Leveraging the Multifaceted Platelet Storage Lesion to Advance Precision Platelet Transfusion Medicine

Platelet transfusions are a cornerstone of modern medical care, yet the impacts of donor variability, manufacturing processes, and storage conditions on efficacy and safety remain to be comprehensively evaluated. In this review, the key factors contributing to the platelet storage lesion and recent clinical findings on cold-stored platelets are explored. Critical gaps in our understanding of platelet product function in hemostasis and beyond, including the roles of platelets in vascular integrity and thromboinflammation, are also highlighted. The impact of platelet product manufacturing and storage conditions on these domains is not yet understood. Furthermore, the need for improved preclinical models to assess storage-related functional changes is discussed and the importance of evaluating clinical outcomes associated with platelet storage lesions is emphasized. By addressing these challenges, clinicians can refine transfusion strategies through precision medicine and optimize platelet product selection and manufacturing to improve patient outcomes.