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Abstract
Platelet cryopreservation has been investigated for several decades as an alternative to room temperature storage of platelet concentrates. The use of dimethylsulfoxide as a cryoprotectant has improved platelet storage and cryopreserved concentrates can be kept at −80 °C for two years. Cryopreserved platelets can serve as emergency backup to support stock crises or to disburden difficult logistic areas like rural or military regions. Cryopreservation significantly influences platelet morphology, decreases platelet activation and severely abrogates platelet aggregation. Recent data indicate that cryopreserved platelets have a procoagulant phenotype because thrombin and fibrin formation kicks in earlier compared to room temperature stored platelets. This happens both in static and hydrodynamic conditions. In a clinical setting, low 1-h post transfusion recoveries of cryopreserved platelets represent fast clearance from circulation which may be explained by changes to the platelet GPIbα receptor. Cryopreservation splits the concentrate in two platelet subpopulations depending on GPIbα expression levels. Further research is needed to unravel its physiological importance. Proving clinical efficacy of cryopreserved platelets is difficult because of the heterogeneity of indications and the ambiguity of outcome measures. The procoagulant character of cryopreserved platelets has increased interest for use in trauma stressing the need for double-blinded randomized clinical trials in actively bleeding patients.
Highlights
Transfusion of platelet concentrates (PC) is a life-saving intervention for patients suffering from acute blood loss but is more often used as a supportive prophylactic therapy for patients with diverse hematologic diseases
We investigated platelet adhesion by perfusion of reconstituted whole blood onto collagen only or onto collagen and tissue factor (TF) in microfluidic flow chambers at a wall shear rate of 1000 s−1
Results from thrombin generation assays (TGA) across labs should be compared with caution
Summary
Transfusion of platelet concentrates (PC) is a life-saving intervention for patients suffering from acute blood loss but is more often used as a supportive prophylactic therapy for patients with diverse hematologic diseases. Ex vivo platelet storage induces a series of biochemical and functional changes to the platelet, collectively called platelet storage lesion [3]. DMSO had to be removed by centrifugation and washing before platelet transfusion. These additional manipulations resulted in significant practical limitations of the protocol, especially for use in the military where fast supply and minimal product manipulation is required. The hyperconcentrated platelet pellet is reconstituted in either plasma or saline Since this landmark publication, interest in cryopreservation is renewed especially in the military or in vast rural areas the technique may function to support regular blood banks to further reduce risks of stock failure [10]. In doing so we wish to reveal the gaps in the research and stimulate further development in this field
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