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TEG PlateletMapping assay results may be misleading in the presence of cold stored platelets.

Authors
  • Scorer, Thomas G1, 2, 3
  • FitzGibbon, Lucy2
  • Aungraheeta, Riyaad2
  • Sharma, Umang3
  • Peltier, Grantham C3
  • McIntosh, Colby S3
  • Reddoch-Cardenas, Kristin M3
  • Meyer, Andrew3, 4
  • Cap, Andrew P3
  • Mumford, Andrew D2
  • 1 Centre of Defence Pathology, Royal Centre of Defence Medicine, Birmingham, UK.
  • 2 School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.
  • 3 Coagulation and Blood Research, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
  • 4 Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Health Science Center, San Antonio, Texas, USA.
Type
Published Article
Journal
Transfusion
Publisher
Wiley (Blackwell Publishing)
Publication Date
Jun 01, 2020
Volume
60 Suppl 3
Identifiers
DOI: 10.1111/trf.15753
PMID: 32478898
Source
Medline
Language
English
License
Unknown

Abstract

Viscoelastic tests (VETs) are used widely to monitor hemostasis in settings such as cardiac surgery. There has also been renewed interest in cold stored platelets (CSPs) to manage bleeding in this setting. CSPs are reported to have altered hemostatic properties compared to room temperature platelets (RTPs), including activation of GPIIb/IIIa. We investigated whether the functional differences between CSP and RTP affected the performance of the PlateletMapping VET on the TEG 5000 and 6s analyzer. Platelet concentrates were divided equally into CSP (stored at 4°C ± 2°C) and RTP (stored at 22°C ± 2°C) fractions. Whole blood was treated to induce platelet dysfunction (WBIPD) by incubating with anti-platelet drugs (1.0 μM ticagrelor and 10 μM aspirin) or by simulating cardiopulmonary bypass. WBIPD samples were then mixed with 20% by volume of CSPs or RTPs to model platelet transfusion before analysis using the PlateletMapping VET. Addition of CSPs to WBIPD increased the PlateletMapping MAFIBRIN and MAADP parameters with the TEG 5000 analyzer (both p < 0.0001 compared to addition of buffer alone). This effect was not observed with RTPs. The differential effect of CSPs on the MAFIBRIN corrected after pre-incubation with the GPIIb/IIIa antagonist tirofiban and was quantitatively less with the PlateletMapping test for the TEG 6s analyzer which contains the GPIIb/IIa antagonist abciximab. The PlateletMapping MAFIBRIN and MAADP test results may be misleadingly high with CSPs, particularly with the TEG 5000 analyzer, most likely due to constitutive activation of GPIIb/IIIa on CSPs during storage. TEG PlateletMapping results should be interpreted with caution following CSP transfusion. © 2020 Crown copyright.Transfusion © 2020 AABB.

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