Scientific Comments

Platelets from platelet-rich-plasma versus buffy-coat-derived platelets: What is

the difference?
Hans Gulliksson
Department of Clinical Immunology and
Transfusion Medicine, Karolinska University
Hospital, Stockholm, Sweden

Conflict-of-interest disclosure:
The author declares no competing
financial interest
Submitted: 2/14/2012
Accepted: 2/15/2012
Corresponding author:
Hans Gulliksson
Department of Clinical Immunology and
Transfusion Medicine
Karolinska University Hospital,
Huddinge C2 66
SE-141 86 Stockholm, Sweden
Phone: 46 858 589 401
Fax: 46 858 589 410
hans.gulliksson@karolinska.se
www.rbhh.org or www.scielo.br/rbhh
DOI: 10.5581/1516-8484.20120024

76

Platelets can be prepared from whole blood either using the platelet-rich-plasma
(PRP) method or the buffy-coat method (BC-PC). Yet a third type of platelet component is
collected using the apheresis technique. Only a few countries still produce PRP platelets
with the USA remaining among those countries. For this reason, studies on PRP platelets
often were published quite a long time ago. Using the PRP method, whole blood units are
centrifuged using a soft spin to concentrate the platelets in the supernatant, i.e. the
plasma. The PRP is transferred into a satellite bag. After pelleting the platelets by "hardspin" centrifugation of the PRP with removal of most of the supernatant, platelet poor
plasma, platelets are resuspended and stored as a platelet concentrate (PC) in a reduced
volume of the remaining plasma. The second centrifugation in the preparation of PC is
associated with reversible platelet aggregation, which probably is induced by activation
due to the close contact between platelets in the platelet pellet. Several methods for the
preparation of buffy-coat derived platelet concentrates (BC-PCs) are used with differences
in the time of storing whole blood preceding the preparation of BC, the time before the
preparation of platelet units and the platelet storage medium. BC-PCs are generally prepared
from a pool of BCs using sterile connections. Pre-storage leukocyte removal by filtration
is often preferred. In contrast to the PRP method, BC methods do not involve significant
close cell contact between platelets in a pellet.
The collection of blood is associated with primary activation of coagulation and the
generation of significant levels of thrombin and in the next step, activation of platelets.(1)
The activation of platelets may result in the release of cytokines and other factors during
preparation and storage of platelets that may cause febrile non-hemolytic transfusion
reactions (FNHTR) at transfusion. The activation may also affect platelet metabolism,
platelet function and morphology of platelets.
In the 1980s, Snyder et al. studied the degree of damage that occurred during the
preparation and storage of PC prepared by the PRP method by determining the
extracellular percentage of beta-thromboglobulin, a marker for alpha-granule release
during the activation of platelets.(2) The results suggested that the degree of in vitro
activation, as evidenced by the release of alpha-granule content, was dependent on the
different preparative steps. In particular, the concentration of platelets into a pellet by
centrifugation was found to result in a large degree of release. However, the subsequent
storage of platelet was associated with even higher levels of platelet activation. In a
later comparative study, Metcalfe et al. studied platelet activation associated with the
different preparation methods. (3) They found that the extent of activation was
significantly higher in PRP platelets than in BC-PC. In contrast to the studies by Snyder
(measuring beta-thromboglobulin), the greatest incremental change occurred during
preparation (measuring P-selectin); this was highest in PRP-PC and lowest in BC-PC
preparations. These findings further support the negative effects on platelet activation
associated with close cell contact between platelets during preparation. (4) Whether
these in vitro differences translate into a meaningful clinical difference has not been
definitely answered. In an even later study by Shanwell et al., the release of RANTES,
beta-thromboglobulin, platelet factor 4 (PF4) and IL-7 was measured in BC-PCs stored
in different platelet storage media.(5) A continuous increase in cytokine levels during
storage was observed. They also observed that the presence of magnesium in the latest
generation of platelet additive solutions (PAS) significantly reduced the release of
cytokines and other factors from alpha-granules. It was suggested that since FNHTR
still occur even after pre-storage leukocyte removal from platelets, such cytokines
could be released from platelets during storage and potentially cause transfusion
reactions.
In this issue of the journal, Costa et al. present data on CD42b, CD62p (P-selectin),
and cytokines IL-1b, IL-6, IL-8, and TNF-alpha.(6) In some respect, this study is similar
to the earlier study by Metcalfe et al. since P-selectin was measured in both studies.
Rev Bras Hematol Hemoter. 2012;34(2):73-9

Scientific Comments

In contrast to the results of the study by Metcalfe et al.,

Costa et al. did not observe higher levels of P-selectin in
PRP PCs than in BC-PC. However, the BC-PC may have
been prepared in a different way. The cytokines measured
are generally derived from white blood cells. The platelet
units used in the present study were not leukocyte-reduced,
suggesting that higher levels of leukocyte-derived cytokines
could be expected than in leukocyte-reduced platelet units.
Increasing, but similar, levels during storage were observed
in PCs from PRP and in BC-PCs indicating continuous
release of cytokines over time. A number of other in vitro
parameters were also included, viz. pH, pO 2 , pCO 2 ,
bicarbonate, Na+, K+, Cl-, glucose, and lactate. No significant
differences were observed that would indicate difference in
quality between the two types of platelet preparations.
Previous studies suggest that the pH tends to be lower in
PRP PCs than in BC-PCs.
The presence of cytokines in platelet preparations poses
a potential risk for transfusion-related reactions. The
concentrations can be reduced by using leukocyte-reduced
platelet units to avoid release of cytokines from leukocytes
during storage. In addition, release of platelet-derived
cytokines such as RANTES, alpha-TG, PF4, and IL-7 can be
reduced by using storage media that will reduce activation of
platelets associated with release of alpha-granule content.
The clinical consequences of the effects of passive

transfusion of low concentrations of leukocyte- or plateletderived cytokines need to be addressed in further studies.

References
1. Skjnsberg OH, Kierulf, Fagerhol MK, Godal HC. Thrombin
generation during collection and storage of blood. Vox Sang.
1986;50(1):33-7.
2. Snyder EL, Hezzey A, Katz AJ, Bock J. Occurrence of the release
reaction during preparation and storage of platelet concentrates.
Vox Sang. 1981;41(3):172-7.
3. Metcalfe P, Williamson LM, Reutelingsperger CP, Swann I,
Ouwehand WH, Goodall AH. Activation during storage of
therapeutic platelets affects deterioration during storage: a
comparative flow cytometric study of different production
methods. Br J Haematol. 1997;98(1):86-95.
4. Packham MA, Kinlough-Rathbone RL, Mustard JF. Thromboxane
A2 causes feedback amplification involving extensive
thromboxane A2 formation on close contact of human platelets
in media with a low concentration of ionised calcium. Blood.
1987;70(3):647-51.
5. Shanwell A, Falker C, Gulliksson H. Storage of platelets in additive
solutions: The effects of magnesium and potassium on the release
of RANTES, b thhromboglobulin, platelet factor 4 and interleukin
7, during storage. Vox Sang. 2003;85(3):206-12.
6. Costa EJ, Guimares TM, Almeida NC, Toledo VP. Comparison of
cytokine levels and metabolic parameters of stored platelet
concentrates of the Fundao Hemominas, Belo Horizonte, Brazil.
Rev Bras Hematol Hemoter. 2012;34(2):94-9.

xxx

Gene deletions of glutathione S-transferase and iron status in sickle cell patients
Paula Juliana Antoniazzo Zamaro
Laboratory of Hemoglobin and Genetics of
Hematological Diseases, Biology
Department, Universidade Estadual Paulista
"Jlio de Mesquita Filho" UNESP
So Jos do Rio Preto, SP, Brazil

Conflict-of-interest disclosure:
The author declares no competing
financial interest
Submitted: 3/7/2012
Accepted: 3/8/2012
Corresponding author:
Paula Juliana Antoniazzo Zamaro
Biology Department, Universidade Estadual
Paulista "Jlio de Mesquita Filho" UNESP
Rua Cristvo Colombo, 2265 Jd. Nazareth
15041-000 So Jos do Rio Preto
SP, Brazil
paulazamaro@yahoo.com.br
www.rbhh.org or www.scielo.br/rbhh
DOI: 10.5581/1516-8484.20120025

Rev Bras Hematol Hemoter. 2012;34(2):73-9

Glutathione S-transferases (GSTs) constitute multifunctional enzymes that are coded

by at least eight distinct loci: (GSTA); (GSTM); (GSTT); (GSTP); (GSTS);
(GSTK); (GSTO); and (GSTZ), each one composed of one or more homodimeric or
heterodimeric isoforms. These enzymes are involved in the conjugation reactions between
glutathione (GSH) and a variety of potentially toxic and carcinogenic electrophilic
compounds. Additionally, GSTs display peroxidase activity and this can protect against
oxidative damage. Deficiency in the activity of this enzyme may be due to inherited GST
polymorphisms, e.g., GSTT1 (22q11.23); GSTM1 (1q13.3) and GSTP1 (11q13).(1,2)
Hemoglobin S (Hb S) that results from a substitution of valine for glutamic acid at
position 6 of the -globin chain was the first hemoglobin variant to be discovered. This
group of disorders, characterized by the polymerization of deoxygenated Hb S into rigid
rod-like polymers, causes the sickling of red blood cells. The clinical severity and
hematological manifestations of sickle cell anemia are varied and are influenced by the
participation of several genes in modulating the phenotype of sickle cell disease;
polymorphisms of these genes may be related to the different manifestations between
individuals.(3,4) Some studies involving different polymorphisms of GST have been
performed in patients with sickle cell disease. Silva et al.(5) found an association between
GSTP1 polymorphisms and increased GSH in Brazilian sickle cell patients.
In this issue of the Revista Brasileira de Hematologia e Hemoterapia there is an
important assessment of GST in sickle cell disease patients which estimates the frequency
of polymorphisms and correlates the different genotypes with the iron status of patients.(6)
GST polymorphisms were evaluated in 100 patients with sickle cell disease in India and no
correlation was found in relation to iron status, unlike beta thalassemia patients as reported
77