Dried platelets in a swine model of liver injury

Kenji Inaba, Galinos Barmparas, Peter M Rhee, Bernardino C. Branco, Michael Fitzpatrick, Obi T. Okoye, Demetrios Demetriades

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Introduction: Lyophilization may facilitate production of a safe, portable, easily storable, and transportable source of platelets for bleeding patients. The objective of this study was to examine the impact of lyophilized human and porcine platelets in a swine liver injury model of nonsurgical hemorrhage. Methods: Anesthetized pigs (40 kg) had a controlled 35% total blood volume bleed from the right jugular vein followed by cooling to 35-C and resuscitation with Ringer's lactate to achieve a 3:1 blood withdrawal resuscitation. Through a midline laparotomy, the liver was injured with two standardized 5 × 5-cm grids with lacerations 1 cm apart and 0.5 cm deep. After 2 min of uncontrolled hemorrhage, the animals were treated with placebo (n = 5), lyophilized human (n = 5, HP), or swine platelets (n = 5, SP). At 15 min, shed blood was calculated. The animals then underwent abdominal closure. At 48 h, the animals were killed for histopathologic evaluation of the lung, kidney, and heart. Results: Intraoperative blood loss at 15 min was significantly higher in the HP arm (SP: 4.9 ± 2.9 mL/kg, HP: 12.3 ± 4.7 mL/kg, and control: 6.1 ± 2.5 mL/kg; P = 0.013). Mortality at 48 h was 20% in all three arms, due to uncontrolled intra-abdominal bleeding. At the time the animals were killed, SP animals had a significantly higher hematocrit (SP: 22.0% ± 3.0%, HP: 15.1% ± 4.9%, and control: 13.9% T 0.6%; P = 0.026). No significant difference was found in platelet count (SP: 319.3 ± 62.1 × 103/HL, HP:361.5 ± 133.6 × 103/HL, and control: 242.7 ± 42.5 × 103/HL; P = 0.259). Histopathology of kidneys, lungs, and heart demonstrated no evidence of thromboembolic complications. Conclusion: In this swine model of liver injury, human lyophilized platelets increased intraoperative blood loss. With the use of species-specific lyophilized platelets, however, this effect was abolished, with a decrease in blood loss at 48 h after injury.

Original languageEnglish (US)
Pages (from-to)429-434
Number of pages6
JournalShock (Augusta, Ga.)
Volume41
Issue number5
DOIs
StatePublished - 2013

Fingerprint

Swine
Blood Platelets
Liver
Hemorrhage
Wounds and Injuries
Resuscitation
Kidney
Lung
Freeze Drying
Lacerations
Jugular Veins
Blood Volume
Platelet Count
Hematocrit
Laparotomy
Placebos
Mortality

Keywords

  • Dried platelets
  • Hemorrhage
  • Lyophilization
  • Outcomes
  • Swine model of liver injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine
  • Medicine(all)

Cite this

Inaba, K., Barmparas, G., Rhee, P. M., Branco, B. C., Fitzpatrick, M., Okoye, O. T., & Demetriades, D. (2013). Dried platelets in a swine model of liver injury. Shock (Augusta, Ga.), 41(5), 429-434. https://doi.org/10.1097/SHK.0000000000000141

Dried platelets in a swine model of liver injury. / Inaba, Kenji; Barmparas, Galinos; Rhee, Peter M; Branco, Bernardino C.; Fitzpatrick, Michael; Okoye, Obi T.; Demetriades, Demetrios.

In: Shock (Augusta, Ga.), Vol. 41, No. 5, 2013, p. 429-434.

Research output: Contribution to journalArticle

Inaba, K, Barmparas, G, Rhee, PM, Branco, BC, Fitzpatrick, M, Okoye, OT & Demetriades, D 2013, 'Dried platelets in a swine model of liver injury', Shock (Augusta, Ga.), vol. 41, no. 5, pp. 429-434. https://doi.org/10.1097/SHK.0000000000000141
Inaba K, Barmparas G, Rhee PM, Branco BC, Fitzpatrick M, Okoye OT et al. Dried platelets in a swine model of liver injury. Shock (Augusta, Ga.). 2013;41(5):429-434. https://doi.org/10.1097/SHK.0000000000000141
Inaba, Kenji ; Barmparas, Galinos ; Rhee, Peter M ; Branco, Bernardino C. ; Fitzpatrick, Michael ; Okoye, Obi T. ; Demetriades, Demetrios. / Dried platelets in a swine model of liver injury. In: Shock (Augusta, Ga.). 2013 ; Vol. 41, No. 5. pp. 429-434.
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abstract = "Introduction: Lyophilization may facilitate production of a safe, portable, easily storable, and transportable source of platelets for bleeding patients. The objective of this study was to examine the impact of lyophilized human and porcine platelets in a swine liver injury model of nonsurgical hemorrhage. Methods: Anesthetized pigs (40 kg) had a controlled 35{\%} total blood volume bleed from the right jugular vein followed by cooling to 35-C and resuscitation with Ringer's lactate to achieve a 3:1 blood withdrawal resuscitation. Through a midline laparotomy, the liver was injured with two standardized 5 × 5-cm grids with lacerations 1 cm apart and 0.5 cm deep. After 2 min of uncontrolled hemorrhage, the animals were treated with placebo (n = 5), lyophilized human (n = 5, HP), or swine platelets (n = 5, SP). At 15 min, shed blood was calculated. The animals then underwent abdominal closure. At 48 h, the animals were killed for histopathologic evaluation of the lung, kidney, and heart. Results: Intraoperative blood loss at 15 min was significantly higher in the HP arm (SP: 4.9 ± 2.9 mL/kg, HP: 12.3 ± 4.7 mL/kg, and control: 6.1 ± 2.5 mL/kg; P = 0.013). Mortality at 48 h was 20{\%} in all three arms, due to uncontrolled intra-abdominal bleeding. At the time the animals were killed, SP animals had a significantly higher hematocrit (SP: 22.0{\%} ± 3.0{\%}, HP: 15.1{\%} ± 4.9{\%}, and control: 13.9{\%} T 0.6{\%}; P = 0.026). No significant difference was found in platelet count (SP: 319.3 ± 62.1 × 103/HL, HP:361.5 ± 133.6 × 103/HL, and control: 242.7 ± 42.5 × 103/HL; P = 0.259). Histopathology of kidneys, lungs, and heart demonstrated no evidence of thromboembolic complications. Conclusion: In this swine model of liver injury, human lyophilized platelets increased intraoperative blood loss. With the use of species-specific lyophilized platelets, however, this effect was abolished, with a decrease in blood loss at 48 h after injury.",
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AU - Inaba, Kenji

AU - Barmparas, Galinos

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AU - Fitzpatrick, Michael

AU - Okoye, Obi T.

AU - Demetriades, Demetrios

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N2 - Introduction: Lyophilization may facilitate production of a safe, portable, easily storable, and transportable source of platelets for bleeding patients. The objective of this study was to examine the impact of lyophilized human and porcine platelets in a swine liver injury model of nonsurgical hemorrhage. Methods: Anesthetized pigs (40 kg) had a controlled 35% total blood volume bleed from the right jugular vein followed by cooling to 35-C and resuscitation with Ringer's lactate to achieve a 3:1 blood withdrawal resuscitation. Through a midline laparotomy, the liver was injured with two standardized 5 × 5-cm grids with lacerations 1 cm apart and 0.5 cm deep. After 2 min of uncontrolled hemorrhage, the animals were treated with placebo (n = 5), lyophilized human (n = 5, HP), or swine platelets (n = 5, SP). At 15 min, shed blood was calculated. The animals then underwent abdominal closure. At 48 h, the animals were killed for histopathologic evaluation of the lung, kidney, and heart. Results: Intraoperative blood loss at 15 min was significantly higher in the HP arm (SP: 4.9 ± 2.9 mL/kg, HP: 12.3 ± 4.7 mL/kg, and control: 6.1 ± 2.5 mL/kg; P = 0.013). Mortality at 48 h was 20% in all three arms, due to uncontrolled intra-abdominal bleeding. At the time the animals were killed, SP animals had a significantly higher hematocrit (SP: 22.0% ± 3.0%, HP: 15.1% ± 4.9%, and control: 13.9% T 0.6%; P = 0.026). No significant difference was found in platelet count (SP: 319.3 ± 62.1 × 103/HL, HP:361.5 ± 133.6 × 103/HL, and control: 242.7 ± 42.5 × 103/HL; P = 0.259). Histopathology of kidneys, lungs, and heart demonstrated no evidence of thromboembolic complications. Conclusion: In this swine model of liver injury, human lyophilized platelets increased intraoperative blood loss. With the use of species-specific lyophilized platelets, however, this effect was abolished, with a decrease in blood loss at 48 h after injury.

AB - Introduction: Lyophilization may facilitate production of a safe, portable, easily storable, and transportable source of platelets for bleeding patients. The objective of this study was to examine the impact of lyophilized human and porcine platelets in a swine liver injury model of nonsurgical hemorrhage. Methods: Anesthetized pigs (40 kg) had a controlled 35% total blood volume bleed from the right jugular vein followed by cooling to 35-C and resuscitation with Ringer's lactate to achieve a 3:1 blood withdrawal resuscitation. Through a midline laparotomy, the liver was injured with two standardized 5 × 5-cm grids with lacerations 1 cm apart and 0.5 cm deep. After 2 min of uncontrolled hemorrhage, the animals were treated with placebo (n = 5), lyophilized human (n = 5, HP), or swine platelets (n = 5, SP). At 15 min, shed blood was calculated. The animals then underwent abdominal closure. At 48 h, the animals were killed for histopathologic evaluation of the lung, kidney, and heart. Results: Intraoperative blood loss at 15 min was significantly higher in the HP arm (SP: 4.9 ± 2.9 mL/kg, HP: 12.3 ± 4.7 mL/kg, and control: 6.1 ± 2.5 mL/kg; P = 0.013). Mortality at 48 h was 20% in all three arms, due to uncontrolled intra-abdominal bleeding. At the time the animals were killed, SP animals had a significantly higher hematocrit (SP: 22.0% ± 3.0%, HP: 15.1% ± 4.9%, and control: 13.9% T 0.6%; P = 0.026). No significant difference was found in platelet count (SP: 319.3 ± 62.1 × 103/HL, HP:361.5 ± 133.6 × 103/HL, and control: 242.7 ± 42.5 × 103/HL; P = 0.259). Histopathology of kidneys, lungs, and heart demonstrated no evidence of thromboembolic complications. Conclusion: In this swine model of liver injury, human lyophilized platelets increased intraoperative blood loss. With the use of species-specific lyophilized platelets, however, this effect was abolished, with a decrease in blood loss at 48 h after injury.

KW - Dried platelets

KW - Hemorrhage

KW - Lyophilization

KW - Outcomes

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