Advancements in the preparation of platelet concentrates, which are often required to treat fetal and neonatal alloimmune thrombocytopenia (FNAIT), have the potential to significantly improve patient care, according to a recently published study in Frontiers in Hematology.
Understanding challenges in transfusion medicine
Platelets are very sensitive to their environment and undergo structural and functional changes during storage, potentially affecting their clinical performance.
There are two subcellular components involved in these changes: mitochondria, the powerhouse of the cells which fuel platelet activation, and the canalicular system (CS), which facilitates degranulation, a process by which platelets release biologically active substances to form a clot.
Additionally, when platelets are stored for transfusion, they are kept at room temperature. This makes it easier for germs like bacteria and viruses to grow, which can cause serious infections after transfusion.
PRTs as a solution
Pathogen reduction technologies (PRTs) use light (such as ultraviolet light) and special chemicals to kill or inactivate these germs before the platelets are transfused. This process helps protect patients from infections, including those caused by germs that may not be detected by regular testing.
Efforts to improve the safety of blood transfusions have led to the widespread adoption of pathogen reduction technologies (PRTs), such as INTERCEPT (psoralen-UVA) and MIRASOL (riboflavin-UVB), in the preparation of platelet concentrates.
While these methods effectively inactivate a broad range of pathogens, concerns remain regarding their potential to exacerbate storage-related platelet storage lesions.
In this context, the authors aimed to assess the effect of PRTs at a subcellular level using transmission electron microscopy (TEM), which allows researchers to look at mitochondria and other cellular organelles.
Results show PRTs do not significantly affect organelle function
The study used blood from nine healthy volunteers. One unit served as the untreated control, while the other two were treated with either INTERCEPT or MIRASOL. All units were resuspended in platelet additive solutions and stored under standard conditions for up to seven days.
The results revealed that compared to freshly isolated platelets, those stored for 24 hours exhibited a 37% reduction in mitochondrial volume and an 88% increase in CS volume, regardless of PRT treatment. This means that PTR did not cause significant physical damage to platelets.
These changes remained stable through day seven, with no significant ultrastructural differences between untreated, INTERCEPT-treated, or MIRASOL-treated platelets. A minor trend toward lower CS volume in MIRASOL-treated samples was observed at day seven but it did not reach statistical significance.
“The initial changes remain fairly constant for up to 7 days of storage in all groups. Our data suggest that Pathogen Reduction Technology – both INTERCEPT and MIRASOL – does not increase morphological platelet storage lesion as compared to simple storage in PAS,” the authors wrote.
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