Cryopreserved platelets: frozen in a logjam?

Dumont, Larry J.; Slichter, Sherrill J.; Reade, Michael C.

doi:10.1111/trf.12758

Cited by 19 publications

(17 citation statements)

References 12 publications

(9 reference statements)

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“…These results are consistent with a variety of clinical experiences where CPP have been successfully used, such as cancer 15 and surgical settings, 13 patients with PLT refractoriness because of HLA alloimmunization, 5 or in combat casualty care. 6,12,22 Results from these clinical studies suggest that CPPs are hemostatically effective and do not significantly increase the risk of intravascular thrombosis after transfusion. 23 The apparent discrepancy between standard in vitro PLT test results and in vivo observations is because the in vitro assays do not typically take into account all activities that PLTs should retain for successful PLT transfusion such as adhesive, aggregating, and procoagulant activities.…”

Section: Discussionmentioning

confidence: 97%

“…To simplify postfreezing preparation logistics, the no‐wash, prefreeze volume reduction method is being used and investigated by several groups worldwide . Resuspension techniques after thaw vary from a full unit of type‐compatible plasma to large‐ and small‐volume crystalloids.…”

mentioning

confidence: 99%

“…2,16 To simplify postfreezing preparation logistics, the nowash, prefreeze volume reduction method is being used and investigated by several groups worldwide. 12 Resuspension techniques after thaw vary from a full unit of type-compatible plasma to large-and small-volume crystalloids. We are investigating CPPs prepared from leukoreduced apheresis PLTs, concentrated to approximately 15.9 3 10 12 PLTs/L in 20 to 35 mL of 6% DMSO, and frozen at less than 2658C.…”

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confidence: 99%

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In vitro evaluation of the hemostatic effectiveness of cryopreserved platelets

et al. 2015

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In vitro evaluation of the hemostatic effectiveness of cryopreserved platelets

et al. 2015

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“…In the absence of sufficient comparative trial evidence, cryopreserved PLTs are not registered for routine clinical use in most countries, despite clear hypothesized advantages that include: 1) potentially greater hemostatic activity, 2) reduced risk of infectious disease transmission, 3) reduced wastage, 4) not having to transport liquid PLTs urgently to hospitals unable to hold an adequate supply, 5) providing PLTs in hospitals where this currently is not possible, and 6) prolonged storage of rare PLT units for use in alloimmunized patients . Accordingly, we embarked on a program of research designed to generate sufficient evidence for regulatory approval and widespread introduction into clinical practice.…”

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A randomized, controlled pilot clinical trial of cryopreserved platelets for perioperative surgical bleeding: the CLIP‐I trial (Editorial, p. 2759)

et al. 2019

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BACKGROUND: Cryopreservation extends platelet (PLT) shelf life from 5 to 7 days to 2 to 4 years. However, only 73 patients have been transfused cryopreserved PLTs in published randomized controlled trials (RCTs), making safety data insufficient for regulatory approval. STUDY DESIGN AND METHODS: The Cryopreserved vs. Liquid Platelet (CLIP) study was a double-blind, pilot, multicenter RCT involving high-risk cardiothoracic surgical patients in four Australian hospitals. The objective was to test, as the primary outcome, the feasibility and safety of the protocol. Patients were allocated to study group by permuted block randomization, with patients and clinicians blinded by use of an opaque shroud placed over each study PLT unit. Up to 3 units of cryopreserved or liquid-stored PLTs were administered per patient. No other aspect of patient care was affected.Adverse events were actively sought. RESULTS:A total of 121 patients were randomized, of whom 23 received cryopreserved PLTs and 18 received liquid-stored PLTs.There were no differences in blood loss (median, 715 mL vs. 805 mL at 24 hr; difference between groups 90 mL [95% CI, -343.8 to 163.8 mL], p = 0.41), but the Bleeding Academic Research Consortium criterion for significant postoperative hemorrhage in cardiac surgery composite bleeding endpoint occurred in nearly twice as many patients in the liquidstored group (55.6% vs. 30.4%, p = 0.10). Red blood cell transfusion requirements were a median of 3 units in the cryopreserved group versus 4 units with liquid-stored PLTs (difference between groups, 1 unit [95% CI, -3.1 to 1.1 units]; p = 0.23). Patients in the cryopreserved group were more likely to be transfused fresh-frozen plasma (78.3% vs. 27.8%, p = 0.002) and received more study PLT units (median, 2 units vs. 1 unit; difference between groups, 1 unit [95% CI, -0.03 to 2.0 units]; p = 0.012).There were no between-group differences in potential harms including deep venous thrombosis, myocardial infarction, respiratory function, infection, and renal function. No patient had died at 28 days, and postoperative length of stay was similar in each group. CONCLUSION:In this pilot RCT, compared to liquid-stored PLTs, cryopreserved PLTs were associated with no evidence of harm. A definitive study testing safety and hemostatic effectiveness is warranted.A fter donation, platelets (PLTs) are stored at 20 to 24 C with agitation to prolong circulating time after transfusion. This limits their shelf life to 5 to 7 days 1 but despite this, PLTs cause 84% of transfusiontransmitted bacterial infections. 2 Short shelf life also leads to high levels of wastage: one-fourth to one-third of units are discarded due to expiry. 3,4 To limit wastage, PLTs are only kept routinely in larger hospitals where use is high and predictable. Bleeding patients in smaller hospitals are more likely to be denied this potentially lifesaving treatment. ABBREVIATIONS: BARC = Bleeding Academic Research Consortium; DVT = deep venous thrombosis; ICU = intensive care unit; IQR = interquartile range; OR ...

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“…Adjunctive therapies include the use of antifibrinolytic agents, a slow near‐continuous infusion of otherwise incompatible PLT products, and increasing the hematocrit to 30% or higher . Additional options include the use of recombinant Factor VIIa, thrombopoietic agents, and autologous cryopreserved PLTs (CPPs) …”

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confidence: 99%

Autologous cryopreserved platelets to overcome immune platelet refractoriness

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2016

Transfusion

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Cryopreserved platelets: frozen in a logjam?

Cited by 19 publications

References 12 publications

In vitro evaluation of the hemostatic effectiveness of cryopreserved platelets

In vitro evaluation of the hemostatic effectiveness of cryopreserved platelets

A randomized, controlled pilot clinical trial of cryopreserved platelets for perioperative surgical bleeding: the CLIP‐I trial (Editorial, p. 2759)

Autologous cryopreserved platelets to overcome immune platelet refractoriness

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