Abstract
Acute normovolemic hemodilution (ANH) is a potential transfusion method for platelets, as well as for red blood cells. However, previous studies have shown that whole blood storage in ANH decreases platelet aggregability by 14.7–76.3% and that this decrease is not recovered by reinfusion. We investigated whether a new whole blood storage method for 6 h using a polyolefin bag, based on the platelet concentrates storage method, would maintain platelet function better than the conventional method using a polyvinyl chloride bag. We demonstrated that storage of whole blood in a polyolefin bag maintained ADP-induced aggregation rates at more than twofold higher than those in a polyvinyl chloride bag, and also significantly suppressed P-selectin expression, a platelet activation marker (ADP-induced aggregation rates: 24.6 ± 5.1% vs. 51.7 ± 11.5%, p = 0.002; P-selectin expression; 50.3 ± 8.4MFI vs. 31.6 ± 9.3MFI, p = 0.018). These results could be attributed to the high gas permeability of polyolefin, which lowered PCO2 and maintained a high pH with or without agitation. There were no significant changes in platelet count and red blood cell parameters due to the storage methods. Our results suggest that ANH using polyolefin bags is advantageous in improving hemostatic function compared to the conventional method.
Highlights
Acute normovolemic hemodilution (ANH) is a potential transfusion method for platelets, as well as for red blood cells
Several studies have found that the conventional method of ANH severely impairs platelet aggregability assessed by whole blood aggregometry, multiple electrode aggregometry, and impedance aggregometry (14.7–76.3% compared to pre-surgery) and that the function does not recover after transfusion[11,12,13,14] (Fig. 1)
We showed that whole blood storage in a polyolefin bag maintained higher ADP-induced platelet aggregation rates and lower P-selectin expression, compared to the conventional method used in ANH (Table 2 and Fig. 2)
Summary
Acute normovolemic hemodilution (ANH) is a potential transfusion method for platelets, as well as for red blood cells. We demonstrated that storage of whole blood in a polyolefin bag maintained ADP-induced aggregation rates at more than twofold higher than those in a polyvinyl chloride bag, and significantly suppressed P-selectin expression, a platelet activation marker (ADP-induced aggregation rates: 24.6 ± 5.1% vs 51.7 ± 11.5%, p = 0.002; P-selectin expression; 50.3 ± 8.4MFI vs 31.6 ± 9.3MFI, p = 0.018). These results could be attributed to the high gas permeability of polyolefin, which lowered PCO2 and maintained a high pH with or without agitation. Platelet concentrates are stored with agitation in bags made of highly oxygen-permeable materials such as polyolefin[16,22], which provide sufficient oxygen for platelets to maintain aerobic respiration and ensure gas exchange between the storage medium and the atmosphere[24]
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