Refrigerating platelets before use could expand their lifespan threefold without losing function, according to new research led by the University of Pittsburgh. Writing in JAMA, the investigators reported results from a trial of 989 patients who underwent platelet transfusion as part of cardiac surgery. The study found that platelets refrigerated for 21 days were as effective as those stored at room temperature for five to seven days.
Platelets stored cold (1-6 °C), previously investigated 50 to 60 years ago in healthy volunteers, demonstrated decreased platelet count recovery and survival compared with room temperature platelets. Based on these early studies, cold-stored platelet use was largely abandoned. However, recent in vitro and animal data suggest that cold-stored platelet stored for seven to 14 days may be superior in hemostatic function for patients with active bleeding.
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In this study, almost 1,000 patients undergoing complex heart surgery requiring a heart-lung bypass machine were randomly assigned (2:1 ratio) to receive either cold-stored platelets kept for as long as 21 days, or standard room-temperature platelets kept for up to seven days. The trial gradually tested longer cold-storage times as safety data came in, and measured how well each type of platelet controlled active surgical bleeding using a validated bleeding score.
The results showed cold-stored platelets performed just as well as room-temperature ones at controlling bleeding, even when stored for the full 21 days. Bleeding-related measures like chest tube drainage after surgery were similar between the two groups, and there was no meaningful difference in dangerous side effects such as blood clots, kidney failure, or death.
Currently, up to 20% of donated platelets are wasted due to their short shelf life. Being able to safely store them three times longer than currently allowed could ease chronic platelet shortages, cut wastage, and let hospitals that currently cannot stock any platelets because of the short lifespan keep an emergency supply for bleeding patients.
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While the slight increase in reoperation rates warrants attention, the ability to extend shelf life significantly addresses a persistent logistical hurdle in transfusion medicine. This approach could allow blood banks to distribute products over wider geographic areas without the immediate pressure of time-sensitive expiration, potentially stabilizing supply chains that often struggle to meet fluctuating demand.
“Our findings could result in major international public health benefits,” said Spinella in a press statement. “This is incredibly transformative and will dramatically improve the availability of platelets while also reducing waste, allowing hospitals that aren’t in major cities to afford to keep this life-saving blood product on hand for bleeding patients.”
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