Platelet Storage: Time to Rethink the Cold

Cherise Farrugia

Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Malta.

Byron Baron

Centre for Molecular Medicine and Biobanking, University of Malta, Malta.

Vanessa Zammit *

Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Malta and Centre for Molecular Medicine and Biobanking, University of Malta, Malta and National Blood Transfusion Services, Malta.

*Author to whom correspondence should be addressed.


Abstract

Platelet concentrates (PCs) are widely used in transfusion medicine for therapeutic purposes and their demand is constantly on the rise. Current storage regulations make this product highly susceptible to bacterial contaminations and platelet storage lesions (PSL) causing the need for alternative storage methods to be considered. The implementation of cold storage not only reduces unnecessary wastage of valuable donations and overall costs but also decreases both the risk of bacterial contamination and the occurrence of PSL. The current study aimed at determining how a prolonged cold storage may affect PCs. This was accomplished by investigating two different PC cohorts of 10 units each. One of the cohorts, labelled as ‘Room Temperature’, was stored at 22℃±2℃ for 5 days and then transferred to a temperature of 4℃±2℃. The other cohort, labelled as ‘Cold’, was stored directly at 4℃±2℃. Both cohorts were stored for a total of 21 days and platelet indices, platelet counts, pH, and platelet factor IV (PF4) were measured at different time intervals. Sterility was performed on Day 21. The key findings showed no significant difference in mean platelet count, platelet distribution width (PDW), mean platelet volume (MPV), platelet-large cell ratio (P-LCR), and plateletcrit (PCT) between the two cohorts. On the other hand, a significant difference in mean pH and PF4 resulted between the two cohorts. Moreover, no significant difference in mean platelet count, and PCT was found between Days 1, 5, or 10, and Day 21 in both cohorts. However, an overall significant difference in mean PDW, MPV, P-LCR and pH was discovered between Days 1 and 21, Days 5 and 21, and Days 10 and 21 in both cohorts. Regards PF4, a significant difference was detected between Days 1 and 21, and Days 10 and 21; however, no significant difference was found between Days 5 and 21 in both cohorts. Corynebacterium freneyi and Microbacterium liquefaciens, were cultured from 1 unit of the room temperature cohort after it was flagged positive during the sterility testing. In conclusion, through the implementation of a delayed cold storage system, PCs can be safely administered to the patient.

Keywords: Platelet concentrates, cold storage, prolonged shelf-life, quality, safety


How to Cite

Farrugia , C., Baron , B., & Zammit , V. (2023). Platelet Storage: Time to Rethink the Cold. International Blood Research & Reviews, 14(4), 57–69. https://doi.org/10.9734/ibrr/2023/v14i4318


References

European Directorate for the Quality of Medicines and Healthcare; 2020. Available:https://www.edqm.eu/en/

[Access on 2022 Aug 23].

Farrugia C, Baron B, Zammit V. Platelet Storage – Current limitations and future solutions. International Journal of Research and Reports in Hematology. 2022;278– 83.

Reddoch KM, Pidcoke HF, Montgomery RK, Fedyk CG, Aden JK, Ramasubramanian AK, et al. Hemostatic function of apheresis platelets stored at 4°C and 22°C. Shock. 2014;41(1):54–61.

Wood B, Johnson L, Hyland RA, Marks DC. Maximising platelet availability by delaying cold storage. Vox Sang. 2018;13(5):403–11.

Johnson L, Vekariya S, Tan S, Padula MP, Marks DC. Extended storage of thawed platelets: Refrigeration supports postthaw quality for 10 days. Transfusion. 2020; 60(12):2969–81.

Braathen H, Sivertsen J, Lunde THF, Kristoffersen EK, Assmus J, Hervig TA, et al. In vitro quality and platelet function of cold and delayed cold storage of apheresis platelet concentrates in platelet additive solution for 21 days. Transfusion. 2019; 59(8):2652– 61.

Hegde S, Akbar H, Zheng Y, Cancelas JA. Towards increasing shelf life and haemostatic potency of stored platelet concentrates. Curr Opin Hematol. 2018 Nov;25(6):500–8.

Scott J, Ali YS. Verywell Health. What High or Low MPV Levels Mean; 2023. Available:https://www.verywellhealth.com/mpv-low-5193725 Access on: 2023 Jul 27.

Tzur I, Barchel D, Izhakian S, Swarka M, Garach-Jehoshua O, Krutkina E, et al. Platelet distribution width: a novel prognostic marker in an internal medicine ward. J Community Hosp Intern Med Perspect. 2019;9(6):464–70.

Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochem Med (Zagreb). 2016;26(2):178–93.

Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28–32.

Baghdadi V, Yari F, Rezaei N, Rafiee MH. The surface markers and survival rate of platelets during storage at 4°C: The influence of sodium octanoate. Iranian Journal of Pediatric Hematology and Oncology. 2019;9(2):105–16.

Winokur R, Hartwig JH. Mechanism of shape change in chilled human platelets. Blood. 1995;85(7):1796–804.

Berzuini A, Spreafico M, Prati D. One size doesn’t fit all: Should we reconsider the introduction of cold-stored platelets in blood bank inventories? F1000Res. 2017;6:95.

Shin EK, Park H, Noh JY, Lim KM, Chung JH. Platelet Shape Changes and Cytoskeleton Dynamics as Novel Therapeutic Targets for Anti-Thrombotic Drugs. Biomol Ther (Seoul). 2017; 25(3):223–30.

Hornsey VS, McColl K, Drummond O, McMillan L, Morrison A, Morrison L, et al. Extended storage of platelets in SSP platelet additive solution. Vox Sang. 2006; 91(1):41–6.

Vit G, Klüter H, Wuchter P. Platelet storage and functional integrity. Journal of Laboratory Medicine. 2020;44(5):285– 93.

Johnson L, Tan S, Wood B, Davis A, Marks DC. Refrigeration and cryopreservation of platelets differentially affect platelet metabolism and function: a comparison with conventional platelet storage conditions. Transfusion. 2016;56(7):1807–18.

Auzias A, Bollet C, Ayari R, Drancourt M, Raoult D. Corynebacterium freneyi bacteremia. Journal of Clinical Microbiology. 2003;41(6):2777–8.

Kannambath R, Sistla S, Jayakar S, Pillai VM. Isolation of corynebacterium freneyi from a case of exudative pharyngitis, a close mimicker of corynebacterium diphtheriae. Access Microbiol. 2021;3(7): 000238.

Debrincat A, Gialanze J, Spiteri N, Zammit V. Bacterial screening of blood components: past, present and possibly future methodologies for improving transfusion safety. Austin Hematology. 2021;6:1–2021.

Kim R, Reboli AC. Other Coryneform Bacteria, Arcanobacterium haemolyticum, and Rhodococci - ClinicalKey [Internet]; 2015. Available:https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323482554002058?scrollTo=%23hl0001497

Access on: 2023 Jul 27.

Wink JM. German Collection of Microorganisms and Cell Cultures GmbH: Compendium of Actinobacteria [Internet]; 2016. Available:https://www.dsmz.de/collection/catalogue/microorganisms/special-groups-of- organisms/compendium-of-actinobacteria

Access on: 2023 Jul 27.

Schiraldi C, De Rosa M. Mesophilic Organisms. In: Drioli E, Giorno L, editors. Encyclopedia of Membranes [Internet]. Berlin, Heidelberg: Springer. 2016;1–2. Available:https://doi.org/10.1007/978-3-642-40872-4_1610-2

Access on: 2023 Jul 27.

Cai Z, Greene MI, Zhu Z, Zhang H. Structural Features and PF4 Functions that Occur in Heparin-Induced Thrombocytopenia (HIT) Complicated by COVID-19. Antibodies (Basel). 2020; 9(4):52.

Winskel-Wood B, Padula MP, Marks DC, Johnson L. Cold storage alters the immune characteristics of platelets and potentiates bacterial-induced aggregation. Vox Sang. 2022;117(8):1006–15.

Rinder HM, Murphy M, Mitchell JG, Stocks J, Ault KA, Hillman RS. Progressive platelet activation with storage: evidence for shortened survival of activated platelets after transfusion. Transfusion. 1991;31(5): 409–14.

Dreier J, Störmer M, Kleesiek K. Real-time polymerase chain reaction in transfusion medicine: applications for detection of bacterial contamination in blood products. Transfus Med Rev. 2007;21(3):237– 54.