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In the latest episode of Blooducation Baristas, Monica and I served up a piping hot discussion on a cool topic - cold-stored platelets. This fascinating conversation brought together three experts from diverse backgrounds to explore the past, present, and future of back to the future blood product.
A Journey Through Time: The History of Cold-Stored Platelets
Dr. Moritz Stolla, a researcher in platelet biology at the University of Washington, took us on a journey back to the early days of transfusion medicine. Believe it or not, cold storage was once the norm for all blood products, including platelets. However, a landmark study in 1969 by Scott Murphy changed the game. It revealed that cold-stored platelets had a significantly shorter circulation time compared to their room temperature counterparts. This discovery led to a shift in storage practices, with room temperature becoming the new standard.
But why the sudden interest in revisiting cold storage? Dr. Stolla explained that while room temperature platelets may have a longer circulation time, cold-stored platelets show superior function in vitro. They respond better to agonists like collagen and thrombin, making them potentially more effective for patients who are actively bleeding. With about 50% of platelet transfusions now going to actively bleeding patients, platelet function might just trump circulation time.
The Cold Hard Facts: Shelf Life and Storage
One of the most exciting aspects of cold-stored platelets is their potential for extended platelet shelf life. Dr. Stolla shared data showing that while recovery decreases with longer storage, the platelets' ability to provide a procoagulant surface remains strong even after 14 days of cold storage. This could be a game-changer for blood banks struggling with platelet shortages and waste. And will talk more about the ramifications of cold stored platelets when it comes to emergency preparations and expanding access to health in remote locations.
The ongoing CHIPS trial in the US is pushing the boundaries even further, testing storage times up to 21 days. If successful, this could revolutionize platelet inventory management and availability.
From Lab to Hospital: The Production Process
Jim Latimer, Director of Systems Integration at South Texas Blood & Tissue, gave us a behind-the-scenes look at how cold-stored platelets are produced. The collection process remains the same as for room temperature platelets, but the magic happens in the four hours post-collection. That's when the platelets are processed and refrigerated.
He shared that currently, cold platelets make up only about 1% of their production, primarily due to limited demand. However, Latimer highlighted some significant advantages of cold storage, including reduced bacterial growth and the ability to produce more double and triple units from a single donation.
Clinical Practice: A Norwegian Perspective
Dr. Torunn Apelseth, Director of the Norwegian Center for Blood Preparedness, shared her experience implementing cold-stored platelets in clinical practice. Norway adopted a dual inventory system during the COVID-19 pandemic as a shortage mitigation strategy. They now maintain a small stock of cold-stored platelets, primarily used for surgical patients, especially in cardiovascular surgery.
Dr. Apelseth emphasized the importance of standardized routines and clear algorithms to ensure proper use and avoid confusion. Their approach includes keeping cold-stored platelets in the same fridge as other emergency products to prevent them from being forgotten.
Inventory Management: A Balancing Act
Managing a dual inventory of room temperature and cold-stored platelets presents unique challenges. Latimer noted that cold platelets are easier to store and manage, but emphasized the importance of minimizing temperature excursions. Dr. Apelseth echoed this sentiment, stressing the need for standardized routines and clear algorithms to guide usage.
The Future is Cool: Potential Applications and Ongoing Research
As the discussion wrapped up, it became clear that cold-stored platelets have the potential to address several challenges in transfusion medicine. They could help mitigate platelet shortages, reduce waste, and provide a more effective product for actively bleeding patients.
However, questions remain. How will cold-stored platelets perform in different patient populations? What's the optimal storage time? The ongoing CHIPS trial is expected to provide crucial data to help answer these questions and guide future clinical practice.
The experts also touched on the potential use of cold-stored platelets in emergency and austere settings. Their extended shelf life and no bacterial testing required make them an attractive option for military applications, rural hospitals, and disaster response scenarios.
A Brewing Revolution in Transfusion Medicine
As we savored the last drops of this invigorating discussion, it became clear that cold-stored platelets represent a brewing revolution in transfusion medicine. By revisiting and refining a decades-old concept, researchers and clinicians are opening up new possibilities for improving patient care and blood product management.
The conversation highlighted the importance of continued research and collaboration across disciplines. From basic science to clinical practice to inventory management, each aspect plays a crucial role in bringing this innovative product from the lab to the patient's bedside. As we await the results of CHIlled Platelet Study “CHIPS” ongoing trials, the future of cold-stored platelets looks bright - or should we say, refreshingly cool.
So, the next time you hear about cold-stored platelets, consider our traditional paradigms of transfusion practice and if innovation can help us rethink practice. As transfusion medicine continues to evolve, it's clear that cold-stored platelets are more than just a passing trend. They're a testament to the power of revisiting old ideas with new technology and knowledge, potentially revolutionizing how we approach platelet transfusions and blood product management.
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