Cold‐stored platelets have better preserved contractile function in comparison with room temperature‐stored platelets over 21 days

Abstract

Although it is well established that transfusion of platelets in cases of severe bleeding reduces mortality, the availability of platelets is hampered by harsh restrictions on shelf life due to elevated risks of microbial contamination and functional losses with room temperature‐stored platelets (RTP) kept at 22°C. In contrast, many recent studies have shown that 4°C cold‐stored platelets (CSP) are able to overcome these shortcomings leading to the recent Food and Drug Administration licensure for 14‐day stored CSP when conventional platelets are unavailable. This work expands the evidence supporting superiority of CSP function by assaying the less explored platelet‐mediated clot retraction of RTP and CSP in either autologous plasma (AP) or platelet additive solution (PAS) for up to 21 days. The results demonstrate that CSP have better preservation of contractile function, exhibiting retraction for up to 21 days in both AP and PAS and forming highly ordered fibrin scaffolds similar to those of fresh platelets. In contrast, RTP stored in AP showed impaired contractile function by Day 5 with no retraction after 10 days, whereas PAS‐stored RTP retained contractile function for up to 21 days. Collectively, these findings support extended storage of CSP and suggest that storage in PAS can mitigate functional losses in RTP.

Cold‐stored platelet function is not significantly altered by agitation or manual mixing

“…We and others have provided evidence for the in vitro functionality of CS‐PLT stored out to 21 days. Others have also demonstrated that CS‐PLT stored in PAS out to 21 days have been shown to be non‐inferior to RT‐PLT stored for 5 days as assessed by in vitro assessments 42,43 . These data are supportive of increasing the shelf life of CS‐PLT out to 21 days, however, we do not currently have safety or efficacy data regarding day 21 CS‐PLT transfusion in humans.…”

“…Others have also demonstrated that CS-PLT stored in PAS out to 21 days have been shown to be non-inferior to RT-PLT stored for 5 days as assessed by in vitro assessments. 42,43 These data are supportive of increasing the shelf life of CS-PLT out to 21 days, however, we do not currently have safety or efficacy data regarding day 21 CS-PLT transfusion in humans. The CHIPS trial (NCT04834414), a multicenter randomized controlled trial comparing RT-PLT to CSP-PLT in actively bleeding cardiac surgery patients, includes an adaptive design that will allow for the extension of CS-PLT storage from 7 days out to 21 days if they remain non-inferior to the RT-PLT group.…”

The Missing Pieces to the Cold-Stored Platelet Puzzle

“…The superior fiber crosslinking in CPs could be mediated by factor XIII through binding on the activated glycoprotein IIb/IIIa on the CPs surfaces [20]. In addition, clot histology showed that CPs had higher porosity and more well-defined structure in their clots similar to fresh platelets [21]. On the other hand, RPs formed clots with altered structure and decreased porosity.…”

Effects of room temperature and cold storage on the metabolic and haemostatic properties of whole blood for acute normovolaemic haemodilution

“…compare the in-vivo properties of RT and cold-stored WB for haemostasis during surgery. Second, cold storage induces many changes in platelets not corresponding with aging or storage lesions of platelets stored at RT [28][29][30]. These changes can be influenced by several factors such as the levels of surface-receptor modifications, platelet-activation markers, and thrombotic microparticles, that were not measured herein.…”