Assistant Professor Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh Pittsburgh, Pennsylvania, United States
Background/Case Studies: Platelets (PLTs) are a critical component of massive transfusion protocols for the management of hemorrhagic patients. Recently, cold-stored platelets (CSPs) have gained renewed interest due to their extended shelf life and potential hemostatic benefits. However, evidence supporting their efficacy in actively bleeding trauma patients remains limited.
Study
Design/Methods: This exploratory in vitro study evaluated the hemostatic efficacy of CSPs in a dilutional coagulopathy model to mimic massive transfusion scenarios. Whole blood (WB) was collected from healthy donors and diluted with normal saline to achieve a Hct of 20, simulating the dilutional loss of RBCs, clotting factors, and PLTs observed in trauma resuscitation. Two hemostatic resuscitation strategies were mimicked: (1) CSPs alone, using PLT concentrates from Trima plasma apheresis at a concentration equivalent to 20% of WB volume, with CSPs stored at 4°C for 6–21 days (n = 5); and (2) a balanced 1:1:1 strategy involving in vitro mixing of autologous RBCs, plasma, and CSPs stored under the same conditions (n = 4), termed transfusion package (TP), comprising 70% TP and 30% diluted WB. Hemostatic evaluation following mixing included PLT count, Hct, and rotational thromboelastometry (ROTEM) using EXTEM and INTEM. Repeated-measures ANOVA was used for statistical analysis.
Results/Findings: Both 20% PLT and TP mixing significantly improved PLT count post-dilution. In 20% PLT, PLT declined (WB 157.80·103 cells/μL vs. dWB 83.60, p=0.01) and was restored (20% PLT 204.00, p=0.02). Similarly, TP showed recovery (WB 144.50 vs. dWB 81.00, p=0.02; CS-TP 179.50, p=0.02). No group difference was observed (p=0.30). Hct fell in both groups (20% PLT: WB 34.06% vs. dWB 20.24; TP: WB 42.35% vs. dWB 20.15), but only TP showed recovery (24.83, p=0.01).
EXTEM/INTEM MCF declined with dilution (20% PLT EXTEM: WB 60.20mm vs. dWB 43.00, p< 0.01; INTEM: WB 60.40mm vs. dWB 39.80, p< 0.01; 1:1:1 EXTEM: WB 59.25 vs. dWB 42.50, p=0.03; INTEM: WB 59.25mm vs. dWB 39.00, p=0.02). CSP addition improved clot firmness (20% PLT EXTEM: dWB 43.00mm vs. 55.20, p=0.03; INTEM: dWB 39.80 vs. 54.20, p< 0.01). Final MCF values did not differ between groups.
Dilution significantly increased CT and CFT and decreased α. CSP improved EXTEM CT in both groups (p = 0.04) and significantly improved α only in the 20% PLT group (p = 0.01). For INTEM, CFT was reduced with 20% PLT mixing (p = 0.03), while CT and α remained unchanged. In the CS-TP group, trends toward improvement were observed.
Conclusions: CS PLTs effectively restored counts and clot strength following dilutional coagulopathy in vitro. Multiple clotting parameters improved, mitigating the hemostatic deficits induced by dilution when mixed using two transfusion strategies. These findings support their potential as a viable, effective option in transfusion medicine.
