Good hemostatic effect of platelets stored at 4°C in an in vitro model of massive blood loss and thrombocytopenia

Abstract

This study compared the corrective effects of storage of platelets at 4°C and at 22°C in an in vitro model of massive blood loss and thrombocytopenia to provide an experimental basis for the storage of platelets for clinical applications.In vitro model of massive blood loss and thrombocytopenia were constructed by the in vitro hemodilution method and cell washing method. Using storage of platelets at 4°C (1, 3, 5, 7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the coagulation condition of the different models, by thromboelastography and by routine blood indices.①Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of massive blood loss. Platelet count results improved from 17 to 27 × 10/L to greater than 120 × 10/L for 4°C storage, and 20 to 27 × 10/L to greater than 120 × 10/L for 22°C storage. Thromboelastography maximum amplitude (TEG-MA) results improved from 8.8 to 15.4 mm to greater than 43 mm for 4°C storage, and 12.2 to 14.4 mm to greater than 44.8 mm for 22°C storage. Thromboelastography reaction time values decreased from 9.9-24.9 minutes to 3.8-5.5 minutes for 4°C storage, and 9.9-22.7 minutes to 4.3-4.5 minutes for 22°C storage. ②Platelets stored at 4°C (1, 3, 5,7, 10, 14 days) and at 22°C (1, 3, 5 days) to correct the in vitro model of thrombocytopenia. Platelet count results improved from 12 to 34 × 10/L to greater than 99 × 10/L for 4°C storage, and 12 to 34 × 10/L to greater than 120 × 10/L for 22°C storage. TEG-MA results improved from 21.4 to 32.1 mm to greater than 49.1 mm for 4°C storage, and 21.4 to 31.6 mm to greater than 50.5 mm for 22°C storage.Platelets stored at 4°C and 22°C have the same correcting effect for 1, 3, and 5 days. Platelets stored at 4°C for 7 to 14 days have similarly hemostatic effect on the in vitro model of massive blood loss and thrombocytopenia.

Figure 1

Study design experimental flow chart.

Figure 2

A flowchart showing the correction of models of in vitro blood loss and thrombocytopenia. Analysis of routine blood parameters: WBC, RBC, Hb, MCV, PLT, PCT, MPV, PDW. Analysis of TEG parameters: TEG-R, TEG-K, TEG-alpha, TEG-MA, TEG-CI. Hb = haemoglobin, MCV = mean corpuscular volume, MPV = mean PLT volume, PCT = plateletcrit, PDW = PLT distribution width, PLT = platelet, RBC = red blood cell, TEG = thromboelastography, TEG-α = thromboelastography alpha, TEG-CI = thromboelastography coagulation indice, TEG-K = thromboelastography kinetics, TEG-MA = thromboelastography maximum amplitude, TEG-R = thromboelastography reaction time, WBC = white blood cell.

Figure 3

The routine blood before and after the correction of the models of in vitro massive blood loss. Dashed lines (-------): Appropriate standard of in vitro blood loss models. With reference to the current international guidelines for massive transfusion and surgical blood transfusion, we defined the following critical criteria for the administration of the blood supplements after in vitro hemodilution: Hb of 60 to 80 g/L, for RBC suspension; FIB of 0.8 to 1.0 g/L or PT or APTT 1.5 times the normal, for FFP; and PLT count of 50 to 75 × 10⁹/L or TEG-MA of <40, for apheresis PLT. APTT = activated partial thromboplastin time, FFP = fresh frozen plasma, FIB = fibrinogen, Hb = haemoglobin, PLT = platelet, PT = prothrombin time, RBC = red blood cell, TEG-MA = thromboelastography maximum amplitude.

Figure 4

Blood routine indices changes in the in vitro model of thrombocytopenia.