β and IL‐6, but a decrease in transforming growth factor‐β production in THP‐1 cells. Surface‐exposed PS was more effective than P‐selectin for the activation of THP‐1 cells. CONCLUSION CPPs triggered PS and P‐selectin–mediated phagocytosis by macrophages and stimulated the inflammatory response of macrophages.

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“…Cold storage of platelet concentrates might allow storage with preserved hemostatic function for 14–21 days. Otherwise, Thrombosomes® (Cellphire), which are lyophilized platelet fragments, are under clinical evaluation and might serve as a viable option together with cryopreserved platelets …”

Section: Discussionmentioning

confidence: 99%

How do I get an emergency civilian walking blood bank running?

et al. 2019

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The shift toward using a transfusion strategy in a ratio to mimic whole blood (WB) functionality has revitalized WB as a viable option to replace severe blood loss in civilian health care. A military‐civilian collaboration has contributed to the reintroduction of WB at Haukeland University Hospital in Bergen, Norway. WB has logistical and hemostatic advantages in both the pre‐ and in‐hospital settings where the goal is a perfectly timed balanced transfusion strategy. In this paper, we describe an event leading to activation of our emergency WB collection strategy for the first time. We evaluate the feasibility of our civilian walking blood bank (WBB) to cover the need of a massive amount of blood in an emergency situation. The challenges are discussed in relation to the different stages of the event with the recommendations for improvement in practice. We conclude that the use of pre‐screened donors as a WBB in a civilian setting is feasible. The WBB can provide platelet containing blood components for balanced blood resuscitation in a clinically relevant time frame.

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Safety and efficacy of cryopreserved platelets in bleeding patients with thrombocytopenia

Abstract: Cryopreserved PLT transfusions appear to be safe and effective when given to bleeding patients with thrombocytopenia.

Cited by 58 publications

References 12 publications

Freezing expired platelets does not compromise in vitro quality: An opportunity to maximize inventory potential

Freezing expired platelets does not compromise in vitro quality: An opportunity to maximize inventory potential

Cryopreserved platelets augment the inflammatory response: role of phosphatidylserine‐ and P‐selectin–mediated platelet phagocytosis in macrophages

How do I get an emergency civilian walking blood bank running?

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