R.N.I. Pietersz’s research while affiliated with Sanquin Blood Supply Foundation and other places

R. N. I. Pietersz, H. W. Reesink, S. Panzer, S. Oknaian, S. Kuperman, C. Gabriel, A. Rapaille, M. Lambermont, V. Deneys,D. Sondag, S. Ramirez-Arcos, M. Goldman, G. Delage, F. Bernier, M. Germain, T. Vuk, J. Georgsen, P. Morel, C. Naegelen,L. Bardiaux, J.-P. Cazenave, J. Dreier, T. Vollmer, C. Knabbe, E. Seifried, K. Hourfar, C. K. Lin, M. Spreafico, L. Raffaele,A. Berzuini, D. Prati, M. Satake, D. de Korte, P. F. van der Meer, J. L. Kerkhoffs, L. Blanco, J. Kjeldsen-Kragh,A.-M. Svard-Nilsson, C. P. McDonald, I. Symonds, R. Moule, S. Brailsford, R. Yomtovian & M. R. JacobsSeptic reactions after transfusion, particularly of plateletconcentrates, still occur and belong to the most serioustransfusion reactions. From a previous InternationalForum [1] on the subject, it could be concluded that inpart of the countries that participated in the forum, plate-let concentrates (PCs) were tested for bacterial contamina-tion and that culture-based methods, particularly theBacT/Alert system, were used.In recent years, several rapid bacterial detection meth-ods, such as surrogate measurements of the pH or glu-cose, the detection of bacteria with a scan system orPCR tests that detect bacterial RNA, have been devel-oped. These tests can either be performed immediatelyprior to transfusion of the PC or at a variety of testmoments at which culture and release tests are com-bined.Pathogen inactivation (PI) methods also affect bacterialcontamination of PCs. In 2007 [1], in some countries, theIntercept method of PI of PCs was implemented insteadof bacterial screening.It seemed of interest to evaluate the present state ofthe art of this subject. In order to obtain the desiredinformation, the following questions were sent to expertsin the field.Question 1: How long do you store PC and is there adifference between whole-blood-derived PC and apheresisPC? Which method of preparation do you use for whole-blood-derived PC? Are PCs leuco-reduced?Question 2: Do you use a culture method to detect bac-terial contamination of PC? If so,

The aim of this article is to reflect on the historical background on what urged the authors in the 1980s to investigate the prolonged storage of whole blood at ambient temperature before component preparation, the routine implementation of the method in the Netherlands, and the effect on logistics and plasma procurement.

Three types of platelet concentrates (PC) are compared: PC either processed with the platelet-rich plasma (PRP) or the Buffy coat (BC) method from whole blood units and PC obtained by apheresis. Leuko-reduction (LR) pre-storage is advocated to improve quality of the PC during storage and reduce adverse reactions in recipients. Standardization of methods allow preparation of PC with comparable yields of approximately 400 x 10(9) platelets in pooled non-LR-PRP, approximately 370 x 10(9) in pooled LR-BC-PC and in LR apheresis PC the number of platelets can be targeted on 350 x 10(9) or more with devices of various manufacturers. While viral transmission can be prevented by outstanding laboratory tests, the risk of bacterial contamination should be reduced by improved arm disinfection, deviation of the first 20-30 ml of blood and culture or rapid detection assays of the PC pre-issue. In a large prospective multicenter trial no significant difference was observed between cultures of apheresis PC (n = 15,198): 0.09% confirmed positive units versus 0.06% in pooled BC-PC (n = 37,045), respectively. Though platelet activation as measured by CD62 expression may differ in vitro in PC obtained with various apheresis equipment, and also between PC processed with the two whole blood methods there is scarce literature about the clinical impact of these findings. In conclusion the final products of LR-PC derived from whole blood or obtained by apheresis can be comparable, provided the critical steps of the processing method are identified and covered and the process is in control.

Whole blood (WB) can be stored overnight before processing, provided that it is quickly cooled to room temperature (20-25 degrees C), for example, with butane-1,4-diol plates. A new design of cooling plates became available (CompoCool-WB, Fresenius HemoCare), where WB must be placed vertically against the plates, versus placing of WB under plates in the current version (Compocool). This study compared cooling efficiency and in vitro quality of plasma and of stored white cell (WBC)-reduced red cells (RBCs) from overnight-stored WB, cooled with either of the systems. Temperature curves following cooling with Compocool or CompoCool-WB were studied with a 25 percent glycerol solution as simulated WB. WB from voluntary donors was cooled with Compocool or CompoCool-WB, stored overnight at room temperature, centrifuged, and separated into components. WBC-reduced RBCs in SAGM were stored until Day 42 with measurement of in vitro parameters (n=23/group). Simulated WB reached a temperature of less than 25 degrees C after 2:15+/-1:04 hours for Compocool versus 1:39+/-0:38 hours for CompoCool-WB (p=0.02). On Day 35, RBCs had a hemolysis of 0.3+/-0.2 percent in both groups, and ATP levels were 3.3+/-0.5 and 3.6+/-0.5 micromol per g hemoglobin for Compocool and CompoCool-WB, respectively (not significant). Factor VIII content in plasma was 1.05+/-0.25 and 0.97+/-0.18 IU per mL for Compocool and CompoCool-WB, respectively. WB can be cooled to room temperature within 2 hours with both Compocool and CompoCool-WB butane-1,4-diol plates, improving temperature uniformity in WB donations. Application of either design for overnight storage of WB at room temperature had no adverse effects on the composition of subsequently prepared blood components.

For hygienic purposes, plastic overwraps can be used for storage of leucoreduced red cell concentrates (LR-RCC). However, the effect of the use of such overwrapping on in vitro parameters during 42 days of storage was unknown. In paired experiments, LR-RCCs in SAGM (saline, adenine, glucose, mannitol) were packed in two types of polyethylene overwrap or in a polypropylene overwrap; no overwrap served as reference (n = 12 paired experiments). Units were stored at 2-6 degrees C for 42 days and sampled at regular intervals for in vitro analysis. No significant effect was found for any of the overwraps investigated. All units contained > 2.7 micromol adenosine triphosphate per gram haemoglobin and had a haemolysis rate well below 0.8% on Day 42. The use of plastic overwraps does not affect red cell quality markers in vitro.

Interruption of agitation results in lower in vitro quality of platelet concentrates (PCs). The rates at which the deleterious effects occur, however, are unknown. Therefore, in vitro parameters of PCs in additive solution (AS) during various periods without agitation have been investigated. PCs from five buffy coats in AS (Composol, Fresenius HemoCare) were white cell (WBC)-reduced by filtration. Four PCs were pooled and divided to obtain paired samples. Beginning immediately after processing, three PCs were stored without agitation and placed on an agitator after 16, 20, and 24 hours. The fourth PC was agitated throughout storage and served as reference (n = 10 paired experiments). pH(37 degrees C) on Day 7 was greater than 6.8 in reference PCs, and in PCs that were not agitated for 16 hours, longer interruption resulted in lower pH values. During interruption of agitation, metabolic rates were significantly higher in the study groups: glucose consumption was 12.5 +/- 1.6 micromol per 10(11) platelets (PLTs) per hour in PCs during the first 24 hours without interruption versus 2.0 +/- 0.4 micromol per 10(11) PLTs per hour in the reference group (p < 0.01). Lactate formation was 24.7 +/- 4.2 versus 3.9 +/- 0.4 micromol per 10(11) PLTs per hour in the above-mentioned groups, respectively (p < 0.01). Once replaced on the agitator, the metabolic rates lowered, but remained significantly elevated during consecutive storage days compared to the reference. WBC-reduced PCs in Composol AS may experience 16 hours without agitation with no permanent effects on in vitro measures compared to reference units. During interruption of agitation, glucose and lactate metabolism is elevated, resulting in lower pH values in the subsequent storage period.