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 Table of Contents  
SHORT ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 212-214

White particulate matter – A mini review


Department of Blood Bank, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission06-May-2020
Date of Decision10-Oct-2020
Date of Acceptance15-Oct-2020
Date of Web Publication13-Nov-2020

Correspondence Address:
Tanuja Pangtey
Department of Blood Bank, Government Medical College, Haldwani, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_41_20

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  Abstract 


White particulate matter has been an enigmatic entity inside blood bags. Frequent encounter with this uncommon phenomenon is described world over as a sporadic report or small series. Over the years, as its incidence keeps increasing so is the need to understand this strange entity that may provide valuable insights into the fascinating world of blood physiology and storage. An attempt to comprehend this strange phenomenon has been made in this brief review based on the literature available on this subject.

Keywords: Blood banking, blood storage, blood, contamination, human blood, white particulate matter


How to cite this article:
Pangtey T, Chaudhary R. White particulate matter – A mini review. Glob J Transfus Med 2020;5:212-4

How to cite this URL:
Pangtey T, Chaudhary R. White particulate matter – A mini review. Glob J Transfus Med [serial online] 2020 [cited 2020 Nov 26];5:212-4. Available from: https://www.gjtmonline.com/text.asp?2020/5/2/212/300624




  Introduction Top


White particulate matter (WPM) is a term given to microaggregates within blood units that are whitish and visible to the naked eye [Figure 1]. The number and size of these striking structures may vary.[1] The identification of WPM warrants careful observation of blood units and these may be missed when smaller in size. These are considered normal phenomena of blood storage and their formation is not believed to depend on donor characteristics.[2]


  Pathogenesis of White Particulate Matter Top


The actual pathogenesis of WPM is still unclear. WPM is believed to be composed of normal blood elements such as platelets, white blood cells (WBCs), cellular debris, and fibrin.[3] No external matter (like plastic particle) or organism has been associated with these formations.[3],[4] Cellular fragments and granules are also found in microscopic observation within the WPM.[4] Mostly, they are described to report in red cell units and not in whole blood units [Table 1].[5]
Figure 1: The image showing multiple, tiny, and discrete whitish particulate matter immersed in the blood bag

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Table 1: Recent articles reporting the white particulate matter

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Some of the factors described to be associated with their formation are as follows:

  1. Adhesiveness – Increased adhesiveness of platelet and WBCs compounded by increased stickiness on storage and cold temperature[3]
  2. High G forces – More frequent if higher “g” forces used in component preparation[3]
  3. Hard spin – WPM is commonly encountered in red cell units that undergo hard spin without platelet separation[4]
  4. Heavy centrifugation – WPM is more likely to form in component prepared by heavy centrifugation compared to the lighter method[5]
  5. Rate of flow – The rate of flow of blood unit with platelet is slower than platelet-poor red cell units. This favors microaggregation[6]
  6. High pressure – Stored whole blood undergoes high pressure through filters to increase storage time and might lead to compact aggregation due to increased platelet and WBC adhesiveness[7]
  7. Citrate-phosphate-dextrose-adenine (CPDA-1) in bag – Many reports of WPM have been found in units with CPDA-1. Random presence of WPM in whole blood units was found in 12 out of 356 units stored in a bag with citrate-phosphate-dextrose.[8] CPDA-1 is widely used in blood bags and impurity in this chemical compound may be a factor for macroaggregate formation.[9] The longer the blood is stored higher the concentration of acid phosphate in the blood, thus accelerating the formation of WPM when coupled with cellular breakdown products[10]
  8. Miscellaneous – Favorable factors in WPM formation are lipemia, increased platelet count, and hard spin during component preparation.[4],[10] High cholesterol was fund to associate with WPM, but triglyceride level had no apparent association.[5]



  Prevention Top


Buffy coat removal and leukofiltration may decrease the chances of their formation.[1] Removal of platelets and leukoreduction helps check the formation of WPM.[3],[4],[11]

Standard filters on normal use following proper instructions and microfilters usage for high-risk cases is advocated to be used as standard practice in this regard.[12]


  Further Investigations Top


Researchers advocate detailed investigation such as culture of contaminated blood unit and quarantine of the affected units.[12]


  What is to Be Done to Detect White Particulate Matter? Top


Every blood bank should have its own standard operating protocols regarding checking the blood before issuing the units. Many centers advocate and practice strict visualization of blood units before issuing apart from necessary paperwork. As per guidelines, the blood bag is kept with the labeled side down on a flat surface for 10 min undisturbed before visual inspection for any particles.[4],[12],[13] These may be small dots to big steaks that do not dissolve on shaking and may disintegrate on rubbing only to reappear again. WPM may also be found in tubings.[14]


  What Happens When This Blood Unit is Transfused? Top


Published articles believe that its inadvertent transfusion should not pose risk, but the issuance and transfusion should be avoided.[4],[12],[13] Potential adverse event (AE) and WPM association have not been conclusively given by authorities.[13] Quarantine of such units is advocated till compatibility and relevant investigation conclude suitability to transfuse these units.[12],[13],[14],[15] An observation by multiorganizational task force to assess increase AEs related to particulate matter and the effect of postleukofiltration on the particulate matter found no difference on AE in patients transfused with particulate matter laden blood. The authors, however, cautioned and concluded that results did not mean that there is no AE and the final evidence requires further research.[16]


  Types of White Particulate Matter Top


Enhanced visualization is advocated and the WPM has been divided into four types:[17]

  • Type 1 matter – consist of 20–5000 small WPM per unit
  • Type 2 matter – consist of 2–50 large WPM per unit
  • Type 3 matter – consist of atypical bubbles
  • Type 4 matter – consist of yellow/white oil slick.



  Is White Particulate Matter Found at Places Other Than Blood Bag? Top


A white thrombus type of matter, resembling as WPM with the composition of platelet and thrombin aggregation was noticed adhering in the lumen of dialysis blood tubings of many chronic dialysis patients. No previous report of WPM associated with hemodialysis treatment has been reported. Patient-specific and tubing-specific factors were supposed to cause this phenomenon warranting further studies.[18] One more case of recurrent white thrombi formation inside hemodialysis tubings of a young male with no pro-thrombotic risk factor is reported. The thrombus consisted of platelet aggregates and episodes improved on increased heparin dose.[19]


  Current Status and Future Trends Top


There are, however, no universal guidelines for issuing and transfusion of WPM containing units. Long-term studies to see the effect of WPM on recipient safety and AEs are required for better policy formation.


  Conclusion Top


WPM is an uncommon but important phenomenon that is sporadically reported in the literature. Vigilant observation is crucial to report and record these unusual events. The knowledge of this phenomenon shall help to anticipate and identify these properly. While these particles are still enigmatic, collaborative studies are warranted to comprehend them fully.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Subramniyan R. White particulate matter in blood bag: Revisited. Glob J Transfus Med 2017;2:70-1.  Back to cited text no. 1
    
2.
Simon TL. White particulate matter: This time too much precaution. Transfusion 2004;44:956-8.  Back to cited text no. 2
    
3.
McCullough J, Dodd R, Gilcher R, Murphy S, Sayers M. White particulate matter: Report of the ad hoc industry review group. Transfusion 2004;44:1112-8.  Back to cited text no. 3
    
4.
Rentas FJ, Macdonald VW, Rothwell SW, McFaul SJ, Asher LV, Kennedy AM, et al. White particulate matter found in blood collection bags consist of platelets and leukocytes. Transfusion 2004;44:959-66.  Back to cited text no. 4
    
5.
Patel HD, Byrne KM, Horne M, Leitman SF, Stroncek DF. Factors affecting the formation of white particulate matter in red blood cell components. Transfusion 2005;45:1127-32.  Back to cited text no. 5
    
6.
Reiss RF, Katz AJ. Microaggregate content and flow rates of packed red blood cells. Transfusion 1977;17:484-9.  Back to cited text no. 6
    
7.
Swank RL. Alteration of blood on storage: Measurement of adhesiveness of “aging” platelets and leukocytes and their removal by filtration. N Engl J Med 1961;265:728-33.  Back to cited text no. 7
    
8.
Hillyer CD, Roback JD, Hillyer KL, Josephson CD, Page PL. Description and investigation of white particulate matter in additive solution-1 red blood cell units. Transfusion 2004;44:977-83.  Back to cited text no. 8
    
9.
Bang SU, Lee SM, Oh SC, Chung K, Lee DJ. Macroaggregates in the packed red blood cell unit during transfusion. Korean J Anesthesiol 2013;65:587-8.  Back to cited text no. 9
    
10.
Truter EJ, Rossouw JJ, Böhm L. Studies on the ultrastructure of blood cells and the microaggregate fraction in stored human blood. Intensive Care Med 1981;7:115-9.  Back to cited text no. 10
    
11.
Update on FDA's continuing investigation of particulate matter in blood shows normal blood components and no evidence of an increase in adverse events. Available from: https://www.infectioncontroltoday.com/view/update-fdas-continuing-investigation-particulate-matter-blood-shows-normal-blood. [Last accessed on 2020 May 01].  Back to cited text no. 11
    
12.
Sachdev S, Dhawan HK, Khetan D, Marwaha N, Jain A, Sharma RR. White particulate matter in a packed red blood cells unit. Asian J Transfus Sci 2011;5:175-6.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Iwamoto M, Curns AT, Blake PA, Jernigan DB, Holman RC, Lance-Parker SE, et al. Rapid evaluation of risk of white particulate matter in blood components by a statewide survey of transfusion reactions. Transfusion 2004;44:967-72.  Back to cited text no. 13
    
14.
Dubey A, Sonker A. A curious case of thick white slick in a blood bag. Asian J Transfus Sci 2018;12:93-4.  Back to cited text no. 14
[PUBMED]  [Full text]  
15.
Namiranian P, Tirandazi B, Frizhand AS, Belgi SH, Abad SA. A case report of a whole blood unit with white particulate matter. Sci J Iran Blood Transfus Organ 2015;1292:179-82.  Back to cited text no. 15
    
16.
Orton SL, Leparc GF, Rossmann S, Lewis RM. Particulate matter phenomenon: Adverse event data and the effect of leukofiltration. Transfusion 2004;44:973-6.  Back to cited text no. 16
    
17.
AABB. Key and Terminology as Relates to Atypical Blood Units. AABB Press Release. Bethesda: AABB; 2003.  Back to cited text no. 17
    
18.
Watnick S, Stooksbury M, Winter R, Riscoe M, Cohen DM. White thrombus formation in blood tubing lines in a chronic hemodialysis unit. Clin J Am Soc Nephrol 2008;3:382-6.  Back to cited text no. 18
    
19.
Sathe KP, Yeo WS, Liu ID, Ekambaram S, Azar M, Yap HK, et al. Recurrent white thrombi formation in hemodialysis tubing: A case report. BMC Nephrol 2015;16:3.  Back to cited text no. 19
    


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  In this article
Abstract
Introduction
Pathogenesis of ...
Prevention
Further Investig...
What is to Be Do...
What Happens Whe...
Types of White P...
Is White Particu...
Current Status a...
Conclusion
References
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