Frozen for combat: Quality of deep‐frozen thrombocytes, produced and used by The Netherlands Armed Forces 2001–2021

Noorman, Femke; Rijnhout, Tim W.H.; Kort, B de; Hoencamp, Rigo

doi:10.1111/trf.17166

Cited by 9 publications

(8 citation statements)

References 49 publications

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“…In addition, cryopreserved platelets can be used as a backup stock in larger hospitals, e.g., during long weekends when it is difficult to predict the need, in mass causality situations, and in military preparedness. There is potential to further improve the freezing and thawing procedures and to increase the storage time from today's 1 to 4 years to a longer time, that is, 12 years reported in a recent study (8). Our study describes the logistics of using cryopreserved platelets in small remote hospitals and supports the potential of having platelets available in all hospitals occasionally treating bleeding patients.…”

Section: Discussionsupporting

confidence: 59%

“…Cryopreserved platelets extend platelet shelf life and the upper limit for storage has currently been set to 1 year in the European Guide to the preparation, use, and quality assurance of blood components (EDQM) (7). However, studies indicate an extended shelf life of up to 12 years (8), which will make it possible to have a platelet stock in remote hospitals. Cryopreserved platelets have been used on special indications since the 1970s, and the early use was most often in refractory hematologic patients (9).…”

Section: Introductionmentioning

confidence: 99%

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Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden

Wikman

Diedrich

Björling

et al. 2023

Front. Public Health

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BackgroundBalanced transfusions, including platelets, are critical for bleeding patients to maintain hemostasis. Many rural hospitals have no or limited platelet inventory, with several hours of transport time from larger hospitals. This study aimed to evaluate the feasibility of using cryopreserved platelets that can be stored for years, in remote hospitals with no or limited platelet inventory.Material and methodsThree remote hospitals participated in a prospective study including adult bleeding patients where platelet transfusions were indicated. Cryopreserved platelets were prepared in a university hospital, concentrated in 10 ml, transported on dry ice, and stored at −80°C at the receiving hospital. At request, the concentrated platelet units were thawed and diluted in fresh frozen plasma. The indications, blood transfusion needs, and laboratory parameters pre- and post-transfusion, as well as logistics, such as time from request to transfusion and work efforts in preparing cryopreserved platelets, were evaluated.ResultsTwenty-three bleeding patients were included. Nine patients (39%) were treated for gastrointestinal bleeding, five (22%) for perioperative bleeding, and four (17%) for trauma bleeding. The transfusion needs were 4.9 ± 3.3 red blood cell units, 3.2 ± 2.3 plasma units, and 1.9 ± 2.2 platelet units, whereof cryopreserved were 1.5 ± 1.1 (mean ± SD). One patient had a mild allergic reaction. We could not show the difference in laboratory results between pre- and post-transfusion of the cryopreserved units in the bleeding patients. The mean time from the order of cryopreserved platelets to transfusion was 64 min, with a range from 25 to 180 min.ConclusionCryopreserved platelets in remote hospitals are logistically feasible in the treatment of bleeding. The ability to have platelets in stock reduces the time to platelet transfusion in bleeding patients where the alternative often is many hours delay. Clinical effectiveness and safety previously shown in other studies are supported in this small feasibility study.

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Section: Discussionsupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden

Wikman

Diedrich

Björling

et al. 2023

Front. Public Health

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“…Platelet concentrates frozen in dimethyl sulfoxide (DMSO) have been shown to be similar in quality to other platelet components, as reported by the two-decades long experience of the military with no data indicative of higher rates of bacterial contamination [ 76 ]. Similar successes have been obtained when freezing platelet concentrates derived from buffy coats in additive solution and DMSO [ 77 ].…”

Section: Alternatives To Room Temperature Storagementioning

confidence: 99%

Bacterial Contamination of Platelet Products

Jacobs,

Zhou,

Tayal

et al. 2024

Microorganisms

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Transfusion of bacterially contaminated platelets, although rare, is still a major cause of mortality and morbidity despite the introduction of many methods to limit this over the past 20 years. The methods used include improved donor skin disinfection, diversion of the first part of donations, use of apheresis platelet units rather than whole-blood derived pools, primary and secondary testing by culture or rapid test, and use of pathogen reduction. Primary culture has been in use the US since 2004, using culture 24 h after collection of volumes of 4–8 mL from apheresis collections and whole-blood derived pools inoculated into aerobic culture bottles, with limited use of secondary testing by culture or rapid test to extend shelf-life from 5 to 7 days. Primary culture was introduced in the UK in 2011 using a “large-volume, delayed sampling” (LVDS) protocol requiring culture 36–48 h after collection of volumes of 16 mL from split apheresis units and whole-blood derived pools, inoculated into aerobic and anaerobic culture bottles (8 mL each), with a shelf-life of 7 days. Pathogen reduction using amotosalen has been in use in Europe since 2002, and was approved for use in the US in 2014. In the US, recent FDA guidance, effective October 2021, recommended several strategies to limit bacterial contamination of platelet products, including pathogen reduction, variants of the UK LVDS method and several two-step strategies, with shelf-life ranging from 3 to 7 days. The issues associated with bacterial contamination and these strategies are discussed in this review.

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“…Cryopreservation at À80 C can extend the storage period of platelets by at least 2 years [7][8][9]. A literature review evaluated the efficacy and safety of platelets cryopreserved with dimethyl sulphoxide (DMSO) from 1972 to 2013.…”

Section: Introductionmentioning

confidence: 99%

“…However, the Food and Drug Administration (FDA) stipulates that the shelf life of platelets stored by conventional shaking methods at 22 ± 2°C is only 5 days [5, 6]. Cryopreservation at −80°C can extend the storage period of platelets by at least 2 years [7–9]. A literature review evaluated the efficacy and safety of platelets cryopreserved with dimethyl sulphoxide (DMSO) from 1972 to 2013.…”

Section: Introductionmentioning

confidence: 99%

Cryopreserved platelets washed with a dialysis machine for dimethyl sulphoxide removal

Huang

Lin

et al. 2023

Vox Sanguinis

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Background and ObjectivesCryopreserved platelets (cPLTs) can be stored for years and are mainly used in military settings. However, the commonly used cryoprotectant dimethyl sulphoxide (DMSO) has toxic side effects when utilized in high quantities. We developed a novel method to aseptically remove DMSO from thawed cPLTs by dialysis.Materials and MethodsOne unit of platelets (N = 6) was mixed with 75 mL of 27% DMSO within 4 days after collection and stored at −80°C for 1 week. The platelet counts, platelet distribution width, mean platelet volume (MPV), platelet activity, platelet release, platelet aggregation, platelet metabolism indicators and platelet ultrastructural features (determined by electron microscopy) of the samples at the pre‐freeze, post‐thaw wash (post‐TW) and 24 h post‐thaw wash (24‐PTW) stages were determined and compared.ResultsThe DMSO clearance rate from the post‐TW platelets was 95.56 ± 1.3%, and the platelet recovery rate after washing was 74.66 ± 6.34%. The total count, activity, release factors, aggregation and thrombolytic ability of the post‐TW platelets were lower, whereas the MPV and apoptosis rates were higher compared with those of the pre‐freeze platelets. The lactic acid, glucose and potassium ions released from the platelets during washing were filtered away by the dialyser, which significantly reduced their concentration. However, 24‐PTW platelets were metabolically active, resulting in a decrease in pH and glucose content and an increase in lactic acid content. The level of potassium ions remained low after 24 h of storage and washing. The pre‐freeze platelets maintained their normal disc shape and exhibited an open canalicular system (OCS) and a dense tubular system. The cPLTs appeared irregular after washing, with protruding pseudopodia and an extensive OCS, which increased the release of their contents.ConclusionWe developed a novel dialysis method to effectively remove DMSO from cPLTs under aseptic conditions and maintain platelet quality. The clinical efficacy of our method remains to be determined. However, the function of the platelets declined 24 h after washing, making them unsuitable for transfusion.

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Frozen for combat: Quality of deep‐frozen thrombocytes, produced and used by The Netherlands Armed Forces 2001–2021

Cited by 9 publications

References 49 publications

Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden

Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden

Bacterial Contamination of Platelet Products

Cryopreserved platelets washed with a dialysis machine for dimethyl sulphoxide removal

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