Abstract
Cell Biology/Immunology and Biochemistry (Basic and Preclinical Research) - Platelets
Susan M. Shea, MSME, PhD (she/her/hers)
Assistant Professor
Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh
Pittsburgh, Pennsylvania
Disclosure information not submitted.
Sex-based differences in platelet (PLT) biology have been increasingly recognized, especially in the context of transfusion medicine. However, the impact of donor sex on cold-stored platelets (CSPs) remains poorly understood. As CSPs gain FDA approval and clinical use, understanding sex-based differences in response to cold storage is essential. This study aims to investigate sex dimorphism in PLT hemostatic function during 21-day cold storage.
Study
Design/Methods:
Apheresis PLT units (n=40) were collected from healthy donors and stored at 4°C. Each group included 10 units: Trima in plasma (TP), Trima in PAS: Isoplate (TI), Amicus in plasma (AP), and Amicus in PAS: Intersol (AI). The cohort included 21 males (TP=4, TI=6, AP=4, AI=6) and 19 females (TP=6, TI=4, AP=7, AI=3). Complete blood counts, biochemistry, and hemostatic function were analyzed on Days 0, 7, 14, and 21. Statistical comparisons were performed using unpaired t-tests (α=0.05).
Results/Findings:
PLT counts, MPV, pH, and lactate levels did not significantly differ by sex at any time point. At D0, the mean count was 1246±191 in males vs. 1232±237.7; by D21, they declined in both groups (853.7±196.7 vs. 788.9±266.2) without significant difference.
Thrombin generation measured by calibrated automated thrombogram (CAT) showed that female PLTs had significantly higher mean endogenous thrombin potential (ETP) at D0 (2047±575.0 vs. 1562±378.7; p=0.010), D7 (2100±546.8 vs. 1577±390.3; p=0.003), and D14 (1993±356.5 vs. 1603±349.1; p=0.002) but the difference was not significant at D21. Peak thrombin generation was significantly higher in females at all timepoints, including D0 (167.3±76.5 vs. 99.3±48.1; p=0.003), D7, D14, and D21 (p< 0.05 for all).
PLT aggregation by light transmission aggregometry (LTA) (reported as median maximal amplitude) showed agonist-specific sex-based trends. In response to ADP, females showed greater aggregation at all timepoints, with significant differences at D14 (0.21 vs. 0.105; p=0.017) and D21 (0.19 vs. 0.09; p=0.031). Collagen-induced aggregation declined in both sexes, more prominently in males, with significant differences at D14 (0.32 vs. 0.17; p=0.032) and D21 (0.25 vs. 0.08; p=0.002). In epinephrine-induced aggregation, both sexes exhibited increased responsiveness over time, but females consistently had higher aggregation, with significant differences at D0 (0.03 vs. 0.00; p=0.006), D14 (0.38 vs. 0.19; p=0.034), and D21 (0.31 vs. 0.15; p=0.023).
CAT and LTA data are visualized in Figure 1.
Conclusions:
This analysis demonstrates significant sex-based differences in PLT function during cold storage. Female PLTs exhibited better preservation of hemostatic function over 21 days over male PLTs. These findings suggest that sex is an important biological variable affecting PLT quality during storage and emphasize the importance of a personalized approach in transfusion medicine.