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Platelet‐enhanced plasma: Characterization of a novel candidate resuscitation fluid's extracellular vesicle content, clotting parameters, and thrombin generation capacity
Author(s) -
Price Joshua,
Gardiner Chris,
Harrison Paul
Publication year - 2021
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16423
Subject(s) - platelet , chemistry , thromboelastometry , platelet activation , thrombin , phosphatidylserine , clotting factor , activated clotting time , tissue factor , immunology , biochemistry , medicine , heparin , coagulation , phospholipid , membrane
Background Platelet transfusion is challenging in emergency medicine because of short platelet shelf life and stringent storage conditions. Platelet‐derived extracellular vesicles (PEV) exhibit platelet‐like properties. A plasma generated from expired platelet units rich in procoagulant PEV may be able to combine the benefits of plasma and platelets for resuscitation while increasing shelf life and utilizing an otherwise wasted resource. Study design and methods Freeze–thaw cycling of platelet‐rich plasma (PRP) followed by centrifugation to remove platelet remnants was utilized to generate platelet‐enhanced plasma (PEP). An in vitro model of dilutional coagulopathy was also designed and used to test PEP. Rotational thromboelastometry and calibrated automated thrombography were used to assess clotting and extracellular vesicles (EV) procoagulant activity. Capture arrays were used to specifically measure EV subpopulations of interest (ExoView™, NanoView Biosciences). Captured vesicles were quantified and labeled with Annexin‐V‐FITC, CD41‐PE, and CD63‐AF647. Platelet alpha granule content (platelet‐derived growth factor AB, soluble P‐selectin, vascular endothelial growth factor A, and neutrophil activating peptide 2‐chemokine (C‐X‐C motif) ligand 7) was measured. Commercially available platelet lysates were also characterized. Results PEP is highly procoagulant, rich in growth factors, exhibits enhanced thrombin generation, and restores hemostasis within an in vitro model of dilutional coagulopathy. The predominant vesicle population were PEV with 7.0 × 10 9 CD41+PS+ EV/ml compared to 4.7 × 10 7 CD41+PS+ EV/ml in platelet‐free plasma ( p = .0079). Commercial lysates show impaired but rescuable clotting. Discussion PEP is a unique candidate resuscitation fluid containing high PEV concentration with preliminary evidence, indicating a potential for upscaling the approach using platelet concentrates. Commercial lysate manufacturer workflows may be suitable for this, but further optimization and characterization of PEP is required.