Related Experiment Video
Updated: Jan 25, 2026
Author Spotlight: Developing Innovative Therapeutic Strategies for Hemorrhagic Shock Research
Published on: March 22, 2024
Cold-stored whole blood platelet function is preserved in injured children with hemorrhagic shock
Christine M Leeper1, Mark H Yazer, Franklyn P Cladis
1From the Department of Surgery, (C.M.L., B.A.G.); Department of Pathology (M.H.Y., D.T.), the University of Pittsburgh Medical Center; Department of Surgery (C.M.L., B.A.G.), Division of Pediatric Emergency Medicine (R.S.), Department of Anesthesiology and Perioperative Medicine (F.P.C.), Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.
Insights
Cold-stored whole blood (WB) provides effective platelet function in pediatric trauma patients, matching conventional transfusions. This finding supports WB use in pediatric resuscitation, though larger studies are needed.
Area of Science:
- Trauma Resuscitation
- Pediatric Hematology
- Blood Product Transfusion
Background:
- Cold-stored whole blood (WB) is increasingly used in pediatric trauma resuscitation.
- In vitro and animal studies suggest platelets in cold-stored WB retain hemostatic capabilities.
- Platelet function in pediatric recipients of cold-stored WB has not been previously evaluated.
Purpose of the Study:
- To evaluate the posttransfusion platelet count and function in pediatric trauma patients receiving cold-stored WB.
- To compare outcomes between pediatric trauma patients receiving cold-stored WB and those receiving conventional blood components.
Main Methods:
- A cohort of injured children (≥2 years, ≥10 kg) with hemorrhagic shock received cold-stored, low-titer, group O- WB.
- Patients receiving WB without conventional platelets were compared to a historical cohort receiving red blood cells and room temperature platelets.
- Platelet count and thromboelastography maximum amplitude were measured pre- and post-transfusion.
Main Results:
- No significant differences were observed in posttransfusion platelet count or thromboelastography maximum amplitude between the WB and component groups.
- Weight-adjusted platelet transfusion volume was significantly lower in the WB cohort.
- Mortality, intensive care unit length of stay, hospital length of stay, and ventilator days did not differ significantly between groups.
Conclusions:
- Cold-stored whole blood effectively provides adequate platelet number and function in severely injured children.
- Findings suggest cold-stored WB is a viable alternative to conventional component therapy in pediatric trauma.
- Larger studies are recommended to confirm these findings and support broader clinical adoption.
Background:
Recent data demonstrate the safety of uncrossmatched cold-stored whole blood (WB) transfusion in pediatric trauma patients. The hemostatic capabilities of platelets within the cold-stored WB unit have been demonstrated via in vitro studies and animal models. However, platelet function has not been evaluated in pediatric recipients of cold-stored WB transfusions.
Methods:
Injured children, 2 years or older and 10 kg or greater with hemorrhagic shock received up to 30 mL/kg of cold-stored, low titer (<50) anti-A and -B, leukoreduced, group O- WB during their initial resuscitation. Patients were included if (1) they received WB and no conventional platelets, and (2) platelet count and thromboelastography maximum amplitude were measured both before and after transfusion. These data and relevant clinical outcomes (mortality, intensive care unit length of stay [LOS], hospital LOS and ventilator days) were compared to a historical cohort of pediatric trauma patients who received uncrossmatched red blood cells (RBC) and conventional room temperature platelets.
Results:
Twenty-two children were included in the study; 14 in the component cohort versus 8 in the WB cohort. Neither posttransfusion platelet count (129 × 109/L vs. 135 × 109/L) nor function (thromboelastography maximum amplitude, 59.5 mm vs. 60.2 mm) differed significantly between children receiving cold-stored platelets within the WB unit versus children who received conventional warm platelets. Median (interquartile range) weight-adjusted platelet transfusion volume in the historical cohort was 4.6 (2.5-7.7) mL/kg vs. 2.4 (1.3-4.0) mL/kg in the WB cohort (p = 0.03). There was no difference between groups in age, race, mechanism of injury, Injury Severity Score, vital signs, and severe traumatic brain injury (TBI). Outcomes, including mortality, intensive care unit LOS, hospital LOS, and ventilator days, were not significantly different between groups.
Conclusion:
No difference was seen in posttransfusion platelet number or function in severely injured children receiving cold-stored WB platelets as compared to those receiving conventional room temperature-stored platelets. Larger cohorts are required to confirm these findings.
Level Of Evidence:
Therapeutic, level IV.
Related Concept Videos
01:18Structure and Function of Platelets
Platelets are continually replenished, circulating in the bloodstream for 9-12 days before being removed by phagocytes, primarily in the spleen. A microliter of circulating blood contains between 150,000 and 450,000...
01:24Blood Pressure Imbalances and Circulatory Shock
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
02:45Responses to Heat and Cold Stress
01:12Energy Stored in a Capacitor
01:26Characteristics and Functions of Blood
The primary function of blood is to transport oxygen and carbon dioxide between tissues and the lungs. Oxygenated blood is bright red, while oxygen-depleted blood is darker. It also carries...
01:10Energy Stored in Capacitors
By integrating the equation that relates voltage and current in a capacitor, one can derive an equation for the voltage across the capacitor at any given time. This equation is crucial in understanding and predicting the behavior of capacitors in...