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Chilling controversy: cold-stored platelets for prophylactic transfusions.
Moritz Stolla1,2,3,4, Andrew P Cap5, Philip C Spinella6
1Bloodworks Northwest Research Institute, Bloodworks Northwest, Seattle, WA.
Blood
|August 11, 2025
Summary
The FDA now allows 14-day cold-stored platelets for bleeding patients, increasing availability in hospitals. Their use for prophylaxis in thrombocytopenia requires further study, despite recent room temperature-stored platelet trial data.
Area of Science:
- Hematology
- Transfusion Medicine
- Clinical Policy
Background:
- FDA approval of 14-day cold-stored platelets marks a policy reversal from their 1970s discontinuation due to short circulation.
- This change enhances platelet availability in US hospitals, particularly in trauma centers and rural areas.
Purpose of the Study:
- To review the history and rationale behind cold-stored platelet discontinuation and recent re-licensure.
- To analyze recent clinical trial data on room temperature-stored platelets and their transfusion intervals.
- To critically evaluate the role of platelet count as a transfusion trigger.
Main Methods:
- Review of historical data on cold-stored platelets.
- Analysis of recent clinical trial findings for room temperature-stored platelets.
- Examination of the correlation between platelet counts and bleeding events.
Main Results:
- Cold-stored platelets are now available for bleeding patients, improving accessibility.
- Recent trials show similar transfusion intervals for room temperature-stored platelets as potentially achievable with cold-stored platelets.
- The direct correlation between morning platelet counts and bleeding risk is questionable, suggesting multifactorial causes.
Conclusions:
- While using cold-stored platelets for prophylaxis may seem unconventional, expanded indications show promise.
- Further research is needed to determine the efficacy of cold-stored platelets for prophylactic transfusions in hypoproliferative thrombocytopenia.
- Transfusion strategies may need to consider factors beyond just platelet count, including red blood cells, coagulation factors, and vascular health.
