Evaluación in vitro de la eficacia de plaquetas convencionales, atemperadas y congeladas. Posible empleo en el medio militarArtículo resumido del trabajo ganador ex aequo de la XI Edición del Premio Fidel Pagés Miravé

  1. J.R. Díaz-Valdés 1
  2. R. Navarro-Suay 2
  3. N. Díez-Navarro 3
  4. A. Pérez-Ferrer 4
  1. 1 Capitán médico. Servicio de Hematología y Transfusión. Hospital Central de la Defensa Gómez Ulla. Universidad de Alcalá. España
  2. 2 Teniente coronel médico. Servicio de Anestesia y Reanimación. Hospital Central de la Defensa Gómez Ulla. Universidad de Alcalá. España
  3. 3 SpotLab. Universidad Politécnica de Madrid. España
  4. 4 Servicio de Anestesia y Reanimación. Hospital Infanta Sofía. Universidad Europea. Madrid. España
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Revista:
Sanidad militar: revista de sanidad de las Fuerzas Armadas de España

ISSN: 1887-8571

Ano de publicación: 2022

Volume: 78

Número: 4

Páxinas: 216-228

Tipo: Artigo

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Outras publicacións en: Sanidad militar: revista de sanidad de las Fuerzas Armadas de España

Resumo

Introduction. Exsanguinating hemorrhage is the first preventable cause of death for combatants in armed conflicts, thus making the possibility of transfusing blood components early an absolutely essential benefit during health care for casualties generated in military operations. Throughout the numerous conflicts that have occurred during the past century, there have been important changes in the hemotherapy treatment of casualties along with an evolution of the health doctrine regarding this issue. In some massive transfusion protocols, the diagnostic technique of thromboelastometry (TE) has been used. TE is a test that shows the viscoelastic properties of blood from clot formation to fibrinolysis, evaluates platelet function and correlates quickly with the physiological process of hemostasis. The main objective of this study is the evaluation in vitro of the hemostatic capacity of the various cold, frozen and fresh platelet concentrates through standardized coagulation tests and thromboelastometry, clarifying whether the contribution to the clot is significantly improved with cold platelet pools (preserved at 4ºC), compared to fresh and frozen platelets. It is also intended to determine what advantages would be the incorporation of cold platelets in transfusion medicine performed in the military environment. Material and methods. An experimental study was designed to compare cold (refrigerated), frozen and fresh (conventional) platelets in vitro, analyzing their performance and effectiveness through systematic blood analysis, routine laboratory coagulation mechanisms (Prothrombin Time, Prothrombin Activity, Cephalin and Fibrinogen) and Rotational Thromboelastometry (ROTEM). A sample of 20 healthy patients was recruited, after informing them in writing and obtaining the mandatory informed consent, they donated 6 tubes with 10 ml citrate. of blood per patient. For the comparison, the data collected from the performance of the ROTEM between baseline and experimental samples (after platelet transfusion) were normally distributed and analyzed using the paired Student’s t-test and were analyzed by multiple linear regression, adjusting and not adjusting according to the platelet count. Approval was obtained from the Drug Research Ethics Committee and the hospital research committee. Results. The mean of the EXTEM CT parameter is significantly lower in the sample with frozen platelets compared to that of tempered and normal platelets. The mean of the EXTEM CFT parameter is significantly lower in the sample with normal platelets compared to that of frozen platelets. The mean of the EXTEM CFT parameter is significantly lower in the sample with frozen platelets compared to that of tempered platelets. The mean of the Platelet Index parameter is significantly higher in the sample with normal platelets compared to that of tempered platelets. The mean of the MCE PI parameter is significantly higher in the sample with tempered platelets compared to that of frozen platelets. Conclusion. After evaluating the hemostatic capacity in vitro using standardized coagulation tests and thromboelastometry, tempered platelets significantly improve the maximum elasticity of the clot in relation to platelet count compared to frozen platelets, but not compared to fresh platelets. The incorporation of tempered platelets in transfusion medicine in the military environment would be another treatment alternative for discharge with exsanguinating hemorrhage and would provide logistical advantages by increasing the shelf life of standard platelets from seven to twenty-one days and simplifying processing, transportation and Reconstitution of the blood component to the liquid medium as it is not necessary to freeze it.

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