Toward a definition of “fresh” whole blood: an in vitro characterization of coagulation properties in refrigerated whole blood for transfusion

Abstract

Background The hemostatic property of “fresh” whole blood (WB) has been observed in military application and cardiac surgery and is associated with reduced blood loss, transfusion requirements, and donor exposures. The time from donation to transfusion defining “fresh” has not been systematically studied. We undertook an in vitro study of coagulation properties of refrigerated WB stored for 31 days. Study design and methods Twenty-one WB units were obtained from healthy volunteer donors and stored under standard AABB refrigerated conditions. Samples were obtained on the day after donation and again on Days 2, 4, 7, 11, 14, 17, 21, 24, and 31. Tests included complete blood count, pH, pO2, pCO2, glucose, lactate, thromboelastography (TEG), and platelet function by light transmission aggregometry (LTA). Results There was progressive decline in pH, pO2, glucose, and sodium, but progressive increase in potassium, pCO2, and lactate. TEG variables in all units were normal through Day 11; abnormal values in some variables in some units began on Day 14. Final aggregation levels exhibited no change from Day 1 to Day 21 with adenosine diphosphate and epinephrine, but a decline with collagen (Day 7) and ristocetin (Day 17). Conclusion This in vitro study of coagulation properties demonstrates preservation of normal integrated coagulation function to a minimum of 11 days under standard conditions of refrigerated storage of WB for transfusion. These observations strongly suggest that the hemostatic quality of WB may extend beyond current transfusion practices. If confirmed clinically, this would increase availability and extend benefits of reduced donor exposure and transfusion requirements.

Stationary Versus Agitated Storage of Whole Blood During Acute Normovolemic Hemodilution

“…12 When refrigerated, coagulation changes as measured by TEG® are not noticed until 11 days of storage. 13 Our study expanded on these previous observations by demonstrating that at room temperature, the storage of whole blood under stationary or agitated conditions for 8 hours did not reduce its coagulation potential.…”

Refrigerated Platelets for the Treatment of Acute Bleeding

“…Refrigerated PLTs are cleared over 2 to 3 days; thus, they certainly remain in circulation long enough to contribute to hemostasis during the crucial initial period after injury (10). Furthermore, recent data suggest that 4C-PLTs retain hemostatic function for at least 10 days when refrigerated (12,14). In the context of remote damage control resuscitation, whole blood or PLT units could be collected at support bases or forward locations and transported to remote sites in isothermal transport boxes (e.g., Golden Hour boxes) along with other blood products and medications.…”

Effect of Storage Conditions and Activation on Growth Factor Concentration in Platelet‐Rich Plasma

“…While PRP can be used immediately after its preparation, in practice, it may be needed to be stored until the time of its use. It is known that platelets remain active for 5–7 days at room temperature or up to 10 days at temperatures of 0–6℃ . However, the number of studies dealing with growth factor release kinetics in PRP stored under different conditions is limited.…”