Now that we know that activated platelets are good for plugging holes in bleeding patients, if we get a platelet unit back out of temp because someone stuck in the cooler on the ice with the RBC units, would it be safe to use in an emergency in a bleeding patient?  I'm sure we would need to get pathologist approval to use it outside of regulations.  We are ~4 hours from our supplier and stock 3-6 platelet units.  All input appreciated.

12 hours ago, Mabel Adams said:

Now that we know that activated platelets are good for plugging holes in bleeding patients, if we get a platelet unit back out of temp because someone stuck in the cooler on the ice with the RBC units, would it be safe to use in an emergency in a bleeding patient?  I'm sure we would need to get pathologist approval to use it outside of regulations.  We are ~4 hours from our supplier and stock 3-6 platelet units.  All input appreciated.

activated platelets are good for plugging holes in bleeding patients when they are naturally activated and inside the body with physiological limits but those activated outside the body by ice or violent shaking for example, cannot be used , you will never guarantee the good results 

Short periods of time (<12 to 24 hours say) at refrigerator temperatures have no known deleterious effect on platelet transfusion efficacy, so I would use them as I would use any platelet component stored at room temperature.  I routinely approve this at my own institution when this happens.

On 11/30/2023 at 5:44 AM, Neil Blumberg said:

Short periods of time (<12 to 24 hours say) at refrigerator temperatures have no known deleterious effect on platelet transfusion efficacy, so I would use them as I would use any platelet component stored at room temperature.  I routinely approve this at my own institution when this happens.

If it isn't too much trouble, do you have any references on this?  Or should I refer to the recent papers on cold stored platelets?

On 11/29/2023 at 10:33 PM, drmsherpiny said:

activated platelets are good for plugging holes in bleeding patients when they are naturally activated and inside the body with physiological limits but those activated outside the body by ice or violent shaking for example, cannot be used , you will never guarantee the good results 

If you have any references that you wouldn't mind sharing, I would appreciate it.

Here's one paper that involves extended cold storage of room temperature platelets.  They actually seemed more functional.

Xu F, Gelderman MP, Farrell J, Vostal JG. Temperature cycling improves in vivo recovery of cold-stored human platelets in a mouse model of transfusion. Transfusion. 2013 Jun;53(6):1178-86. doi: 10.1111/j.1537-2995.2012.03896.x. Epub 2012 Sep 24. PMID: 22998069.

 

 

Background: Platelet (PLT) storage at room temperature (RT) is limited to 5 days to prevent growth of bacteria, if present, to high levels. Storage in cold temperatures would reduce bacterial proliferation, but cold-exposed PLTs are rapidly cleared from circulation by the hepatic Ashwell-Morell (AM) receptor, which recognizes PLT surface carbohydrates terminated by β-galactose. We cycled storage temperature between 4 and 37°C to preserve PLT function and reduce bacterial growth.

Study design and methods: Temperature-cycled (TC) human PLTs were stored at 4°C for 12 hours and then incubated at 37°C for 30 minutes before returning back to cold storage. PLTs stored at RT or at 4°C (COLD) or TC for 2, 5, and 7 days were infused into SCID mice and the in vivo recovery was determined at 5, 20, and 60 minutes after transfusion.

Results: PLTs stored for 2 days in COLD had significantly lower in vivo recoveries than RT PLTs. TC PLTs had improved recoveries over COLD and comparable to RT PLTs. After 5- and 7-day storage, TC PLTs had better recoveries than RT and COLD PLTs. PLT surface β-galactose was increased significantly for both COLD and TC PLTs compared to RT. Blocking of the AM receptor by asialofetuin increased COLD but not TC PLT recovery.

Conclusion: TC cold storage may be an effective method to store PLTs without loss of in vivo recovery. The increased β-galactose exposure in TC PLTs suggests that mechanisms in addition to AM receptors may mediate clearance of cold-stored PLTs.

Agree with Dr. Blumberg. If platelets are returned in an RBC cooler "on ice", we take a temp of the unit. If out of 20-24C range, we check for swirling, and if still swirling we will ask pathology if we can keep it, based on our current platelet inventory and the temp we got. Always up to them, but in general if it's only out of range by a degree or two, we'll accept it back. The coolers we use for RBCs are only out for 4 hours max, so these units are never in there very long, and they often come back within temp range (like they tossed the unit in the cooler right before bringing back the cooler). 

On 12/7/2023 at 8:47 AM, jshepherd said:

Agree with Dr. Blumberg. If platelets are returned in an RBC cooler "on ice", we take a temp of the unit. If out of 20-24C range, we check for swirling, and if still swirling we will ask pathology if we can keep it, based on our current platelet inventory and the temp we got. Always up to them, but in general if it's only out of range by a degree or two, we'll accept it back. The coolers we use for RBCs are only out for 4 hours max, so these units are never in there very long, and they often come back within temp range (like they tossed the unit in the cooler right before bringing back the cooler). 

This happens a lot at my hospital. How do you take the temp of the platelets?

We have a Temp Check device. Temp-Check Rapid Response Thermometer For Healthcare| Digi-Trax®

This is what we use to take temps of all products being returned to us. 

What would you do if cold-stored platelets were left at room temperature? Is it safe to return them to inventory? Does the expiration date need to be adjusted?

5 hours ago, urvibhula said:

What would you do if cold-stored platelets were left at room temperature? Is it safe to return them to inventory? Does the expiration date need to be adjusted?

1) If left in room temp, pH drops, number of activated platelets increase, and risk for infection increases.

2) Return to room temp or cold temp inventory? 

3) 4 to 6 hours shelf life in left in room temp. 

Source: https://pubmed.ncbi.nlm.nih.gov/33085783/

 

There is no evidence that cold stored platelets returned to room temperature need any change in outdating.  I wouldn't go beyond 7 days for pathogen reduced platelets or 5 days for non-PRT platelets.  Would just use clinical judgement.  The reference above relates only to frozen platelets in any case, an entirely different critter,  so not necessarily informative.

Edited October 16, 2024Oct 16 by Neil Blumberg

On 10/15/2024 at 6:51 PM, urvibhula said:

What would you do if cold-stored platelets were left at room temperature? Is it safe to return them to inventory? Does the expiration date need to be adjusted?

The ARC guide that we use say that return of csp are guided by similar conditions for blood product return.