The Functional Integrity of Platelets in Volume-Reduced Platelet Concentrates

Abstract

Premature and low-birth-weight infants usually require small-volume platelet transfusions to treat thrombocytopenia. Also, infants undergoing open-heart surgery with extracorporeal circulation and with compromised cardiac function are at risk for excessive intravascular volume. The small-volume platelet substitution can be achieved by dispensing an aliquot from the unit of a standard single-donor platelet concentrate (PC). Alternatively, there is an indication for volume reduction of PCs to maximize the number of platelets transfused in the smallest possible volume. We determined the spontaneous and induced activation of platelets before and after volume reduction in 20 consecutive single-donor-apheresis PCs. After a mean storage time of 2 days, the PCs were plasma-depleted by centrifugation. Spontaneous, adenosine diphosphate (ADP)-induced, and collagen-induced activation were determined by flow cytometry. Furthermore, ADP- and collagen-induced aggregation were measured. A total of 33.8% of platelets in standard PCs were activated spontaneously. Volume reduction of PCs led to a mild but significant increase of spontaneous activation of platelets (43.2%). Additionally, volume reduction resulted in an impaired ADP-induced aggregability of platelets, whereas collagen induction was unaffected. Transfusion of volume-reduced PCs is an effective alternative to use of standard PCs in patients at frequent risk for excessive intravascular volume, because equal volumes increase the platelet count twice as effectively.

Effects of storage duration and volume on the quality of leukoreduced apheresis‐derived platelets: implications for pediatric transfusion medicine

“…7 Furthermore, volume reduction of LR-ADP, a common practice in neonatal and pediatric transfusion medicine, has been reported to result in increased spontaneous in vitro PLT activation with resultant decreased aggregability. 16 Still, another publication has shown that PLT components with altered volumes maintained under original storage conditions have acceptable pH concentrations with the current FDA and AABB standards and have no significant difference in the improvement of posttransfusion PLT increments when compared to unaltered volume products, suggesting that these manipulated products may be as efficacious. 17 Despite impaired aggregation in vitro, transfusion of PLTs with metabolic derangements accrued over 5 days of storage has resulted in recovery of PLT function in vivo.…”

Washed and Volume-Reduced Blood Components

“…94 There is no standard method for preparing volume-reduced platelet concentrates. [80][81][95][96][97][98][99] If secondary volume reduction of platelet components is necessary, the authors recommend the method of Moroff and colleagues. [80][81][95][96][97][98][99] If secondary volume reduction of platelet components is necessary, the authors recommend the method of Moroff and colleagues.…”

Platelet transfusions to infants

“…Although reported methods exist to reduce the volume of PLT concentrates when truly warranted (i.e. many PLT transfusions anticipated in which multiple doses of passive anti‐A or –B can not be avoided), additional processing should be performed with great care because of probable PLT loss, clumping, and dysfunction caused by the additional handling [1,11,12]. If a reasonable immediate post‐transfusion blood PLT count is not achieved by transfusing 10 ml/kg of unmodified PLTs and infusing a larger volume (e.g.…”