Refrigerated Platelets for the Treatment of Acute Bleeding: A Review of the Literature and Reexamination of Current Standards.

Abstract

To the Editor In the review article, “Refrigerated platelets for the treatment of acute bleeding: a review of the literature and reexamination of current standards,” published in Shock 41(suppl 1):51–53, 2014, Pidcoke and associates (1) reported that a “one-size-fits-all” method to store platelets at room temperature (22°C ± 2°C) does not provide platelets with the hemostatic effectiveness of platelets stored at 4°C for the treatment of actively bleeding patients. The authors suggest that platelets should be stored at 4°C to treat actively bleeding patients, and that platelets should be stored at room temperature (22°C ± 2°C) to treat patients to increase the platelet count in thrombocytopenic patients to prevent bleeding. Platelets stored at 4°C for 24 h have an in vivo survival value of 38% and exponential life span of less than 3 days and reduce the bleeding time in aspirin-treated normal volunteers (2). Platelets stored at 22°C for 24 h have an in vivo survival of 50% and linear life span of 8 days and do not reduce the bleeding time in aspirin-treated normal volunteers (2). In the review article, Pidcoke and associates reported that platelets stored at 4°C are more hemostatically effective than platelets stored at room temperature (22°C ± 2°C) to treat patients who are bleeding. These authors recommend that platelets should be stored at 4°C for patients who are bleeding and at room temperature (22°C ± 2°C) to treat thrombocytopenic patients who are not bleeding. Two methods to store platelets (one at 4°C and the other at 22°C) are proposed by the authors of this review article. During the past 45 years, the NBRL, Boston, Mass, has published numerous articles on cryopreserved dimethyl sulfoxide (DMSO)–treated platelets frozen with 6% DMSO by storage in a −80°C mechanical freezer (3). The frozen thawed, washed, and nonwashed platelets contain a bimodal population of platelets. One population that simulates survival and function of liquid-preserved platelets stored at 4°C and the other population of platelets simulates survival and function of platelets stored at 22°C. Cryopreserved platelets have been extensively used by the Netherlands military for the past 10 years for military and civilian casualties treated in Iraq, Afghanistan, and Bosnia by Dr. Charles Lelkens, Dr. Femke Noorman, and Dr. John Badloe, with excellent clinical results and without adverse events. The issues raised by Pidcoke and associates regarding storage of platelets at 4°C and at room temperature (22°C ± 2°C) can be resolved by freezing platelets with 6% DMSO and storage at −80°C for at least 2 years as reported by the Netherlands military. The data reported by the NBRL during the past 45 years and the 10-year experience by the Netherlands military document the safety and therapeutic effectiveness of frozen thawed platelets that contain a population of platelets that circulate and function like platelets stored at 4°C and a population of platelets that circulate and function like platelets stored at room temperature (22°C ± 2°C). C. Robert Valeri Gina Ragno Giorgio NBRL, Inc., Plymouth, Massachusetts