Strategies to modify production, specification, and storage of blood components to help prevent blood shortage Red blood cellsExtend shelf life if validated and within regulations Review manufacturing process. 64,65 Platelets Extend shelf life from 5 days to 7 days with appropriate bacterial testing or pathogen inactivation Recovery and survival of platelets, as well as count increments following transfusion, decline with increasing storage duration. 66,67 Bacterial risk depends on the timing of sampling, sample volume, and the length of culture; delayed culture methods with 7 day storage have been shown to be effective. 68 Depending on screening methodology, a further test at day 4 or at the end of storage might be required.Extend shelf life to 8 days after review of internal laboratory data to guide feasibility Review internal laboratory data to guide feasibility, and review data on bacterial risk. There is scant clinical data beyond day 7. At day 8, the recovery of fresh platelets manufactured from buffy-coats is nearly 70% and platelet survival is 45%. 69,70 Improved recovery and survival of platelets with prolonged storage has been observed with some types of additive solution. 69,70 Reduce dose for prophylactic transfusion (split products) Some countries already issue split products for neonatal transfusion. Consider half doses, or methods to produce two-thirds to three-quarter doses, such as pooling fewer so-called buffy coats or splitting aphaeresis collections into more doses. 71 Consider use of cold-stored platelets with 7-14-day shelf life for patients with bleeding only Studies in healthy volunteers suggest that the survival of platelets from whole blood or platelet concentrates refrigerated for 10-15 days might maintain acceptable viability. Laboratory data suggest that platelets remain functional for 14-21 days without the need for agitation. 72,[73][74][75][76] Consider frozen platelets for bleeding patients only 77,78 Plasma Remove requirements to freeze plasma Consider use of liquid (never frozen) plasma if freezer capacity or staff to freeze plasma are in short supply. 79 Whole BloodUse of whole blood Consider if staff to manufacture components are in short supply or for massive transfusion. [80][81][82][83][84]

Large national data sets provide useful information about the distribution of hemolysis at the end of RBC storage. This information can aid blood storage system development and regulatory science.