Glucose in platelet additive solutions: to add or not to add?

The metabolic conversion of glucose to energy and reducing power by platelets is examined. Although platelets concurrently metabolize glucose aerobically and anaerobically, the balance between the cytosolic and mitochondrial pathways is affected not only by physiological activation but also by conditions prevailing during in vitro storage. The development of platelet additive solutions and pathogen reduction technologies point to increased glucose metabolism and consequent high levels of lactate production as the effect of platelet damage, rather than the cause. Consequently a different perspective of the data suggests that reduction rather than support of platelet metabolism in vitro would result in a better quality of stored platelets.