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Hot Topics in Platelet Transfusions Speaker Name Jessica Poisson, MD Director of Patient Blood Management Associate Medical Director, Transfusion Duke Health

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Page 1: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Hot Topics in Platelet Transfusions

Speaker Name

Jessica Poisson, MDDirector of Patient Blood ManagementAssociate Medical Director, TransfusionDuke Health

Page 2: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Objectives

▪ Platelet Physiology

▪ Platelet Transfusions

▪ Hot Topics1. Bacterial Mitigation

2. Donor Reimbursement

3. Resting Platelets

4. Cold Platelets

Page 3: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

HEADER / PRESENTATION TITLE

Conflicts of Interest

• Cerus – grant funding - investigator

Page 4: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelets

Made in the Bone Marrow from Megakaryocytes

Life Cycle- Production: 5 days- Circulating: 7-10 days

Machlus KR, Italiano JE. J Cell Biol. 2013 Jun 10; 201(6): 785–796.Image: https://openstax.org/books/anatomy-and-physiology/pages/18-4-leukocytes-and-platelets

Page 5: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

PlateletsPlatelets are anucleate cell fragments

https://oncohemakey.com/platelet-structure-and-function-in-hemostasis-and-thrombosis/

Alpha granules

Dense (d)granules

P-selectin ADP/ATP

Fibrinogen Calcium (Ca++)

Von WillebrandFactor (vWF)

Serotonin

Factors V & XIII

Platelet factor (PF) 4

PDGF

TGF b1

+ more

Page 6: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelets

Papa AL, Jiang A, Korin N et al. Science Translational Medicine. 2019:11 (479); eaau5898https://www.sciencedirect.com/topics/engineering/activated-platelet

Activated Platelets

Page 7: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Activation signal received – commonly

collagen or vWFexposure

Platelet shape changes, “flips

membrane” and rolls along endothelium –

bind fibrinogen

Granule release –activates lots of things including

WBCs and coagulation factors

Aggregation with other platelets to form platelet plug

http://what-when-how.com/acp-medicine/hemostasis-and-its-regulation-part-1/Kumar V, Abbas AK, Aster JC. Chapter 4: Hemodynamic Disorders, Thromboembolic Disease, and Shock. Robbins and Cotran pathologic basis of disease. 9th Ed. Philadelphia, PA : Elsevier/Saunders, [2015]

Page 8: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet TransfusionTreatment of:

• Thrombocytopenia• Hypoproliferative• Consumption• Destruction

• Platelet Dysfunction• Congenital• Acquired

Murphy MF, Stanworth SJ, Estcourt. Ch 20: Hemodynamic Disorders, Thromboembolic Disease, and Shock. In Rossi’s Principles of Transfusion Medicine. 5th Ed. Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons Inc., 2016.

Page 9: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Transfusion

Murphy MF, Stanworth SJ, Estcourt. Ch 20: Hemodynamic Disorders, Thromboembolic Disease, and Shock. In Rossi’s Principles of Transfusion Medicine. 5th Ed. Chichester, West Sussex ; Hoboken, NJ : John Wiley & Sons Inc., 2016.

Indication Platelet Count Patient Condition

Prophylaxis <10K Stable, poor marrow fxn

<50K Invasive procedure

<75-100K CNS procedure

Bleeding <50-100K Oozing or continued non-surgical bleeding

No value Anti-platelet therapy in last 24 hours (aspirin, etc)

Page 10: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Components

Platelet Concentrates

• Derived from Whole Blood Collection

• 5.7 x 1010 platelets per bag minimum

• Adult dose – 4-6 units

Apheresis Platelets

• Apheresis Collection – multiple units

• 3.0 x 1011 per bag minimum

• Adult dose – 1 unit

Page 11: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelets

• Stored 20-24C in gas permeable bags with agitation

• Shelf life: 5 days in closed system

• QC: pH >=6.2 at end of storage

• Method to detect or inactivate bacteria in all platelet components (AABB BBTS standards)

Page 12: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Topic 1:Platelet Bacteria Management

Page 13: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Contamination

• Estimated 1 in 2500-3000 room temperature platelet units contain bacteria

• Mitigation has included• Reduction of unit life from 7 days to 5 days

• Requiring bacterial culture 24 hours after collection

• Risk of Septic Transfusion reaction from platelets still significant• 1 in 10,000 by active surveillance

Hong H, et al, Blood, 2016; 127(4): 496-502

Page 14: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Transfusion

Staphylococcus aureus contamination – day 4 unit

From: Siddon AJ, Snyder EL, TormeyCA. Visualization of bacterial contamination in an apheresis platelet unit. J Clin Apher. 2018 Dec;33(6):671-672.

Page 15: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Fatalities

https://www.fda.gov/media/136907/downloadhttps://www.fda.gov/vaccines-blood-biologics/report-problem-center-biologics-evaluation-research/transfusiondonation-fatalities

Platelet contaminants 2014-2018

Gram Pos 9

Gram Neg 4

Other 1 (WNV)

Most Common Staph aureus

Page 16: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Published September 2019

Page 17: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

FDA Guidance on Bacterial Control

• Implementation 18 months from publication• March 2021

• Requires additional steps to mitigate for potential bacteria in the product• Treat the Product – Pathogen Reduction

• More testing – numerous strategies• Recommendations divided into Apheresis/Pre-pooled platelets and Whole Blood

Derived (WBD) platelets

• Also provides strategies for 7 day platelets

Page 18: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Treatment/Testing OptionsPathogen Reduction - Inactivates cells/pathogens containing nucleic

acids- Will also serve as Irradiation modification- Only for Apheresis platelets

Bacterial Culture - Standard FDA approved bacterial culture technique

- Volumes differ between apheresis/pre-pool and WBD single units

Large Volume, Delayed Sampling (LVDS) - Larger volume taken for bacterial sample – 16 mL- Delayed means the sample collection happen >24

hours (usu 36 or 48 H) post unit collection- Only Apheresis/Pre-pool platelets

Rapid bacterial testing - Small sampling with one hour test time

Page 19: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Apheresis/Pre-Pooled Strategies

Current bacterial culture will only be good for 3 days

Requires strict

platelet unit qualification

Page 20: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Single Unit WBD Platelets

Would still require secondary testing to take it

from 3 day to 5 day life

Page 21: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Strategy Considerations

• Life of Product: Do you want 7 day platelets?• Platelet must be in a bag approved for 7 day storage

• May require relabeling and additional product codes

• Hands-On Time: Do you have staffing to perform the testing?• Some methods can be batched or performed once

• Rapid test could be time of issue

• Cost: How much is the test with new equipment?• Repeat testing may be required and significant staff time is a cost consideration

Page 22: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Financial Analysis

Page 23: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

JHH Analysis

Found Secondary Bacterial testing to be cheapest strategy

• Caveat: Not included in analysis –cost to set up testing platform

Method 2018 $

Baseline $651.45

Pathogen Reduced PLTs $827.82

Point of Release test (rapid test) $686.33

Secondary Bacterial Test $668.50

Page 24: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Bacterial Mitigation

• No “One Size Fits All” Solution

• Option deployed should consider:• Utilization and wastage rates

• Type of unit (including bag type) produced by supplier

• Costs of supplier testing versus in-house testing

• Internal staffing and space

Page 25: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Topic 2:Platelet Supply: Reimbursed Donors

Page 26: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Transfusion

• Platelet inventory management is challenging because of their short shelf life

• Seasonal supply and demand imbalances are particularly stressful• Outdate rates ~20% in 2015 and 2017 NBCUS data

Page 27: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Donor Demographics

TRANSFUSION Volume 58, Issue S2: Abstract Presentations from the AABB Annual Meeting, Boston MA, October 13-16, 2018.

Will we run out of donors using current donor recruitment strategies?

Page 28: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

What is old is new again…

• One way to motivate a steady donor pool is compensation• Apheresis platelet donation requires ~2 hours to complete

• In the 1980s, it was not uncommon to provide monetary compensation for platelets• Mayo donor center open through 2002

• Then the AIDS crisis hit and integrity of the blood supply became critical

Page 29: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Reimbursed Donors

Pros

• Encourages repeat donation

• Treat it like a job

• Steady supply

Cons

• Potential lying on DHQ for to meet criteria

• Could compromise volunteer donation of other blood products

Page 30: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Paid plasma donation

• There is a subset of compensated donors already – source plasma donors

• Difference: Source plasma is pooled and pathogen reduced prior to manufacturing

• Still perform standard donor testing

Page 31: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Source Plasma Donors

Page 32: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Infectious Disease Testing Results

Data: Crowder LA et al. Transfusion 2017:57(S3);47A (abstract)PPTA Presentation Plasma Product Biotechnology Meeting, May ‘17

Major infectious disease testing rates similar between volunteer and paid donor populations

Page 33: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

New Technology

• Pathogen Reduction Technology for Apheresis Platelets• INTERCEPT (Cerus, ) FDA approved in 2017

Viruses inactivated

HIV-1

HIV-2

HBV

HCV

CMV

WNV

Chikungunya virus

Dengue virus (DENV)

Transfusion 2005;45:580-590 INTERCEPT package insert: https://intercept-usa.com/images/resources/Package_Inserts/INTERCEPT_Blood_System_LV_Platelets_Package_Insert_May-2019.pdf

Bacteria Inactivated

Gram Positive Gram Negative Others

Staphylococcus epidermidis

Klebsiella pneumonia Treponema pallidum

Staphylococcus aureus Escherichia coli Borrelia burgdorferi

Listeria monocytogenes

Serretia marcescens Clostridium perfringens(vegetative)

Corynebacteriumminutissimum

Pseudomonas aeruginosa

Streptococcus pyogenes

Enterobacter cloacae

Page 34: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

TRANSFUSION 2020;60;S134–S137

In conclusion, a potential blood sustainability strategy would be to reimburse blood donors to ensure a safe and adequate supply while protecting the donors and meeting the patientsʼ needs. Additionally, we will need to understand the cost and bene ts, the targeted populations (all or only for certain products), and societyʼs acceptance. However, with many changes in blood safety, population demographics, social norms, and economics, it is time we embrace remunerated donors.

Page 35: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Topic 3:Platelet Function – Non-Activated Platelet Products

Page 36: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Transfusion

• 70-75% of platelet transfusions are prophylactic in non-bleeding cancer patients• Goal of transfusion is to raise the platelet count, not stop bleeding

• Older platelet units with higher activation markers have shown poorer count recoveries

Delaflor-Weiss E, Mintz, P. Transfus Med Rev. 2000 Apr;14(2):180-96.

Page 37: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Recovery

• Not dissimilar to RBCs, platelets have been shown to have a storage lesion

• Features of platelets that will not be effective post transfusion- Increased P-selectin expression

- Increase in morphologic complexity

- Decreased response to agonists

- Increased microparticles

Mauer-Spurej E, Chipperfield K. Transfus Med Rev. 2007 Oct;21(4):295-306.

Page 38: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Swirl is the only quality measure performed routinely- But no objective

grading

- More informative tests not easily automated

Mauer-Spurej E, Chipperfield K. Transfus Med Rev. 2007 Oct;21(4):295-306.

Page 39: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Microparticles

• Microparticles have been correlated with inflammation• Linked to SLE, RA, atherosclerosis,

diabetic nephropathy

• Shed when platelets are activated

• What does their presence mean in a platelet unit?

Goubran HA, Burnouf T, Stakiw J, Seghatchian J. Transfus Apher Sci. 2015 Feb;52(1):12-8.Labrie A et al. Transfus Med Hemother 2013;40:93–100

Page 40: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

How can you Make or Keep Platelets Non-Activated?

• Patient Factors

• Age of Unit

• Manufacturing

• Activation is typically irreversible

Page 41: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

TRANSFUSION 2009;49:2276-2284.

Developed an instrument that measures platelet product features and software that combined platelet shape, temperature response and microparticle content into a quality score

Page 42: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

DLS score and platelet recovery

• Platelet unit sampled, tested and scored

• Recipient of unit then reviewed for pre and post transfusion platelet counts (1 hour and 24 hour post)

• 49 patients received 96 analyzed units

Page 43: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Transfusion Outcomes

• Platelet Activation Affects Transfusion Outcomes in Hematology-Oncology Patients: Meta-Analysis of Data From Four North American Hospitals (AABB 2019 Abstract)

• Maurer E, Noland DK, Kniep JN, Ye Z, Chipperfield K, Labrie A, Szefer E, Thompson D

• 432 patients, 2139 transfusions

• Activation measured using dynamic light scattering

• Found receipt of an activated platelet decreased count increment significantly

Non-activated Activated P value

1 hour count increment 32.2 x 109/L 26.7 x 109/L <0.0001

24 hour count increment 19.8 x 109/L 15 x 109/L 0.0008

Page 44: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Platelet Transfusion Outcomes• Activated Platelet Transfusions in Hematology-Oncology Patients are Associated

with Lower Post-Transfusion Count Increments and Shorter Interval Between Transfusions(AABB 2019 Abstract)

• Mettman D , Brown L , Hogan K , Labrie A , Maurer-Spurej E , Ye Z

• 119 patients• Activation measured using dynamic light scattering

• Found receipt of an activated platelet decreased count increment significantly from mean 22.88 to 17.95

• Also days between transfusion decrease 32% after activated transfusion from 3.88 days to 2.63 days

Page 45: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Non-Activated Platelets• Platelets that are not activated will circulate longer in the blood

stream• Good for prophylactic transfusions

• Currently platelet swirl is only measure of quality• Not quantitative

• Microparticle content is a marker of inflammation/activation• New rapid assay gives activation score based on MP content

• Non-activated platelet transfusion have better count recoveries• May reduce utilization by allowing more time between transfusions

Page 46: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Topic 4:Platelet Function – Activated Cold Platelets

Page 47: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Why do we keep platelets room temp?

• Discovered in the 1970s that platelets stored cold (1-6C) result in poor count recoveries

• Refrigerator temperatures lead to platelet shape change and presentation of adherence molecules• As previously mentioned – signs of platelet activation

Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098Slichter SJ, Harker LA. Br J Haematol, 1976;34: 403-419

Page 48: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Cold Platelets vs RT-Platelets

Reddoch KM, Pidcoke HF, Montgomery RK, et al. Hemostatic function of apheresis platelets stored at 4C and 22C. Shock 2014;41:54-61.

Platelet Aggregation StudiesCold Platelet results in blue circle

Thromboelastogram (TEG) StudiesCold Platelet results in blue circle

Page 49: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

TRANSFUSION 2017;57;2836–2844

Page 50: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Cold Platelet Experience at Mayo Clinic

• FDA variance approve for 3 day cold stored (CS) platelets in 2015• Also required AABB Standards exception as no bacterial testing

performed

• Plasma suspended platelets have high clot rate – 24% were discarded

• Next Steps:• PAS suspended cold platelets to decrease clotting

• Pathogen reduction with a goal of extending product life to 10 days

Page 51: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Extended Storage of Cold PLTS

Braathen H, Sivertsen J, Lunde THF, 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 Aug;59(8):2652-2661

Page 52: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

In summary

More bacteria mitigation for platelets is coming – you have options

We can look at changing the platelet donation process by paying donors to stabilize the supply – pathogen reduction is the key

Prophylactic platelet transfusions may be optimized by checking quality markers – non-activated platelets stick around

Bleeding patients may benefit from activated platelets – and keeping them cold (1-6C) gets them ready to clot

Page 53: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Cold Platelets

• Storing platelets at 1-6C activates the platelets• Not good for count recoveries

• Good for rapid hemostasis

• Allows for prolonged storage – slows cell metabolism• Keeps platelets from dying

• Reduces bacterial growth

• Increasing use in bleeding patients• Military and trauma most common

Page 54: Hot Topics in · 2020. 9. 14. · presentation of adherence molecules •As previously mentioned –signs of platelet activation Murphy S, Gardner FH. N Engl J Med 1969;280: 1094-1098

Cold Platelets

• Storing platelets at 1-6C activates the platelets• Not good for count recoveries

• Good for rapid hemostasis

• Allows for prolonged storage – slows cell metabolism• Keeps platelets from dying

• Reduces bacterial growth

• Increasing use in bleeding patients• Military and trauma most common