Vox Sanguinis International Forum on platelet cryopreservation: Summary

Cohn, Claudia S.; Dumont, Larry J.; Lozano, Miguel; Marks, Denese C.; Johnson, Lacey; Ismay, S.; Bondar, N.; T'Sas, F.; Yokoyama, Ana Paula Hitomi; Kutner, José Mauro; Acker, Jason P.; Bohoněk, Miloš; Sailliol, A.; Martinaud, Christophe; Pogłód, Ryszard; Antoniewicz‐Papis, Jolanta; Lachert, Elżbieta; Pun, Pamela Boon Li; Lu, Jia; Cid, Joan; Guijarro, Francesca; Puig, Lluís; Gerber, Bernhard; Alberio, Lorenzo; Schanz, Urs; Buser, Andreas; Noorman, Femke; Zoodsma, Margreet; Meer, Pieter F. van der; Korte, Dirk de; Wagner, Stephen J.; O'Neill, M.

doi:10.1111/vox.12533

Cited by 19 publications

(19 citation statements)

References 12 publications

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“…In recent years, there has been a relatively large resurgence of interest in CP as a promising blood product that is being used, tested, and validated in several countries and institutions. 15,22,[27][28][29][30][31] The US Army is engaged in a multi-million-dollar development effort for the production, manufacture, and approval (by the US Food and Drug Administration) of a CP product currently undergoing clinical trials. 32 At the Military University Hospital in Prague, Czech Republic, CPs are now used as a standard blood product.…”

Section: Discussionmentioning

confidence: 99%

The use of cryopreserved platelets in the treatment of polytraumatic patients and patients with massive bleeding

et al. 2019

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BACKGROUND The short shelf‐life of fresh platelets limits their efficient inventory management and availability during a massive transfusion protocol. Risk of insufficient availability can be mitigated by building an inventory of cryopreserved platelets (CPs). METHODS A comparative study of fresh apheresis platelets (FAPs) and CPs was performed. Type‐O CPs were processed with DMSO frozen at −80°C and reconstituted in thawed AB plasma. All patients enrolled in the study had the following parameters evaluated on admission: vital signs (body temperature, heart rate, mean arterial pressure), blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level, and, in trauma patients, international severity score. Several outcomes were evaluated: 30‐day survival, adverse events, quantity of administered blood products, fibrinogen concentrate and thromboxane (TXA), and laboratory parameters after transfusion (blood count, prothrombin time, activated partial thromboplastin time, fibrinogen level). RESULTS Twenty‐five (25) patients in the study group received transfusions totaling 81 units of CPs. Twenty‐one (21) patients in the control group received a total of 67 units of FAPs. There were no significant differences in patient characteristics (p > 0.05) between groups. Both groups were comparable in clinical outcomes (30‐day survival, administered blood products, fibrinogen concentrate, TXA, and adverse events). Among posttransfusion laboratory parameters, platelet count was higher in the group transfused with FAPs (97.0 ×109/L) than in the group transfused with CPs (41.5 ×109/L), p = 0.02025. Other parameters were comparable in both groups. CONCLUSION The study suggests that CPs are tolerable and a feasible alternative to FAPs. However, larger randomized studies are needed to draw definitive conclusions.

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Section: Discussionmentioning

confidence: 99%

The use of cryopreserved platelets in the treatment of polytraumatic patients and patients with massive bleeding

et al. 2019

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“…The publication of a no-wash protocol by Valeri et al in 2005 presented a gold standard cryopreservation protocol [9,10] and boosted the research field. The method hyperconcentrates the platelets by centrifugation after the addition of 6% (v/v) DMSO.…”

Section: Introductionmentioning

confidence: 99%

Platelet Biochemistry and Morphology after Cryopreservation

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2020

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Platelet cryopreservation has been investigated for several decades as an alternative to room temperature storage of platelet concentrates. The use of dimethylsulfoxide as a cryoprotectant has improved platelet storage and cryopreserved concentrates can be kept at −80 °C for two years. Cryopreserved platelets can serve as emergency backup to support stock crises or to disburden difficult logistic areas like rural or military regions. Cryopreservation significantly influences platelet morphology, decreases platelet activation and severely abrogates platelet aggregation. Recent data indicate that cryopreserved platelets have a procoagulant phenotype because thrombin and fibrin formation kicks in earlier compared to room temperature stored platelets. This happens both in static and hydrodynamic conditions. In a clinical setting, low 1-h post transfusion recoveries of cryopreserved platelets represent fast clearance from circulation which may be explained by changes to the platelet GPIbα receptor. Cryopreservation splits the concentrate in two platelet subpopulations depending on GPIbα expression levels. Further research is needed to unravel its physiological importance. Proving clinical efficacy of cryopreserved platelets is difficult because of the heterogeneity of indications and the ambiguity of outcome measures. The procoagulant character of cryopreserved platelets has increased interest for use in trauma stressing the need for double-blinded randomized clinical trials in actively bleeding patients.

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“…Reconstitution takes less than 30 minutes and requires minimal equipment and training. Dutch and Australian military experience in Afghanistan with 1143 cryopreserved PLT units transfused into 349 patients suggested they were both safe and effective, although no comparisons with liquid‐stored PLTs or whole blood were made. Extensive preclinical assessments have found that, compared to liquid‐stored PLTs, cryopreserved PLTs have increased procoagulant activity, with alterations in membrane receptors and higher microparticle concentrations .…”

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confidence: 99%

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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Vox Sanguinis International Forum on platelet cryopreservation: Summary

Cited by 19 publications

References 12 publications

The use of cryopreserved platelets in the treatment of polytraumatic patients and patients with massive bleeding

The use of cryopreserved platelets in the treatment of polytraumatic patients and patients with massive bleeding

Platelet Biochemistry and Morphology after Cryopreservation

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

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