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October 03, 2020
10/3/2020 9:00:00 AM - 10/5/2020 3:00:00 PM
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Effect Of Storage Temperature And Agitation On Platelet Aggregation Of Whole Blood During Acute Nonmonomeric Hemodilution
Junko Ichikawa, M.D., Masaki Kouta, M.D., Makiko Komori, M.D.
Tokyo Women’s Medical University Medical Center East, Tokyo, Japan
Disclosures: J. Ichikawa: None. M. Kouta: None. M. Komori: None.
Introduction Acute normovolemic hemodilution (ANH) is the removal of whole blood (WB) shortly after the induction of anesthesia and reinfusion of the stored blood at the end of the surgical procedure. ANH can reduce the need for allogeneic blood transfusion.1 Standard guidelines for platelet storage recommend constant gentle agitation at room temperature, since the platelets are metabolically active. Furthermore, cold-stored platelets reduce the risk of bacterial contamination and may preserve hemostatic function better compared with platelets at room temperaurtre.2,3 The aim of this study was to determine if there was a difference in platelet function as measured by ROTEMTM-Platelet among four storage conditions of WB during ANH for 12 hours. Methods After IRB approval and informed patient consent, WB from 10 healthy adults was investigated in an in vitro study. WB (450 ±50ml) was drawn from an antecubital vein through a 18-G needle and was collected into standard sterile bags containing 28 mL of citrate-phosphate-dextrose adenine(CPDA) anticoagulant. Each blood unit was divided evenly into four daughter bags and stored for 12 hours in one of the following conditions: (1) non-agitation at RT (21℃); (2) continuous mechanical horizontal agitation at approximately 60 rpm at room temperature; (3) non-agitation in a refrigerator with an interior temperature between 1 and 6℃; (4) constant agitation in the cold. Time of the initial collection was designated baseline. Samples from four daughter bags were drawn 12 hours after phlebotomy and subjected to complete blood count, coagulation profiles, blood gas, ROTEM and ROTEM-Platelet analyses. The latter measured platelet aggregation in WB samples using a multiple impedance aggregometer with arachidonic acid (ARATEM), adenosine diphosphate (ADPTEM), and thrombin receptor-activating peptide 6 (TRPTEM) as agonists. Results We observed a significant drop in the platelet count in cold agitated storage among the four storage conditions (P<0.05). The lactate level in platelets stored at room temperature significantly increased when compared with that for platelets in cold storage (P<0.05). All samples 12 hours after phlebotomy maintained acceptable levels of pH and the glucose level did not change significantly. Correspondingly, more bicarbonate was consumed and carbon dioxide released in all stored platelets (P<0.05). The dissolved oxygen levels in agitated platelets were significantly higher than that in non-agitated platelets, which suggested adequate gas exchange during storage. Impedance aggregometry involves use of three parameters: A6, MS and AUC. A6 is a measure of the extent of platelet aggregation and describes how well platelets aggregate after selective activation. MS is a measure of the rate of aggregation and describes how quickly platelets aggregates after selective activation. AUC reflects the overall platelet aggregation. All parameters of platelet aggregation induced by various agonists in four storage conditions demonstrated a lower trend. AUC and MS in ARATEM were significantly higher for samples at cold storage compared with samples stored at room temperature. Conclusion In vitro, cold and stationary stored platelets showed greater aggregation response to arachidonic acid, suppressed production of lactate acid, and maintained acceptable levels of pH and platelet counts among the four storage conditions, despite low oxygen levels. References 1. Barile L, et al. Anesth Analg. 2017;124:743-752 2. Rock G, et al. Transfusion. 1976;16:571-9. 3. Reddoch KM, et al. Shock. 2014;41:54-61.
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