Cold storage of platelets in platelet additive solution maintains mitochondrial integrity by limiting initiation of apoptosis-mediated pathways.

Cold-stored platelets are making a comeback. They were abandoned in the late 1960s in favor of room-temperature stored platelets due to the need for longer post-transfusion platelet recoverability and survivability in patients with chronic thrombocytopenia. However, the current needs for platelet transfusions are rapidly changing. Today, more platelets are given to patients who are actively bleeding, such as ones receiving cardiac surgeries. It has been established that cold-stored platelets are more hemostatically effective, have reduced bacterial growth, and have longer potential shelf lives. These compelling characteristics led to the recent interest in bringing back cold-stored platelets to the blood systems. However, before reinstating cold-stored platelets in the clinics again, a thorough investigation of in vitro storage characteristics and in vivo transfusion effects is required. This review aims to provide an update on the recent research efforts into the storage characteristics and functions of cold-stored platelets using modern investigative tools. We will also discuss efforts made to improve cold-stored platelets to be a better and safer product. Finally, we will finish off with discussing the relevance of in vitro data to in vivo transfusion results and provide insights and directions for future investigations of cold-stored platelets.

https://www.mdpi.com/1422-0067/23/3/1100/pdf?version=1642666134

The Missing Pieces to the Cold-Stored Platelet Puzzle

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

Antioxidant prevents clearance of hemostatically competent platelets after long-term cold storage.

Whole blood is currently being reintroduced as a blood product to be used in massive bleeding situations because it affords plasma, red cells and platelets in a balanced ratio and in a logistical advantageous way. Questions concerning the haemostatic potential of the platelets have arisen, especially in cold‐stored whole blood, as this is the major whole blood product in use. When reviewing current knowledge on this, there is an abundance of publications demonstrating that in vitro, platelets in cold‐stored whole blood have a haemostatic capacity up to 14 days, and even after 21 and 35 days of storage depending on type of additive solution. There is a paucity of data on clinical trials of cold‐stored platelets, whereas there is an abundance of previous clinical experience with whole blood, both cold‐stored and fresh, as an efficacious and safe product for use in pre‐ and in‐hospital patients with life‐threatening bleeding.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/voxs.12501

Platelet functionality in cold‐stored whole blood

An in vitro pilot study of apheresis platelets collected on Trima Accel system and stored in T-PAS+ solution at refrigeration temperature (1-6°C).

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An in vitro pilot study of apheresis platelets collected on Trima Accel system and stored in T-PAS+ solution at refrigeration temperature (1-6°C).