Platelet transfusion: The effects of a fluid warmer on platelet function

IntroductionPlatelet dysfunction (thrombocytopathy) is a major problem in the bleeding patient and increases morbidity and healthcare costs. The thrombocytopathy resulting from cardiopulmonary bypass (CPB) can be used to study therapies targeted to improve outcomes in other scenarios, such as trauma. Platelet transfusion is used widely to correct thrombocytopathy. However, the current standard, room temperature stored platelets (RTP) have several disadvantages including; short shelf life, risk of bacterial contamination and deterioration in platelet function during storage. Cold stored platelets (CSP) are a potential alternative product with longer shelf life, reduced contamination risk and better-preserved platelet function.MethodsUsing ex vivo mixing studies, we investigated whether CSP were better able to reverse the thrombocytopathy associated with cardiac surgery than RTP. Blood samples were collected from 20 cardiac surgery patients. Donor platelets were split into two bags and stored at either 4°C (CSP), or 22°C (RTP) for up to seven days. The donor platelets were mixed with the patient blood samples to simulate platelet transfusion. The mixed samples were analysed using the TEG 5000 and using a collagen coated flow chamber at arterial shear. Patient samples were analysed alongside healthy controls (n = 20).ResultsAfter mixing the patient samples with CSP, the TEG R times were shorter than in samples mixed with RTP (p<0.0001), indicating more rapid initiation of clot formation. In the flow chamber experiments, the clot volume was greater in the patient samples mixed with CSP compared with samples mixed with RTP (p<0.0001).ConclusionsThese findings suggest that CSP, but not RTP can partially reverse the thrombocytopathy associated with cardiac surgery ex vivo, at clinically relevant mixing volumes. Reversal of thrombocytopathy by mixing CSP was greatest in the arterial shear model, which may indicate superior in vivo efficacy that requires confirmation in clinical trials.* this abstract presentation was awarded First Place.

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Implementation of Perioperative Point-of-Care Platelet Function Analyses Reduces Transfusion Requirements in Cardiac Surgery: A Retrospective Cohort Study

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0040-1710582 ◽

2020 ◽

Author(s):

Lihui Wang ◽

Oswaldo Valencia ◽

Simon Phillips ◽

Vivek Sharma

Keyword(s):

Blood Loss ◽

Red Blood Cells ◽

Platelet Function ◽

Blood Cells ◽

Platelet Transfusion ◽

Postoperative Blood Loss ◽

Transfusion Rate ◽

Cabg Surgery ◽

Packed Red Blood Cells ◽

Before And After

Abstract Background Platelet dysfunction is a common cause of bleeding, perioperative blood transfusion, and surgical re-exploration in cardiac surgical patients. We evaluated the effect of incorporating a platelet function analyzer utilizing impedance aggregometry (Multiplate, Roche, Munich, Germany) into our local transfusion algorithm on the rate of platelet transfusion and postoperative blood loss in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods Data were collected on patients undergoing CABG surgery from January 2015 to April 2017. Patients who underwent surgery before and after introduction of this algorithm were classified into prealgorithm and postalgorithm groups, respectively. The primary outcome was the rate of platelet transfusion before and after implementation of the Multiplate-based transfusion algorithm. Secondary outcomes included transfusion rate of packed red blood cells, postoperative blood loss at 12 and 24 hours, length of stay in the intensive care unit, and the hospital and mortality. Results A total of 726 patients were included in this analysis with 360 and 366 patients in the pre- and postalgorithm groups, respectively. Transfusion rates of platelets (p = 0.01) and packed red blood cells (p = 0.0004) were significantly lower following introduction of the algorithm in patients (n = 257) who had insufficient time to withhold antiplatelet agents. Receiver operating characteristic curves defined optimal cutoff points of arachidonic acid and adenosine diphosphate assays on the Multiplate to predict future platelet transfusion were 23AU and 43AU, respectively. Conclusions The introduction of a Multiplate-based platelet transfusion algorithm showed a statistically significant reduction in the administration of platelets to patients undergoing urgent CABG surgery.

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Calcium Ion Chelation Preserves Platelet Function During Cold Storage

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.120.314879 ◽

2020 ◽

Author(s):

Binggang Xiang ◽

Guoying Zhang ◽

Yan Zhang ◽

Congqing Wu ◽

Smita Joshi ◽

...

Keyword(s):

Platelet Function ◽

Cold Storage ◽

Calcium Ion ◽

Platelet Transfusion ◽

Room Temperature ◽

Underlying Mechanism ◽

Integrin Activation ◽

Life Saving ◽

A Cell ◽

Rapid Clearance

Objective: Platelet transfusion is a life-saving therapy to prevent or treat bleeding in patients with thrombocytopenia or platelet dysfunction. However, for >6 decades, safe and effective strategies for platelet storage have been an impediment to widespread use of platelet transfusion. Refrigerated platelets are cleared rapidly from circulation, precluding cold storage of platelets for transfusion. Consequently, platelets are stored at room temperature with an upper limit of 5 days due to risks of bacterial contamination and loss of platelet function. This practice severely limits platelet availability for transfusion. This study is to identify the mechanism of platelet clearance after cold storage and develop a method for platelet cold storage. Approach and Results: We found that rapid clearance of cold-stored platelets was largely due to integrin activation and apoptosis. Deficiency of integrin β3 or caspase-3 prolonged cold-stored platelets in circulation. Pretreatment of platelets with EGTA, a cell impermeable calcium ion chelator, reversely inhibited cold storage-induced platelet activation and consequently prolonged circulation of cold-stored platelets. Moreover, transfusion of EGTA-treated, cold-stored platelets, but not room temperature-stored platelets, into the mice deficient in glycoprotein Ibα significantly shortened tail-bleeding times and diminished blood loss. Conclusions: Integrin activation and apoptosis is the underlying mechanism of rapid clearance of platelets after cold storage. Addition of a cell impermeable calcium ion chelator to platelet products is potentially a simple and effective method to enable cold storage of platelets for transfusion.

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Restoration of platelet function with platelet transfusion in cardiac surgery patients on dual antiplatelet therapy

European Heart Journal ◽

10.1093/eurheartj/eht310.p4873 ◽

2013 ◽

Vol 34 (suppl 1) ◽

pp. P4873-P4873 ◽

Cited By ~ 1

Author(s):

S. O'Connor ◽

M. Rejane ◽

J. Amour ◽

J. Abtan ◽

M. Kerneis ◽

...

Keyword(s):

Cardiac Surgery ◽

Antiplatelet Therapy ◽

Platelet Function ◽

Platelet Transfusion ◽

Dual Antiplatelet Therapy

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Perioperative Coagulation Management and Control of Platelet Transfusion by Point-of-Care Platelet Function Analysis

Transfusion Medicine and Hemotherapy ◽

10.1159/000109642 ◽

2007 ◽

Vol 34 (6) ◽

pp. 396-411 ◽

Cited By ~ 58

Author(s):

Klaus Görlinger ◽

Csilla Jambor ◽

Alexander A. Hanke ◽

Daniel Dirkmann ◽

Michael Adamzik ◽

...

Keyword(s):

Platelet Function ◽

Platelet Transfusion ◽

Function Analysis ◽

Point Of Care ◽

Coagulation Management ◽

And Control

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Ontogeny of platelet function

Blood Advances ◽

10.1182/bloodadvances.2018024372 ◽

2019 ◽

Vol 3 (4) ◽

pp. 692-703 ◽

Cited By ~ 6

Author(s):

Andreas Margraf ◽

Claudia Nussbaum ◽

Markus Sperandio

Keyword(s):

Clinical Practice ◽

Premature Infants ◽

Platelet Function ◽

Potential Risk ◽

Platelet Transfusion ◽

Transfusion Practice ◽

The Other ◽

Fetal Life ◽

The One ◽

Reactive Properties

AbstractAlthough the hemostatic potential of adult platelets has been investigated extensively, regulation of platelet function during fetal life is less clear. Recent studies have provided increasing evidence for a developmental control of platelet function during fetal ontogeny. Fetal platelets feature distinct differences in reactive properties compared with adults. These differences very likely reflect a modified hemostatic and homeostatic environment in which platelet hyporeactivity contributes to prevent pathological clot formation on the one hand but still ensures sufficient hemostasis on the other hand. In this review, recent findings on the ontogeny of platelet function and reactivity are summarized, and implications for clinical practice are critically discussed. This includes current platelet-transfusion practice and its potential risk in premature infants and neonates.

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The Role of Monitoring Platelet Function Perioperatively and Platelet Transfusion for Operated Spontaneous Intracerebral Hemorrhage Patients With Long-term Oral Antiplatelet Therapy: A Case Report

10.21203/rs.3.rs-51323/v1 ◽

2020 ◽

Author(s):

Kaiwen Wang ◽

Maogui Li ◽

Qingyuan Liu ◽

Jun Wu ◽

Yong Cao ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Antiplatelet Therapy ◽

Platelet Function ◽

Platelet Transfusion ◽

Perioperative Period ◽

Spontaneous Intracerebral Hemorrhage ◽

Platelet Dysfunction ◽

Ischemic Events

Abstract Spontaneous intracerebral hemorrhage (SICH) with long term oral antiplatelet therapy (LOAPT) is known as a dilemma in balancing the risk of postoperative rebleeding and ischemic events because of confused coagulation function. In this case, the authors reported a 42 year old male SICH patient on LOAPT who received an emergency craniectomy. The thromboelastography suggested that the inhibition of platelet function was high preoperatively. After platelet transfusion during surgery and taking control of the clotting and platelet function postoperatively, the patient was stable without rebleeding and new ischemic events in perioperative period and recovered satisfactorily. The authors presented the importance of monitoring coagulation and platelet function perioperatively for SICH patients on LOAPT. Postoperatively, monitoring and taking control of clotting and platelet function would help in preventing rebleeding and ischemic events in SICH patients on LOAPT; moreover, platelet transfusion may quickly and safely reverse platelet dysfunction for emergency surgery.

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