Data suggestive of damage to mitochondrial metabolism have not been clearly confirmed. Storage lesions may be

more pronounced, since increased P-selectin expression and decreased agonist-induced aggregation was observed [67]. PI-treated platelets seemingly present a higher basic activation state, with higher surface expression of GPIIb/IIIa; this could explain the faster http://www.selleckchem.com/products/pifithrin-alpha.html clearance, leading to lower recirculation rates, observed in some clinical trials. The influence of the storage medium (i.e., plasma, InterSol, or Tyrode buffer) is obviously substantial and could explain some of the discordant study results. However, hemostatic function appears to be preserved in PI-treated PCs compared to standard PCs, under both static and flow conditions, in concordance with clinical observations that did not detect an increase in the bleeding risk. Some of the reactions following PC transfusion can be explained by the presence of cytokines and chemokines that are released during storage. The occurrence of undesirable reactions has notably been linked to the

presence of sCD40L. According to a study by Cognasse et al., treatment of PC with amotosalen/UVA does not increase the production of detrimental cytokines [68]. Published hemovigilance data predominantly concern INTERCEPT. This technique was approved in France in 2002 (AFSSAPS) and in Germany (PEI) and Switzerland (Swissmedic) in 2009. Switzerland EPZ015666 in vivo was the first country to implement INTERCEPT nationwide from 2011. Swiss hemovigilance data on the transfusion of 551 PCs revealed a transfusion reaction (TR) rate of 2% and a corrected count increment (CCI) of 10,000 after 1–4 h [69]. French hemovigilance data showed no increase in the number of platelet transfusions before and after

the introduction of INTERCEPT and confirmed the decrease in the TR rate [70]. A decrease in the TR rate linked to the use of additive solutions has been described Urocanase previously [71], but the French data appears to show a specific PI effect that is independent of plasma substitution. In Belgium, a retrospective study on transfusion data compared a 3-year period before and after the introduction of INTERCEPT; there were no differences in the number of PC transfusions per day of thrombocytopenia, in the total dose of platelets administered to patients, or in the number of red blood cell (RBC) transfusions given to thrombocytopenic patients [72]. Finally, a prospective hemovigilance program conducted in France, Belgium, and Spain that included 7437 PC transfusions, mostly in hemato-oncological patients, revealed an undesirable event rate of 0.9% after transfusion without any bacterial contamination [73]. These hemovigilance reports all confirm both the safety and efficacy of INTERCEPT-treated PCs in a huge number of platelet transfusions.