How are you all interpreting the FDA's guidance to use CSP "where room temperature platelets are not available or their use is not practical"?  What is "not practical" for your site? If using the RT platelets means that the OP transfusion patient has to wait until more arrive from our supplier 4 hours away, that seems impractical to me.  Is it "impractical" that we will have no platelets in stock that we can give the septic oncology patient (non-bleeding) because we gave them all to the MTP patient rather than giving the MTP our CSP and holding onto a RT plt for other critical, but non-bleeding needs?  Should we give the CSP to the trauma and hold the RT plts only if we know we have such a patient in already who has been using platelets?  If you have a policy to share, that would be great--especially if you aren't near your blood supplier.

I think you do what is practical in your setting. There is no evidence one way or the other for prophylactic use of cold vs. room temp platelets in terms of actual bleeding prevention.  Platelet count increments were the metric used, and we now know that platelet count is a relatively minor contributor to bleeding at counts much above 5-10,000/µl.  So we're all operating based upon "expert" (often wrong) opinion, not actual data.  In general, at platelet counts above 10,000/µl there is virtually no evidence of benefit for platelet transfusion and plenty of evidence of harm (particularly if not ABO identical). So the best clinical decision is often to postpone or eschew transfusion in my view.  The long standing view that transfusion is almost always better than no transfusion is tragically wrong.

The quote above is from Implementation of Alternative Procedures for the Manufacture of Cold-Stored Platelets TOOLKIT Updated 12/18/23 put out by AABB.

The interpretation we use is if the patient is actively bleeding then yes we give them. If not we turn it over to the medical director to decide. We then just document and abide by thier decision. They decide after consult with the attending and lab values.