Neural network reveals platelet age from fluorescence microscopy images

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: >97% accuracy

• Primary Outcome: Accuracy of platelet age prediction from confocal microscopy images

• Nnt Or Sensitivity: Sensitivity and specificity not reported - only overall accuracy >97%

• Confidence Interval: Not reported

Clinical Application

Limited by requirement for specialized confocal microscopy equipment and computational infrastructure for CNN implementation Could potentially improve platelet transfusion outcomes under PBS coverage, but would require TGA approval for diagnostic use and integration with existing pathology services Patients requiring platelet transfusions, particularly those with hematological malignancies and platelet disorders

Abstract

Platelets are small, anucleate cells with a primary physiological role in vascular damage repair (hemostasis) and initiation of thrombus formation in response to vascular injury. Platelets circulate approximately 7-10 days, slowly undergoing age-related changes in molecular composition, morphology, activation capacity, function, and surface receptor density. As older platelets are associated with poor clinical outcome, no in vitro tests are available to predict platelet age, or to determine the fitness of platelet transfusion products. In this study, we developed a convolutional neural network model that could determine platelets' chronological age from confocal microscopic images. The model was trained using platelets stored in platelet-rich plasma up to 8 hours and using routine platelet concentrates up to 10 days. The model predicted chronological age of stored platelets with >97% accuracy. To test our model in vivo, we analyzed a cohort of patients with acute myeloid leukemia, experiencing thrombocytopenia due to chemotherapy. Our model could reliably distinguish in vivo between samples with younger and older platelets during the course of treatment. This study demonstrates the ability to predict platelets' chronological age both in vitro during storage and in vivo, which may impact clinical transfusion medicine and the diagnosis and treatment of patients with platelet disorders. What is the context?Platelets circulate approximately 7–10 days, slowly undergoing age-related changes in molecular composition, morphology, activation capacity, function, and surface receptor density. During storage, proinflammatory changes occur in platelets over time and platelet age may be associated with poorer clinical outcomes. Therefore, understanding platelet aging and developing novel tools to interrogate platelet age will be useful. However, no platelet tests are currently available that can predict platelet age accurately based on platelet characteristics without keeping record of the (storage) time.What is new?We developed a convolutional neural network model that could determine platelets’ chronological age from confocal microscopic images. The model was trained using platelets stored in platelet-rich plasma up to 8 hours and using routine platelet concentrates up to 10 days. The model predicted chronological age of stored platelets with very high accuracy. Furthermore, our model was in vivo tested in a cohort of patients with acute myeloid leukemia, experiencing thrombocytopenia due to chemotherapy. Our model could reliably distinguish between in vivo samples with younger and older platelets during the course of treatment.What is the impact?Our study demonstrates the utility of a convolutional neural network model using confocal images of platelets to determine storage time-associated platelet phenotype in vitro as well as physiologic platelets’ chronological age in vivo. This model may be useful in several clinical settings, including clinical transfusion medicine, testing the quality of stored platelet concentrates, and diagnosing and treatment of patients with platelet disorders, thrombocytopenia, or thrombosis.