Comparative analysis of cold-stored platelets using Golden Hour transport boxes: Function and quality

The Emergency Medical Retrieval and Transfer Service in Wales provides prehospital critical care, including the transfusion of red blood cells and plasma. However, the logistical challenges of storing platelet concentrates (PCs) at 22°C with constant agitation limit their prehospital use. Cold-stored platelets (CSP) at 4°C without agitation offer a potential solution, demonstrating superior hemostatic capabilities in vitro and longer storage potential. This study investigated the viability of storing CSP in Golden Hour boxes for up to 96 h, followed by refrigeration, to enhance prehospital damage control resuscitation.

Two buffy-coat-derived PCs were combined and split into two: one PC was refrigerated at 4°C ± 2°C without agitation (CSP) for 15 days, and the other was stored in a Golden Hour cold box from days 2 to 6 (GH-CSP) before being rotated back into refrigeration. In vitro assessments included aggregometry, thrombin generation, thromboelastography, and platelet activation via P-selectin and annexin V binding.

Temperature data demonstrated that a Golden Hour box can maintain a temperature of 2-6°C for up to 84 h with a CSP and two red cell concentrates. Platelet function was not significantly different between the two storage conditions. GH-CSP displayed increased annexin V binding on day 8 compared with CSP (32.31 ± 3.27% vs 26.36 ± 2.17%, p = .0026) and day 15 (41.76 ± 6.13% vs 38.41 ± 3.99%, p = .0199).

CSP stored in a Golden Hour box was comparable with conventional CSP, suggesting this method may be viable for prehospital use.