Hans Gulliksson

Platelet storage solution effects on the accuracy of laboratory tests for platelet function: a multi‐laboratory study

Background and Objectives  Extent of shape change (ESC) and hypotonic shock response (HSR) have been widely used to characterize the in vitro function of platelets and have been shown to correlate with in vivo viability. These assays have been routinely performed using platelet‐poor plasma (PPP) as the test sample diluent. Because of the increasing popularity of storing platelets in synthetic media, it is important to understand the effects of using these synthetic media as test diluents for ESC and HSR measurements. The objective of this study was to determine the effect of using platelet storage solutions vs. plasma for the in vitro testing of ESC and HSR.

Storage of platelets in additive solutions: effects of magnesium and/or potassium

BACKGROUND: Previous studies indicate that platelet concentrates (PCs) in a platelet additive solution (PAS) containing citrate, acetate, and sodium chloride (PAS‐2) show a significantly higher increase of CD62+ platelets than PCs in other brands of PAS containing Mg2+ and K+. To investigate whether this difference can be explained by the presence of Mg2+ and/or K+ in the storage medium, we performed paired studies comparing storage of PCs in PAS‐2 to PAS‐2 with either Mg2+ or K+ or both in combination.

In vitro pH effects on in vivo recovery and survival of platelets: an analysis by the BEST Collaborative.

BACKGROUND: The pH environment of stored platelet (PLT) products is recognized as an important factor and is generally used as a key surrogate measure of PLT viability. It is the only in vitro measurement that has been translated into industry standards and regulatory rules or specifications for storage of PLT products. The objective of this study was to evaluate the effect of in vitro pH on the in vivo recovery and survival of autologous PLT products.

Storage of platelet concentrates from pooled buffy coats made of fresh and overnight-stored whole blood processed on the novel Atreus 2C+ system: in vitro study

BACKGROUND: The Atreus 2C+ system (Gambro BCT) automatically separates whole blood (WB) into buffy coat (BC), red blood cells (RBC), and plasma and transfers the components into separate containers. After processing with the Atreus, 4 to 6 BC units can be pooled and processed into leukoreduced platelets (PLTs) by use of the automated OrbiSac BC system (Gambro BCT). The aim of our in vitro study was to investigate the effects of holding either WB or BC overnight before preparation of PLTs by use of the Atreus 2C+ system for BC preparation. A standard routine procedure involving conventional blood containers for the preparation of BC combined with the OrbiSac process (top‐and‐top system; Terumo) was used as a reference.

Storage of whole blood overnight in different blood bags preceding preparation of blood components: in vitro effects on red blood cells.

BACKGROUND Routines for the storage of whole blood (WB) overnight for the preparation of blood components on the following day are of increasing interest primarily for logistic reasons. The present study focuses on in vitro effects during storage for 6 weeks on red blood cells (RBC) prepared in different blood containers after being held overnight. STUDY DESIGN AND METHODS Five different blood collection systems were used with either inline leucocyte reduction red cell filters for the preparation of RBC, buffy coat (BC) and plasma or WB filters for the preparation of RBC and plasma. A new container with an integrated WB filter removing leucocytes but not platelets was also included for the preparation of leucocyte-reduced RBC, BC and plasma units. Standard CPD solution (63 or 70 mL) and SAG-M solution (100 or 110 mL) were used for the collection of either 450 or 500 mL blood. All WB units were stored at room temperature, either overnight for 18-24 hours (test groups, n=104) or for up to 8 hours (reference groups, n=20). In addition, five test units were stored overnight under refrigeration. RESULTS In test groups (overnight storage at room temperature) we found significantly lower levels of extracellular potassium, 2,3-DPG and pH (up to day 28). During storage, higher levels of ATP (Terumo, CaridianBCT until day 35, Fresenius until day 14, Fenwal throughout storage) were seen in test groups than in reference groups. When WB was stored overnight at 2-6 degrees C before WB filtration, the levels of ATP and haemolysis were higher than in the corresponding reference. CONCLUSION Significant differences in in vitro parameters were observed between RBC prepared within 8 hours and 18-24 hours after blood collection. The results were consistent irrespective of the blood container used. New alkaline solutions may decrease the differences.

Interruption of agitation of platelet concentrates: a multicenter in vitro study by the BEST Collaborative on the effects of shipping platelets

BACKGROUND: Transported platelets (PLTs) are not under continuous agitation. The aim of this study was to determine whether PLTs shipped between 24 and 48 hours would be able to maintain a pH22°C value of 6.5 at the end of 7 days of storage.

Evaluation of overnight hold of whole blood at room temperature before component processing: effect of red blood cell (RBC) additive solutions on in vitro RBC measures

BACKGROUND: Whole blood (WB) can be held at room temperature (18‐25°C) up to 8 hours after collection; thereafter the unit must be refrigerated, rendering it unsuitable for platelet (PLT) production. Overnight hold at room temperature before processing has logistic advantages, and we evaluated this process in an international multicenter study for both buffy coat (BC)‐ and PLT‐rich plasma (PRP)‐based blood components and compared three red blood cell (RBC) additive solutions (ASs) for their ability to offset effects of overnight hold.

Evaluation of a whole-blood WBC-reduction filter that saves platelets: in vitro studies.

BACKGROUND: In this study, a new WBC‐reduction in‐line filter that removes WBCs but not platelets was evaluated. Three WBC‐reduced blood components were prepared: RBCs, plasma, and platelet concentrates (PCs).

Storage of interim platelet units for 18 to 24 hours before pooling: in vitro study

BACKGROUND: The Atreus 3C system (CaridianBCT) automatically produces three components from whole blood (WB), a red blood cell (RBC) unit, a plasma unit, and an interim platelet (PLT) unit (IPU) that can be pooled with other IPUs to form a PLT dose for transfusion. The Atreus 3C system also includes a PLT yield indicator (PYI), which is an advanced algorithm that provides an index that is shown to correlate well with the amount of PLTs that finally end up in the IPU bag. The aim of our in vitro study was to compare the effects of holding WB overnight versus processing WB fresh (2‐8 hr), both with 18‐ to 24‐hour storage of the IPUs before pooling into a transfusable PLT dose.

Storage of platelets: effects associated with high platelet content in platelet storage containers

BACKGROUND A major problem associated with platelet storage containers is that some platelet units show a dramatic fall in pH, especially above certain platelet contents. The aim of this study was a detailed investigation of the different in vitro effects occurring when the maximum storage capacity of a platelet container is exceeded as compared to normal storage. MATERIALS AND METHODS Buffy coats were combined in large-volume containers to create primary pools to be split into two equal aliquots for the preparation of platelets (450-520×10(9) platelets/unit) in SSP+ for 7-day storage in two containers (test and reference) with different platelet storage capacity (n=8). RESULTS Exceeding the maximum storage capacity of the test platelet storage container resulted in immediate negative effects on platelet metabolism and energy supply, but also delayed effects on platelet function, activation and disintegration. CONCLUSION Our study gives a very clear indication of the effects in different phases associated with exceeding the maximum storage capacity of platelet containers but throw little additional light on the mechanism initiating those negative effects. The problem appears to be complex and further studies in different media using different storage containers will be needed to understand the mechanisms involved.