Acceptable uses for cold stored platelets

[Mabel Adams]

Can heart surgery patients coming off the pump be given cold stored platelets?  They aren't hemorrhaging, which is the usual indication for these platelets, but I would think they could make use of activated platelets.  If any references are available, I'd love to have them.

[Neil Blumberg]

Why are we transfusing platelets to patients who aren’t bleeding? More likely to harm them than help them in my view.

[Neil Blumberg]

I should have added that I recognize that some cardiac surgeons transfuse platelets routinely post-bypass in the hope of reducing bleeding.  I suggest this is a traditional practice without the slightest shred of evidence for benefit.  Purely guesswork and expert opinion, for which there is now evidence of harm.   So whether you give cold or room temp platelets probably doesn't matter as (1) there is likely no benefit to either approach,  and (2) there is likely equivalent harm either way. 

So my short answer is it doesn't matter,  but that platelet transfusion to non-bleeding surgical patients likely doesn't help,  and may increase the risk of thrombosis, inflammation and reduced host defenses against post-operative infection. 

Edited November 21, 2023 by Neil Blumberg

[jshepherd]

Agree with Dr. Blumberg. The FDA guidance for CSPs states they can be used when "regular platelets are not available or not practical". This sounds like a more prophylactic use of platelets, which is also not practical. If you didn't have anything but CSPs on the shelf, and there is a request to transfuse, I guess it would be up to you as to how much you want to argue with cardiac surgeons for the sake of your inventory, given that these patients are not actively bleeding. 

[Mabel Adams]

On 11/17/2023 at 5:29 AM, Neil Blumberg said:

Why are we transfusing platelets to patients who aren’t bleeding? More likely to harm them than help them in my view.

They give them if they note excessive oozing when the patient comes off the pump due to the pump "beating up the platelets".  We will be getting a TEG analyzer (finally) so maybe they will have evidence from that testing that they don't need to give platelets in this scenario?  Of course, they have to order the test and wait for the results. 

[Mabel Adams]

I recently learned that there is a study underway on using them in heart surgeries at the University hospital in our state.  Maybe there will be useful evidence at some point in the future.  It's probably non-inferiority to room temp platelets so won't address Dr. Blumberg's concern.

[Neil Blumberg]

The fact is that we have little to no evidence that platelet transfusion of any sort will mitigate post-pump bleeding.  This is expert opinion only that has driven this practice. What we have learned in the last few years is that platelet transfusion as currently practiced (ignoring ABO for one thing) actually increases bleeding and mortality in some clinical settings.  I'd rather have some oozing than be transfused with platelets empirically, both as a patient and a hematologist.  With life threatening bleeding and abnormal platelet function as measured by a closure time or TEG/ROTEM, platelet transfusion makes sense and has some data driven support.  Oozing, no data whatever.