Platelet Components Research Articles

Whole blood administration within USCENTCOM

Introduction Blood product use by the U.S. military has evolved during the conflicts in the U.S. Central Command's area of responsibility to become the preferred resuscitative fluid for damage control procedures. This study evaluates the transition to a whole blood-based trauma system over the past 5 years. Methods Patients who received blood product transfusion within USCENTCOM between January 1, 2017, and December 31, 2021, were identified from the Medical Situational Awareness in Theater (MSAT) blood reports. Transfusion recipients were categorized as recipients of whole blood only, component therapy only, or mixed therapy. The type of transfusions, number of recipients, number of available blood products were compared over the 5-year period. Results A total of 1762 unique patients were included. Of this population, 220 (12.5%) received whole blood only, 1196 (68.9%) received component therapy, and 346 (19.6%) received mixed therapy. The monthly proportion of individuals receiving whole blood (only or mixed) significantly increased over the 5-year period ( p < .0001). The number of individuals requiring transfusions over this same period decreased significantly ( p < .0001). Individuals receiving component therapy (only or mixed) were transfused component platelets 15.7% of the time. The mean and median number of units required per patient receiving whole blood was 2.39 and 1 unit of blood respectively (IQR 1.0–2.5). Conclusion Whole blood use increased significantly within USCENTCOM's AOR secondary to increased supply and low clinical requirement. Without a long-lasting platelet component, component therapy cannot be expected to provide a balanced therapy to casualties in remote locations.

Platelet transfusion in adults: An update.

Many patients worldwide receive platelet components (PCs) through the transfusion of diverse types of blood components. PC transfusions are essential for the treatment of central thrombocytopenia of diverse causes, and such treatment is beneficial in patients at risk of severe bleeding. PC transfusions account for almost 10% of all the blood components supplied by blood services, but they are associated with about 3.25 times as many severe reactions (attributable to transfusion) than red blood cell transfusions after stringent in-process leukoreduction to less than 106 residual cells per blood component. PCs are not homogeneous, due to the considerable differences between donors. Furthermore, the modes of PC collection and preparation, the safety precautions taken to limit either the most common (allergic-type reactions and febrile non-hemolytic reactions) or the most severe (bacterial contamination, pulmonary lesions) adverse reactions, and storage and conservation methods can all result in so-called PC "storage lesions". Some storage lesions affect PC quality, with implications for patient outcome. Good transfusion practices should result in higher levels of platelet recovery and efficacy, and lower complication rates. These practices include a matching of tissue ABH antigens whenever possible, and of platelet HLA (and, to a lesser extent, HPA) antigens in immunization situations. This review provides an overview of all the available information relating to platelet transfusion, from donor and donation to bedside transfusion, and considers the impact of the measures applied to increase transfusion efficacy while improving safety and preventing transfusion inefficacy and refractoriness. It also considers alternatives to platelet component (PC) transfusion.

Single-cell analysis of platelets from patients with periodontitis and diabetes

BackgroundBlood platelets are known to play a role in the development of atherosclerotic disease, thrombi, and hemostasis. Investigation of blood platelet transcriptome could provide evidence of disorders that increase vulnerability to cardiovascular disease. However, research on the molecular insights of platelet activation in patients with periodontitis and patients with periodontitis and type 2 diabetes mellitus (DM) is still lacking. ObjectivesIn this study, we analyzed expression in blood platelets from patients with periodontitis and patients with concurrent periodontitis and DM to examine the transcriptomic profile of platelets induced by periodontitis and the modifying effects of DM. MethodsWe obtained the transcriptional profiles of blood platelets from 11 healthy donors, 10 patients with periodontitis, and 6 patients with periodontitis and DM using single-cell RNA sequencing. The biological processes and coexpressed modules of transcriptionally altered genes were further explored. ResultsBoth the patients with periodontitis and DM and those with periodontitis without DM showed higher levels of platelet activation and coagulation signals than the healthy individuals. Platelets from the patients with periodontitis had higher expression levels of genes for RHO GTPase effectors, whereas platelets from the patients with periodontitis and DM demonstrated higher expression of genes involved in oxidative phosphorylation and cellular responses to stress than those from the controls. However, compared with the patients with only periodontitis, those with periodontitis and DM presented a lower expression level of genes for hemostasis and platelet receptors. ConclusionThese results suggest that periodontitis contributes to establishment of blood coagulation via platelet dysregulation, whereas the comorbidities of patients with periodontitis and DM impair the components of platelets, thus preventing normal functions.

Identification of platelet subpopulations in cryopreserved platelet components using multi-colour imaging flow cytometry

Cryopreservation of platelets, at − 80 °C with 5–6% DMSO, results in externalisation of phosphatidylserine and the formation of extracellular vesicles (EVs), which may mediate their procoagulant function. The phenotypic features of procoagulant platelets overlap with other platelet subpopulations. The aim of this study was to define the phenotype of in vitro generated platelet subpopulations, and subsequently identify the subpopulations present in cryopreserved components. Fresh platelet components (n = 6 in each group) were either unstimulated as a source of resting platelets; or stimulated with thrombin and collagen to generate a mixture of aggregatory and procoagulant platelets; calcium ionophore (A23187) to generate procoagulant platelets; or ABT-737 to generate apoptotic platelets. Platelet components (n = 6) were cryopreserved with DMSO, thawed and resuspended in a unit of thawed plasma. Multi-colour panels of fluorescent antibodies and dyes were used to identify the features of subpopulations by imaging flow cytometry. A combination of annexin-V (AnnV), CD42b, and either PAC1 or CD62P was able to distinguish the four subpopulations. Cryopreserved platelets contained procoagulant platelets (AnnV+/PAC1−/CD42b+/CD62P+) and a novel population (AnnV+/PAC1−/CD42b+/CD62P−) that did not align with the phenotype of aggregatory (AnnV−/PAC1+/CD42b+/CD62P+) or apoptotic (AnnV+/PAC1−/CD42b−/CD62P−) subpopulations. These data suggests that the enhanced haemostatic potential of cryopreserved platelets may be due to the cryo-induced development of procoagulant platelets, and that additional subpopulations may exist.

Responsiveness to Platelet Transfusions in Pediatric Patients with Thrombocytopenia: Incidence, Clinical Variables.

Refractoriness to platelet transfusion has not been adequately studied in pediatric patients with thrombocytopenia. Our objectives were: (1) to describe the practice of platelet transfusion in pediatric patients with thrombocytopenia of various etiologies; (2) to assess the responsiveness to platelet transfusions and clinical variables affecting platelet transfusions response; and (3) to evaluate incidence of PTR. A retrospective study included pediatric patients with thrombocytopenia admitted to a tertiary children's hospital who received ≥ 1 platelet transfusion during hospitalization. Responsiveness was measured by corrected count increment (CCI), poor platelet transfusion response (PPTR), and platelet transfusion refractoriness (PTR). A total of 334 patients were eligible for the study and received 1,164 transfusions, with a median of 2 (IQR: 1 - 5) platelet transfusions. Patients admitted with hematologic malignancies had the highest median number of platelet transfusions (5, IQR: 4 - 10). The median CCI of 1,164 platelet post-transfusions was 17.0 (IQR: 9.4 - 24.6) and the incidence of PPTR was 11.9%. Patients admitted with ITP had the lowest median CCI (7.6, IQR: 1.0 - 12.5) and the highest incidence of PPTR (36.4%, 8/22). Older age of platelet components, low doses of platelet transfusion, increasing number of platelet transfusions (≥ 5), splenomegaly, bleeding, DIC, shock, ECMO supported, and HLA antibody-positive were independent risk factors for PPTR. Finally, the incidence of PTR was 11.4%. Practical experience of clinicians regarding the use of apheresis platelets in pediatric patients is determined. Highlight that PTR is not a low probability event when apheresis platelets are received in pediatric patients.

Recommendations for in vitro evaluation of blood components collected, prepared and stored in non-DEHP medical devices.

DEHP, di(2-ethylhexyl) phthalate, is the most common member of the class of ortho-phthalates, which are used as plasticizers. The Medical Device Regulation has restricted the use of phthalates in medical devices. Also DEHP has been added to the Annex XIV of REACH, "Registration, Evaluation, Authorisation and Restriction of Chemicals" due to its endocrine disrupting properties to the environment. As such, the sunset date for commercialisation of DEHP-containing blood bags is May 27th 2025. There are major concerns in meeting this deadline as these systems have not yet been fully validated and/or CE-marked. Also, since DEHP is known to affect red cell quality during storage, it is imperative to transit to non-DEHP without affecting blood product quality. Here, EBA members aim to establish common grounds on the evaluation and assessment of blood components collected, prepared and stored in non-DEHP devices. Based on data as well as the input of relevant stakeholders a rationale for the validation of each component was composed. The red cell components will require the most extensive validation as their quality is directly affected by the absence of DEHP, as opposed to platelet and plasma components. Studies in the scope of evaluating the quality of blood products obtained with non-DEHP devices, under the condition that they are carried out according to these recommendations, could be used by all members of the EBA to serve as scientific support in the authorization process specific to their jurisdiction or for their internal validation use.

Platelet components and bacterial contamination: hospital perspective 2022

Bacterial contamination of platelet units has been one of the most common transfusion-transmitted infections. Approximately 4 to 7 fatalities are being reported to the US Food and Drug Administration (FDA) annually, which cites bacterially contaminated platelet units as the cause. Over the past 3 decades, different mitigation strategies have been introduced to minimize the risk of morbidity and mortality related to contaminated platelet units. The process of platelet collection and manufacturing as well as storage at 20°C to 24°C contributes to higher prevalence of contaminated units. The risk of transfusing bacterially contaminated platelets can be lowered using different types of interventions. Prevention of bacterial contamination can be done by strict adherence to techniques that minimize contamination during unit collection. The detection of bacteria in platelet products can be improved with a combination of rapid testing and bacterial cultures that involve large volume and delayed sampling. Finally, pathogen reduction can inactivate bacteria or other pathogens present in the unit. This article describes different strategies that blood centers and transfusion services have undertaken since October 2021 to meet FDA guidance requirements. Market forces as well as feasibility of different FDA-proposed approaches have limited the number of practical solutions to just a few. In addition, the blood product availability required hospitals to adopt more progressive strategies to provide patients with needed platelet products.

THE QUANTRA PCS, PLATELET CONTRIBUTION TO CLOT STIFFNESS, PARAMETER IS CLINICALLY USEFUL TO IDENTIFY PLATELET-DEPENDENT BLEEDING IN HIGH-RISK CARDIAC SURGERY PATIENTS

<h3>Objective</h3> Postoperative use of platelet function testing in order to rule out microvascular bleeding due to platelet dysfunction after cardiac surgery still lacks strong reference data and reliable cut-off values. We investigated the performance of two different point-of-care viscoelastic devices and platelet aggregometry in expressing surgery-dependent platelet dysfunction and anticipating postoperative major bleeding in a cohort of high-risk patients. <h3>Design and Method</h3> This is a prospective cohort study on 50 adult patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) being on antiplatelet drugs discontinued for no more than 7 days (clopidogrel, prasugrel) or 5 days (ticagrelor). Coagulation and platelet function testing, including QUANTRA, ROTEM and Multiplate were assessed preoperatively and postoperatively. Chest drain blood loss was measured in the first 12 postoperative hours. Perioperative bleeding was assessed using the Universal Definition of Perioperative Bleeding (UDPB) in cardiac surgery, modified to not consider anemia-correcting packed red cells transfusions in absence of bleeding > 600 ml/12 h. Major bleeding was identified as UDPB class II or higher. <h3>Results</h3> The QUANTRA Platelet contribution to Clot Stiffness (PCS) was significantly (P=0.001) reduced after CPB. Multiplate ADPtest was significantly (P=0.001) reduced, as well, whereas TRAPtest was not. The platelet component (PC) as extrapolated by ROTEM data (EXTEM MCF – FIBTEM MCF) was unchanged after CPB, while the A10 PC (PC at 10 minutes) significantly (P=0.001) decreased. At regression analysis of the preoperative and postoperative platelet function parameters, there was a significant linear correlation (P=0.001) for the PCS, A10 PC and ADPtest. At the ROC analysis for the predictive ability of the post-CPB platelet function testing, the best discrimination was obtained by the QUANTRA PCS, with an AUC of 0.788, followed by the ROTEM A10 PC (AUC 0.765) and PC (AUC 0.758). The Multiplate tests did not achieve an AUC > 0.70. The cut off values identified for the QUANTRA PCS (10.5 hPa), the ROTEM A10 PC (38 mm) and for the ROTEM PC (47 mm) yielded a combination of a negative predictive value > 80% and a positive predictive value > 67%. <h3>Conclusions</h3> QUANTRA PCS, ROTEM A10 PC, and Multiplate ADPtest reflect the post-CPB platelet dysfunction, whereas ROTEM PC and Multiplate TRAPtest do not. Major bleeding was predicted with a moderate degree of discrimination by the post-CPB viscoelastic tests (PCS, PC, A10 PC) but not by the Multiplate tests.

Features of platelet and plasma hemostasis in premature infants with hemorrhagic disorders

The research revealed features of platelet and plasma hemostasis indicators in children born before 32 weeks with hemorrhagic disorders in the early neonatal period, a method for predicting the development of intraventricular hemorrhage was developed.Material and methods. 132 premature newborns were examined, a detailed clinical blood test, a coagulogram with the determination of: activated partial thromboplastin time, prothrombin time, thrombin time, prothrombin index, fibrinogen content, D-dimer were performed on 1–3 days of life. The main group consisted of 58 children with hemorrhagic disorders, the comparison group included 74 children without hemorrhagic disorders.Results. Risk factors for the formation of hemorrhagic disorders in the early neonatal period were established: a lower gestational age of the child, lower Apgar scores at the end of the first and fifth minutes of life, the need for the introduction of an exogenous surfactant, and the use of higher concentrations of oxygen-air mixture during respiratory therapy. The features of hemostasis indicators in deep-premature newborns with hemorrhagic disorders in the early neonatal period were revealed: a lower number of platelets in the blood and higher platelet granularity, higher activated partial thromboplastin time, and a decrease in the prothrombin index. Based on the data obtained, a new method for predicting the formation of intraventricular hemorrhage in deeply premature newborns is proposed based on determining the concentration of total Ca2+ in the blood and the average concentration of platelet components. The results of this study can be used in intensive care units for newborns. Conclusion. The implementation of the obtained results in practice will help timely assess the state of hemostasis in deeply premature newborns to predict the development of intraventricular hemorrhages in the early neonatal period.

Bacterial culture time to detection in platelet components: An evidence synthesis and estimation of detection failures.

Non-pathogen reduction platelet bacterial risk control strategies in the US FDA guidance include at least one culture. Almost all of these strategies have a culture hold time of ≥12 h. Studies have reported time to detection (TTD) of bacterial cultures inoculated with bacteria from contaminated platelets, but these data and estimates of risk associated with detection failures have not been synthesized. We performed a literature search to identify studies reporting TTD for samples obtained from spiked platelet components. Using extracted data, regression analysis was used to estimate TTD for culture bottles at different inoculum sizes. Detection failures were defined as events in which contaminated components are transfused to a patient. We then used published data on time of transfusion (ToT) to estimate the risk of detection failures in practice. The search identified 1427 studies, of which 16 were included for analysis. TTD data were available for 16 different organisms, including 14 in aerobic cultures and 11 in anaerobic cultures. For inocula of 1 colony forming unit (CFU), the average TTD for aerobic organisms was 19.2h while it was 24.9h in anaerobic organisms, but there was substantial overall variation. A hold time of 12 versus 24 h had minimal effect for most organisms. TTD variation occurs between bacterial species and within a particular species. Under typical inventory management, the relative contribution of culture detection failures is much smaller than the residual risk from sampling failures. Increasing the hold period beyond 12 h has limited value.

Are Viscoelastic Tests Clinically Useful to Identify Platelet-Dependent Bleeding in High-Risk Cardiac Surgery Patients?

Postoperative use of platelet function testing to rule out microvascular bleeding due to platelet dysfunction after cardiac surgery still lacks strong reference data and reliable cutoff values, yielding a clinically adequate sensitivity and specificity. The present study aims to investigate the performance of two different point-of-care viscoelastic devices and platelet aggregometry in expressing surgery-dependent platelet dysfunction and anticipating postoperative major bleeding in a cohort of high-risk patients. Prospective cohort study of 50 adult patients who were on antiplatelet drugs discontinued for no more than 7 days (clopidogrel and prasugrel) or 5 days (ticagrelor) undergoing cardiac surgery with cardiopulmonary bypass (CPB). Coagulation and platelet function testing, including QUANTRA, ROTEM, and Multiplate, were assessed preoperatively and postoperatively. Chest drain blood loss was measured in the first 12 postoperative hours. Perioperative bleeding was assessed using a modified version of the Universal Definition of Perioperative Bleeding (UDPB) in cardiac surgery, modified to not consider anemia-correcting packed red cells transfusions in the absence of bleeding >600 mL/12 h. Major bleeding was identified as UDPB class II or higher. Multiplate adenosine diphosphate (ADPtest) was significantly ( P = .001) reduced after CPB, whereas TRAPtest was not. The platelet component (PC) as extrapolated by ROTEM data (EXTEM MCF-FIBTEM MCF) was unchanged after CPB, while the A10 PC (PC at 10 minutes) was significantly ( P = .001) reduced. The QUANTRA platelet contribution to clot stiffness (PCS) was significantly ( P = .001) reduced, as well. At the ROC analysis for the predictive ability of the post-CPB platelet function testing, the best discrimination was obtained by the QUANTRA PCS, with an area under the curve (AUC) (95% confidence interval [CI]) of 0.80 (0.66-0.91), P = .001, followed by the ROTEM A10 PC with AUC (95% CI) of 0.75 (0.51-0.99), P = .004, and PC with AUC (95% CI) of 0.74 (0.50-0.99), P = .009. The Multiplate ADPtest had an AUC (95% CI) of 0.67 (0.42-0.91), and the TRAPtest had an AUC (95% CI) of 0.62 (0.37-0.86). The cutoff values identified were 13 hPa for the QUANTRA PCS, 40 mm for the ROTEM A10, and 48.5 mm for the ROTEM PC, with negative predictive values of 84%, 81%, and 86%, respectively, and positive predictive values of 55%, 53%, and 69%, respectively. QUANTRA PCS, ROTEM A10 PC, and Multiplate ADPtest showed a significant decrease after CPB, whereas ROTEM PC and Multiplate TRAPtest did not. Major bleeding was predicted with a moderate to good discrimination by the post-CPB viscoelastic tests (PCS, PC, and A10 PC).

Влияние масла черного тмина на различные звенья гемостаза крыс в условиях экзогенной тромбинемии

Black cumin oil has a rich phytochemical composition and is widely used as a dietary supplement for preventive purposes. However, there is a lack of scientific data on its effect on haemostasis. Thus, the purpose of this paper was to study the nature of the effect of the dietary supplement Ethiopian Black Cumin Oil on the platelet and coagulation components of the coagulation system under experimental thrombinemia. Materials and methods. The research involved 60 white non-inbred male rats. The following haemostasis parameters under exogenous thrombinemia were studied: prothrombin time, thrombin time, activated partial thromboplastin time, content of fibrinogen and soluble fibrin monomer complexes, antithrombin III activity, total platelet count and the ratio of different forms of platelets. Results. The research showed that pre-administration, in the course of 21 days, of black cumin oil to rats (experimental group) increases their tolerance to thrombin, limiting excessive platelet activation, development of thrombocytopenia and consumption coagulopathy compared with the control group. The data obtained during the experiment revealed a protective effect of oral administration of black cumin oil under provoked hypercoagulation stress. Сonsumption coagulopathy in the test group was less pronounced after 0.5 hours of experimental thrombinemia; after 1 hour, haemostasis parameters returned to baseline values at a faster rate compared to the control. The supposed mechanism behind this effect is the ability of the antioxidants in this dietary supplement to limit the processes of free radical oxidation: black cumin is a combined natural antioxidant rich in flavonoids, phenolic acids, tannins and terpene compounds. The results of the research indicate good prospects for further studies into the effect of the dietary supplement Ethiopian Black Cumin Oil on various components of haemostasis as a non-specific agent.

Bacterial contamination of platelet components

Bacterial contamination of platelet components

Seven years (2015-2021) of blood donor screening for HEV-RNA in France: lessons and perspectives.

The French health authorities are considering expanding the current selective HEV-RNA testing procedure to include all donations in order to further reduce transfusion-transmitted HEV infection. Data obtained from blood donors (BDs) tested for HEV-RNA between 2015 and 2021 were used to assess the most efficient nucleic acid testing (NAT) strategy. Viral loads (VLs) and the plasma volume of blood components, as well as an HEV-RNA dose of 3.85 log IU as the infectious threshold and an assay with a 95% limit of detection (LOD) at 17 IU/mL, were used to assess the proportion of: (i) HEV-RNA-positive BDs that would remain undetected; and (ii) blood components associated with these undetected BDs with an HEV-RNA dose >3.85 log IU, considering 4 NAT options (Individual testing [ID], MP-6, MP-12, and MP-24). Of the 510,118 BDs collected during the study period, 510 (0.10%) were HEV-RNA-positive. Based on measurable VLs available in 388 cases, 1%, 15.2%, 21.8%, and 32.6% of BDs would theoretically pass undetected due to a VL below the LOD of ID, MP-6, MP-12, and MP-24 testing, respectively. All BDs associated with a potentially infectious blood component would be detected with ID-NAT while 13% of them would be undetected with MP-6, 19.6% with MP-12, and 30.4% with MP-24 depending on the plasma volume. No red blood cell (RBC) components with an HEV-RNA dose >3.85 log IU would enter the blood supply, regardless of the NAT strategy used. A highly sensitive ID-NAT would ensure maximum safety. However, an MP-based strategy can be considered given that: (i) the risk of transmission is closely related to the plasma volume of blood components; (ii) RBC are the most commonly transfused components and have a low plasma content; and (iii) HEV-RNA doses transmitting infection exceed 4 log IU. To minimise the potential risk associated with apheresis platelet components and fresh frozen plasma, less than 12 donations should be pooled using an NAT assay with a LOD of approximately 20 IU/mL.

A Comprehensive Review on Efficacy of Leukocyte and Platelet-rich Fibrin (L-PRF) Administration in Reconstruction of Oral and Maxillofacial Structures

Several studies have shown that growth factors are effective in soothing inflammatory processes involved in the initial hemostasis phase of wound healing. Leukocyte and platelet-rich fibrin (L-PRF) is the second generation of concentrated platelets that have been shown to stimulate the proliferation of osteoblasts, gingival fibroblasts, and periodontal ligament cells. Rich platelet components have an immune function and antibacterial properties, which play a critical role in the wound healing process. The present study aimed to review the reported documents on L-PRF administration in regeneration and wound healing of oral and maxillofacial surgeries. The research was performed using well-known medical databases to find controlled clinical trials that used L-PRF as a cotreatment strategy during oral and maxillofacial surgeries. Eligible articles published between 2000 and 2022 in PubMed, Web of Science, Science Direct, and Scopus databases were selected for this review. According to the results of this study, L-PRF has significant effectiveness as a maxillofacial regenerative therapy by improving para-clinical parameters after surgery. However, more clinical practice and additional research are essential for the development of this complementary treatment method

Evaluation of amotosalen and UVA pathogen-reduced apheresis platelets after 7-day storage.

BackgroundAmotosalen/UVA pathogen‐reduced platelet components (PRPCs) with storage up to 7 days are standard of care in France, Switzerland, and Austria. PRPCs provide effective hemostasis with reduced risk of transfusion‐transmitted infections and transfusion‐associated graft versus host disease, reduced wastage and improved availability compared with 5‐day‐stored PCs. This study evaluated the potency of 7‐day PRPCs by in vitro characterization and in vivo pharmacokinetic analysis of autologous PCs.Study Design and MethodsThe in vitro characteristics of 7‐day‐stored apheresis PRPCs suspended in 100% plasma or 65% platelet additive solution (PAS‐3)/35% plasma, thrombin generation, and in vivo radiolabeled post‐transfusion recovery and survival of 7‐day‐stored PRPCs suspended in 100% plasma were compared with either 7‐day‐stored or fresh autologous conventional platelets.ResultsPRPCs after 7 days of storage maintained pH, platelet dose, in vitro physiologic characteristics, and thrombin generation when compared to conventional 7‐day PCs. In vivo, the mean post‐transfusion survival was 151.4 ± 20.1 h for 7‐day PRPCs in 100% plasma (Test) versus 209.6 ± 13.9 h for the fresh autologous platelets (Control), (T‐ΔC: 72.3 ± 8.8%: 95% confidence interval [CI]: 68.5, 76.1) and mean 24‐h post‐transfusion recovery 37.6 ± 8.4% for Test versus 56.8 ± 9.2% for Control (T‐ΔC: 66.2 ± 11.2%; 95% CI: 61.3, 71.1).DiscussionPRPCs collected in both 100% plasma as well as 65% PAS‐3/35% plasma and stored for 7 days retained in vitro physiologic characteristics. PRPCs stored in 100% plasma for 7 days retained in vivo survival. Lower in vivo post‐radiolabeled autologous platelet recovery is consistent with reported reduced count increments for allogenic transfusion.

SARS-CoV-2 pandemic and its impact on blood transfusion services: challenges, experience and lessons learnt at king Abdullah medical city, Makkah, Saudi Arabia

SARS-COVID (COVID-19) epidemic is a great challenge for blood transfusion practice. Hospitals were overwhelmed with increasing number of admitted patients with severe COVID-19 infections as well as limitation of variable medical and pharmaceutical resources partly due to lockdown. This retrospective study analyzes the transfusion medicine practice and approach of health institution toward the pandemics before and during the pandemic era over the four years period, 2018 through 2021. Data was collected from blood bank records and laboratory information system for the whole blood donors, apheresis platelets donors, numbers and types of prepared blood components, details of blood components storage and expiry, and blood components for the study period. The data analyzed showed that the total number of whole blood donors dropped during 2020. However, there is a steady increase in number of voluntary non-numerated whole blood donors. The production of packed Red Blood Cells units, Fresh Frozen Plasma units, and Cryoprecipitate units were actually more or less similar or slightly higher in 2020 compared to 2019 and 2018. However, the production of Platelets components showed a drop during 2020. The transfusion for patients at the institution has slightly increased for 2020 compared to 2019. Therefore, the need to procure blood components from other facilities was increased in 2020 compared to pre COVID-19 pandemics. The percentage of expired and wasted blood components units steadily decreasing over the past few years. The data of expired and or wasted collected blood components were compared through the study period and it illustrates that the percentage of expired and wasted units was steadily dropped over the years. This to mention that automated blood transfusion system was implemented late 2019 and put in full effect in 2020. The presence of validated and secured electronic system supports blood bank to eliminate the number of expired and wasted units due to proper inventory management. Along with all the hard work to maintain adequate and safe blood supply to increasing requests of blood transfusion, blood bank at KAMC participated in the national multidisciplinary study of Convalescent Plasma use for critically ill COVID-19 patients.

Gamma and X-ray irradiation do not affect the in vitro quality of refrigerated apheresis platelets in platelet additive solution (PAS-E).

Platelet refrigeration (cold storage) provides the advantages of an extended shelf life and reduces the risk of bacterial growth, compared to platelets stored at room temperature (RT). However, processing modifications, such as irradiation, may further improve the safety and/or alter the quality of cold-stored platelets. Platelet components are irradiated to prevent transfusion-associated graft versus host disease (TA-GvHD) in high-risk patients; and while irradiation has little effect on the quality of RT-stored platelet components, there is no data assessing the effect irradiation has following cold storage. Triple-dose apheresis platelets were collected in 40% plasma/60% PAS-E, using the TRIMA apheresis platform, and refrigerated (2-6°C) within 8h of collection. On day 2, one of each component was gamma or X-ray irradiated or remained non-irradiated. Platelets were tested over 21 days. The platelet concentration decreased by approximately 20% in all groups during 21 days of storage (p > .05). Irradiation (gamma or X-ray) did not affect platelet metabolism, and the pH was maintained above the minimum specification (>6.4) for 21 days. The surface phenotype and the composition of the supernatant was similar in non-irradiated and irradiated platelets, regardless of the source of radiation. Functional responses (aggregation and clot formation) were not affected by irradiation. Gamma and X-ray irradiation do not affect the in vitro quality of platelet components stored in the cold for up to 21 days. This demonstrates the acceptability of irradiating cold-stored platelets, which has the potential to improve their safety for at-risk patient cohorts.

Comparative risk of pulmonary adverse events with transfusion of pathogen reduced and conventional platelet components.

BackgroundPlatelet transfusion carries risk of transfusion‐transmitted infection (TTI). Pathogen reduction of platelet components (PRPC) is designed to reduce TTI. Pulmonary adverse events (AEs), including transfusion‐related acute lung injury and acute respiratory distress syndrome (ARDS) occur with platelet transfusion.Study designAn open label, sequential cohort study of transfusion‐dependent hematology‐oncology patients was conducted to compare pulmonary safety of PRPC with conventional PC (CPC). The primary outcome was the incidence of treatment‐emergent assisted mechanical ventilation (TEAMV) by non‐inferiority. Secondary outcomes included: time to TEAMV, ARDS, pulmonary AEs, peri‐transfusion AE, hemorrhagic AE, transfusion reactions (TRs), PC and red blood cell (RBC) use, and mortality.ResultsBy modified intent‐to‐treat (mITT), 1068 patients received 5277 PRPC and 1223 patients received 5487 CPC. The cohorts had similar demographics, primary disease, and primary therapy. PRPC were non‐inferior to CPC for TEAMV (treatment difference −1.7%, 95% CI: (−3.3% to −0.1%); odds ratio = 0.53, 95% CI: (0.30, 0.94). The cumulative incidence of TEAMV for PRPC (2.9%) was significantly less than CPC (4.6%, p = .039). The incidence of ARDS was less, but not significantly different, for PRPC (1.0% vs. 1.8%, p = .151; odds ratio = 0.57, 95% CI: (0.27, 1.18). AE, pulmonary AE, and mortality were not different between cohorts. TRs were similar for PRPC and CPC (8.3% vs. 9.7%, p = .256); and allergic TR were significantly less with PRPC (p = .006). PC and RBC use were not increased with PRPC.DiscussionPRPC demonstrated reduced TEAMV with no excess treatment‐related pulmonary morbidity.

Platelet dysfunction after trauma: From mechanisms to targeted treatment.

Platelet dysfunction after trauma: From mechanisms to targeted treatment.