Frozen platelets in clinical praxis: comparative study of native platelets
Authors:
M. Bohoněk 1; D. Kutáč 1; L. Landová 1; M. Kořánová 1; E. Sládková 1; E. Stašková 1; M. Voldřich 2; T. Tyll 2
Authors‘ workplace:
Oddělení hematologie a krevní transfuze, Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha
1; Klinika anestesiologie, resuscitace a intenzivní medicíny 1. LF UK a ÚVN, Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha
2
Published in:
Transfuze Hematol. dnes,22, 2016, No. 4, p. 268-278.
Category:
Comprehensive Reports, Original Papers, Case Reports
Overview
Platelets stored at 20–24 °C have a short shelf life. This complicates the logistics of production, distribution and access when required for clinical use. This limitation is especially problematic for emergency and intensive care departments managing massive bleeding. The early and aggressive use of blood products for massive haemorrhage may correct coagulopathy, control bleeding, and improve outcomes. The timely availability of platelets as part of a massive transfusion protocol within the first “golden hour“ after the injury is often problematic. Many hospitals cannot afford to have platelets permanently in stock because of the short shelf life and high price. An alternative solution is a stock of frozen platelets (FP). FP has successfully been used in military medicine. Since September 2014 we have trialed frozen platelets in routine clinical practice. In the period September 2014 – March 2016, we transfused a total of 265 units (therapeutic doses) platelets to 91 patients presenting with heavy bleeding, of that 160 units of FP (to 57 patients). We performed a comparative study with fresh platelets from apheresis (FAP), in which we enrolled 25 patients transfused with a total of 81 FP and 19 patients transfused with total of 61 FAP. As fresh platelets, as well as platelets for freezing, we used apheresis platelets, leucodepleted, with > 280 x 109 thrombocytes/unit. After adding a 6 % DMSO, the supernatant is removed and platelets are frozen at -80 °C and can be stored in such temperature for up to 2 years. Before clinical use, FP (group O) were hawed and reconstituted in a thawed group AB plasma. In the study we evaluated the following criteria: 1. Patient laboratory values (before and after transfusion) – Blood Count, aPTT, PT, Fbg; 2. Patient vital signs (before and after transfusion) – T, P, MAP; 3. Coagulation activity of product – TEG; 4. Number of transfused PLTs, RBCs, FFP; Dosage of fibrinogen concentrate and tranexamic acid; 5. Clinical data – survival, length of stay in ICU. FP were, in comparison with FAP, partially activated: the clot strength measured by TEG with citrated kaolin was reduced, and onset of clotting and a faster clot amplification. There were no significant differences between the two groups for the parameters PT, aPTT, Fbg, Hb and the mean amount of given blood products, fibrinogen and TXA. The amount of the PLT transfused was significantly higher for the group transfused with FAP. Clinical data in both groups did not display any significant differences. Frozen platelets are an alternative not only for military blood banks, but also for civilian blood banks as a solution for urgent orders in connection with heavy bleeding. The thawing and reconstitution is a simple process and takes 30 minutes at most. Frozen platelet provides a cost effective functional platelets product for the management of bleeding and should be considered for wider use in clinical practice, such as preparation of autologous platelets for transfusion as well as non-transfusion use, preparation of rare or HLA compatible platelets, etc.
Key words:
frozen platelets – cryopreservation of platelets – massive bleeding – reconstitution
Sources
1. Perkins JG, Cap AP, Spinella PC, et al. An evaluation of the impact of apheresis platelets used in the setting of massively transfused trauma patients. J Trauma 2009; 66(Suppl 4): S77–84 [discussion: S84–5].
2. Simmons JW, White CE, Eastridge BJ, et al. Impact of policy change on US Army combat transfusion practices. J Trauma 2010; 69(Suppl 1): S75–80.
3. Holcomb JB, et al. Increased platelet: RBC ratios are associated with improved survival after massive transfusion. J Trauma 2011 Aug; 71(2 Suppl 3): S318–28.
4. Perkins JG, et al. (31st Combat Support Hospital Research Group), Comparison of platelet transfusion as fresh whole blood versus apheresis platelets for massively transfused combat trauma patients (CME). Transfusion 2011 Feb; 51(2): 242–252.
5. Noorman F, et al. Transfusion: -80 °C Frozen Blood Products Are Safe and Effective in Military Casualty Care, Plos one. 2016 Dec 13; 11(12): 1–18.
6. Hess JR, Thomas MJ. Blood use in war and disaster: lessons from the past century. Transfusion. 2003 Nov; 43(11): 1622–1633.
7. Royce A, Reade MC, Johnson L, Marks DC. CLIP (cryopreserved vs. liquid platelets for surgical bleeding): Protocol for a randomised controlled trial. Heart, Lung and Circulation 2015 Dec; 24(1): e57–e58.
8. Holley A, Marks DC, Johnson L, Reade MC, Badloe JF, Noorman F. Frozen blood products: clinically effective and potentially ideal for remote Australia. Anaesth Intensive Care 2013; 41:10–19.
9. Lelkens CCM, et al. Experiences with frozen blood products in the Netherlands military. Transfusion and Apheresis Science 2006; 34: 289–298.
10. Badloe J., Noorman J. The Netherlands experience with frozen -80 °C red cells, plasma and platelets in combat casualty care. Transfusion 2011; 51 Suppl: 24A.
11. Noorman F, Badloe J. -80 °C Frozen platelets, efficient logistics, available, compatible, safe and effective in the treatment of trauma patients with or without massive blood loss in military theatre. AABB anual meeting 2012.
12. Daly PA, Schiffer CA, Aisner J, Wiernik PH. Successful transfusion of platelets cryopreserved for more than 3 years. Blood 1979 Nov; 54(5):1023-7.
13. Schiffer CA, Aisner J, Wiernik PH. Frozen autologous platelet transfusion for patients with leukemia. N J Med. 1978 Jul 6; 299(1):7–12.
14. Amer KA, Proper AS, Prose CHV. Effect of Different Resuspension Media on the Post-thaw Characteristics of Frozen Blood. British J of Haem. 1980, 44: 635–644.
15. Isbister J. Frozen Bblood: time for outcomes. Anaesth Intensive Care. 2013 Jan; 41(1):5–7.
16. Neuhaus S, Wishaw K, Lelkens Ch. Australian experience with frozen blood products on military operations. Med J Aust. 2010; 192 (4):203–205.
17. Bohoněk M. Kryokonzervace krve – historie, metody a současnost, Transfuze Hematol Dnes 19, 2013, No. 1:44–50.
18. Taylor MA. Cryopreservation of platelets: an in-vitro comparison of four methods. J Clin Pathol. 1981; 34:71–75.
19. Dumont LJ, Cancelas JA, Dumont DF, et al. A randomized controlled trial evaluating recovery and survival of 6% dimethyl sulfoxide-frozen autologous platelets in healthy volunteers. Transfusion 2013 Jan; 53(1):128–137.
20. Yılmaz S, Çetinkaya RA, Eker İ, et al. Freezing of Apheresis Platelet Concentrates in 6% Dimethyl Sulfoxide: The First Preliminary Study in Turkey. Turk J Haemato 2015 Apr 27.
21. Handin RI, Valeri CR. Improved Viability of Previously Frozen Platelets. Blood 1972, 40:509–513.
22. Valeri CR, Ragno G, Khuri S. Freezing human platelets with 6 percent dimethyl sulfoxide with removal of the supernatant solution before freezing and storage at -80 degrees C without postthaw processing. Transfusion. 2005; 45:1890–1898.
23. Daly PA, Schiffer CA, Aisner J, Wierni PH. Successful transfusion of platelets cryopreserved for more than 3 years. Blood 1979, 54:1023–1027.
24. Taylor MA. Cryopreservation of platelets: an in-vitro comparison of four methods. J Clin Pathol. 1981, 34:71–75.
25. Valeri CR, Ragno G. Cryopreservation of human blood products. Transfus 2006 Jun; 34(3): 271-87.
26. Johnson LN, et al. Crypreservation of buffy-coat-derived platelet concentrates in dimethyl sulfoxide and platelet additive solution, Cryobiology. 2011; 62: 100–106.
27. Owens M, Werner E, Holme S, Afferbach C. Membrane glycoproteins in cryopreserved platelets. Vox Sanguinis, 1994, 67:28–33.
28. Raynel S, Padula MP, Marks DC, Johnson L. Cryopreservation alters the membrane and cytoskeletal protein profile of platelet microparticles. Transfusion. 2015 Oct; 55(10): 2422–2432.
29. Johnson L, Coorey CP, Marks DC. The hemostatic activity of cryopreserved platelets is mediated by phosphatidylserine-expressing platelets and platelet microparticles. Transfusion 2014 Aug; 54(8):1917–1926.
30. Johnson L, Reade RA, Tan S, Marks DC. In vitro comparison of cryopreserved and liquid platelets: potential clinical implications. Transfusion 2015 Apr; 55(4):838–847.
31. Tegegn TZ, De Paoli SH, Orecna M, et al. Characterization of procoagulant extracellular vesicles and platelet membrane disintegration in DMSO-cryopreserved platelets. J 2016 May 4; 5: 30422.
32. Perez-Ferrer A, Navarro-Suay R, Viejo-Llorente A, et al. In vitro thromboelastometric evaluation of the efficacy of frozen platelet transfusion. Thromb Res 2015 Aug; 136(2):348–353.
33. Valeri CR et al. Freezing human platelets with 6% dimethyl sulfoxide with removal of the supernatant solution before freezing and storage at -80 °C without postthaw processing. Transfusion 2005; 45:1890–1898.
34. Ding GL, QinHYPERLINK WS, Zhao LY, Zhu L, Bo YF, Liu Z, Liu JH. Preparation Technique and Clinical Application of Frozen Platelets. Zhongguo 2016 Aug; 24(4): 1226-31.
35. Eker İ, Yılmaz S, Çetinkaya RA, Pekel A, Ünlü A, Gürsel O, Yılmaz S, Avcu F, Muşabak U, PekoğluH A, Ertaş H Z, Açıkel C, Zeybek N, Kürekçi AE, Avcı İY. Generation of Platelet Microparticles After Cryopreservation of Apheresis Platelet Concentrates Contribute to the Hemostatic Activity. Tur J H Haematol 2016 Apr 18.
36. Hornsey VS, McMillan L, Morrison A, Drummond O, Macgregor IR, Prowse CV. Freezing of buffy coat–derived, leukoreduced platelet concentrates in 6 percent dimethyl sulfoxide. Transfusion 2008; 48:2508–14.
37. Slichter SJ, Jones M, Ransom J, Gettinger I, Jones MK, Christoffel T, Pellham E, Bailey SL, Corson J, Bolgiano D. Review of In Vivo Studies of Dimethyl Sulfoxide Cryopreserved Platelets. Transfusion Medicine Reviews 28 (2014) 212–225.
38. Badloe J., Noorman J. -80 °C Frozen platelets are activated compared to 24 hour liquid stored platelets and quality of frozen platelets is unaffected by a quick preparation method (15 min) which can be used to prepare platelets for the early treatment of trauma patients in military theatre. AABB annual meeting 2012.
Labels
Haematology Internal medicine Clinical oncologyArticle was published in
Transfusion and Haematology Today
2016 Issue 4
Most read in this issue
- Apheresis platelets versus pooled platelets – comparison of quality and safety
- Stability of complete blood count and microscopic differential count parameters
- Low-dose computed tomography of the skeleton in multiple myeloma staging
- Frozen platelets in clinical praxis: comparative study of native platelets