The use of cryopreserved platelets in the treatment of polytraumatic patients and patients with massive bleeding

Abstract

BACKGROUND The short shelf‐life of fresh platelets limits their efficient inventory management and availability during a massive transfusion protocol. Risk of insufficient availability can be mitigated by building an inventory of cryopreserved platelets (CPs). METHODS A comparative study of fresh apheresis platelets (FAPs) and CPs was performed. Type‐O CPs were processed with DMSO frozen at −80°C and reconstituted in thawed AB plasma. All patients enrolled in the study had the following parameters evaluated on admission: vital signs (body temperature, heart rate, mean arterial pressure), blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level, and, in trauma patients, international severity score. Several outcomes were evaluated: 30‐day survival, adverse events, quantity of administered blood products, fibrinogen concentrate and thromboxane (TXA), and laboratory parameters after transfusion (blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level). RESULTS Twenty‐five (25) patients in the study group received transfusions totaling 81 units of CPs. Twenty‐one (21) patients in the control group received a total of 67 units of FAPs. There were no significant differences in patient characteristics (p > 0.05) between groups. Both groups were comparable in clinical outcomes (30‐day survival, administered blood products, fibrinogen concentrate, TXA, and adverse events). Among posttransfusion laboratory parameters, platelet count was higher in the group transfused with FAPs (97.0 ×109/L) than in the group transfused with CPs (41.5 ×109/L), p = 0.02025. Other parameters were comparable in both groups. CONCLUSION The study suggests that CPs are tolerable and a feasible alternative to FAPs. However, larger randomized studies are needed to draw definitive conclusions.

Cryopreserved platelets: the thaw begins … (Article, p. 2794)

“…There were no thrombotic events related to cryopreserved PLTs and no differences in adverse event rates found between cohorts. These safety results are largely consistent with those reported for previous trials …”

“…No serious adverse events were observed, and the cryopreserved PLT transfusions appeared to be effective for bleeding patients with thrombocytopenia. A second trial run in the Czech Republic by Bohonek and colleagues found that transfusing cryopreserved PLTs or standard apheresis PLTs were associated with similar clinical outcomes in trauma patients and patients with massive bleeding.…”

Freezing expired platelets does not compromise in vitro quality: An opportunity to maximize inventory potential

“…There has been a resurgence in interest in cryopreservation of platelets over the past decade . Although CPPs have been transfused for prophylactic purposes, the most prevalent indication for CPPs has been the treatment of active bleeding . In the future, CPPs could represent one component in a multiproduct inventory where the choice of product is dictated by individual patient requirements.…”

“…2 Although CPPs have been transfused for prophylactic purposes, 2,13,14 the most prevalent indication for CPPs has been the treatment of active bleeding. [15][16][17][18][19] In the future, CPPs could represent one component in a multiproduct inventory where the choice of product is dictated by individual patient requirements. RTstored platelets would likely remain the product of choice for prophylactic transfusions, while CPPs may be reserved for actively bleeding patients, particularly in locations where an RT inventory is not available, such as remote or military environments.…”

A randomized, controlled pilot clinical trial of cryopreserved platelets for perioperative surgical bleeding: the CLIP‐I trial (Editorial, p. 2759)

“…A Phase I human study found lower 24‐hour PLT recovery in comparison to liquid‐stored PLTs, but with survival times exceeding US Food and Drug Administration requirements and with no associated adverse events . Three small Phase II trials have been performed in bleeding hematology, cardiac surgery, and a mixed population of mostly trauma patients, all of which suggested at least comparable hemostatic efficacy and no evidence of adverse effects. However, the total number of patients transfused cryopreserved PLTs in these three trials was only 73.…”