Removal of citrate from PAS-III additive solution improves functional and biochemical characteristics of buffy-coat platelet concentrates stored for seven days, with or without Intercept pathogen reduction

Objective Deterioration in the quality of platelet concentrates (PCs) during storage results from the appearance of storage lesions affecting the hemostatic functions and post-transfusion survival of the platelets. These lesions depend on the preparation and pathogen inactivation methods used, the duration of storage and the platelet additive solutions (PAS) present in the storage bags.

We investigated the effects of the citrate contained in third-generation PAS (PASIII) on storage lesions in buffy-coat PCs with or without photochemical (amotosalen-UVA) treatment (PCT) over 7 days.

Material and Methods A pool-and-split method was used to obtain four study groups: PCT-PCs stored in commercial PAS-III solution containing 10 mM sodium citrate, untreated PCs stored in PAS-III, PCT-PCs stored in citrate-free PAS-III and untreated PCs stored in citrate-free PAS-III (n = 3 per group). In vitro platelet quality and function were tested over 7 days (D).

Results Platelet counts were conserved in all groups during storage as was platelet swirling without the appearance of macroscopic aggregates. Glycoprotein (GP) IIbIIIa and GPVI expression remained stable whereas GPIbα declined similarly in all groups during storage. Removal of citrate led to a significant decrease in glucose consumption, which largely countered a modest deleterious effect of PCT. Citrate removal also resulted in decreased lactate generation and better maintenance of pH during storage, while PCT had no impact on these parameters. Citrate-free storage moreover significantly reduced expression of the granule secretion marker P-selectin, and exposure of the apoptosis signal phosphatidylserine, thereby abolishing the activating effect of PCT on both parameters. Citrate removal benefited platelet aggregation to various agonists up to day 7, whereas PCT had no impact on these responses.

Conclusion Removal of citrate from PAS-III has a beneficial impact on platelet metabolism, spontaneous activation and apoptosis, and improves platelet aggregation, irrespective of PCT, which should allow the transfusion of platelets with better and longer lasting functional properties.

Reference

Publication History

Article published online:
18 June 2021