Effects of Platelet Sparing Leukocyte Reduction and Agitation Methods on In Vitro Measures of Hemostatic Function in Cold-Stored Whole Blood

Background Agitation of platelet units stored at room temperature is performed routinely to maintain platelet function and leukoreduction of blood products is standard of care in many countries to reduce immune consequences of transfusion. The effect of agitation and leukoreduction on whole blood stored at 4° C requires investigation as reductions in hemostatic capacity of whole blood may reduce its efficacy in treating trauma-induced coagulopathy and platelet dysfunction. We hypothesize that agitation of whole blood will not affect hemostatic function and that leukoreduction will reduce hemostatic function of whole blood. Methods In this in vitro randomized- controlled study, 21 units of leukoreduced and 20 non-leukoreduced whole blood units were each randomly assigned into 4 agitation groups. Hemostatic parameters were measured using viscoelastic assays (ROTEM-EXTEM and TEG-Platelet Mapping), impedance aggregometry (agonists-adenosine phosphate, arachidonic acid, thrombin receptor activating peptide, and collagen), and a thrombin generation assay from these whole blood units pre- and post-filtration and on day 0, 5, 10 and 15 days of storage at 4°C. Results Leukoreduction compared to non-leukoreduction reduced platelet concentration on day 0. Viscoelastic measures and thrombin generation parameters revealed significant reduction in hemostatic function between the leukoreduced units and the non-leukoreduced units at a few time points. Leukoreduced units consistently demonstrated reduced platelet aggregation compared to the non-leukoreduced units. Agitation methods did not significantly affect any of the hemostatic parameters examined. Conclusions Leukoreduction of whole blood with a platelet-sparing filter caused a moderate but significant reduction in some measures of whole blood hemostatic function most evident early in storage. The benefits of leukoreduction should be weighed against the potential reduced hemostatic function of leukoreduced units. Agitation of whole blood is not required to maintain hemostatic function. Level of Evidence Level 1 Study Type in vitro randomized- controlled trial Corresponding Author: Kenneth E. Remy, MD, MHSc, Washington University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care, 660 S. Euclid Ave. St. Louis, MO 63110, kremy@wustl.edu, (314) 286-2830 This manuscript is for the THOR supplement. Conflicts of Interest and Source of Funding: All authors have no conflicts of interest to declare. © 2018 Lippincott Williams & Wilkins, Inc.

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