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Microvesicles in Stored Blood Microvesicles in Stored Blood Louise Knauth Grifols Australia Microvesicles (MV)/Microparticles What are they ?!? • Traditional categorization is submicron particles which are between 0.1 to 1µm in diameter. • MV can be derived from different haematological and non‐ haematological cell lines ‐ platelets, monocytes, erythrocytes and epithelial cells. • MV are formed when a membrane vesicle is released by an activated parent cell. Mechanisms for cell vesiculation vary. • Importantly, the MV reflect the composition of the parent cell. • Every one has them in low levels. Stored Red Cells • Storage lesion. In vivo aging different to in vitro aging. • After 50 days of storage, around x20 increase in MV. More pronounced between 60 and 120 days. • Haemolysis in stored blood is indicated by the concentration of extracellular haemoglobin, 50% of which may be attributed to haemoglobin‐containing ErMVs. • Filtration removes platelets and a significant number of platelet and red cell microparticles. Depends on filter. • Aging red cells = increased PS = procoagulant. Is this why up to 30% cells are ‘lost’ once transfused? Stored Red Cells • Erythrocyte‐derived MV can promote coagulation by initiating thrombin generation independent of Tissue Factor. • Studies show that transfusion of older red cells carries a higher risk of DVT and multi‐organ failure. • Platelet activation may activate and bind white cells present in non‐ leucoreduced packed cells > inflammation and procoagulant state. • ErMV have also shown a balancing anti‐coagulant effect by prolonging the consolidation of fibrinogen to fibrin, especially if the red cells are washed. Stored Plasma • Plasma derived from whole blood or apheresis collection. • Processing of plasma for transfusion may induce MV. – Filter for leucodepletion may remove MV, but also reduce clotting factors and fibrinogen. – Mixed findings coagulation results – Recommend leucodepletion within 10 hours of collecting whole blood. Thank you References Bebawy M, Roseblade A, Luk F, Rawling T, Ung A, Grau GE 2013. Cell‐derived microparticles: new targets in the therapeutic management of disease. J Pharm Sci, 16(2): 238‐253 Bosman GJ, Were JM, Willekens FL, Novotny VM 2008. Erythrocyte ageing in vivo and in vitro: structural aspects and implications for transfusion. Transfus Med, 18: 335‐47. Cannelini, G., Rubin, O., Delobel, J., Crettaz, D., Lion, N. and Tissot, J. D. 2012. Red blood cell microparticles and blood group antigens: an analysis by flow cytometry. Blood Transfus, 10 Suppl 2, s39‐45. Chan K. S.‐K., & Sparrow, R. L. (2014). 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