Time-dependent coagulation declines in cold-stored whole blood: a paired in-vitro comparison of rotational...

The functional integrity of stored whole blood (WB) is critical for maintaining hemostatic potential during transfusion. While storage-related changes in coagulation components are known, comparative evaluation using viscoelastic and sonorheometric platforms remains limited. This in vitro study explores time-dependent changes in clotting dynamics during WB storage using rotational thromboelastometry (ROTEM) and sonic estimation of elasticity via resonance (SEER) sonorheometry (Quantra).

WB from eight healthy donors was stored at 1-6 °C in citrate-phosphate-dextrose anticoagulant and sampled on Days 0, 1, 3, 7, 14, and 21. ROTEM parameters included INTEM/EXTEM/FIBTEM clotting time and amplitude; Quantra parameters included clotting time (CT), total clot stiffness (CS), platelet contribution (PCS), and fibrinogen contribution (FCS). Nonparametric statistics and effect sizes were used to assess temporal changes and agreement between platforms.

In this pilot in-vitro model ( n = 8) we observed progressive prolongation of clotting time and reduction in clot stiffness were observed across both platforms, as early as 1-3 days into storage. PCS declined significantly, while FCS showed modest reductions. ROTEM and Quantra demonstrated strong correlations in matched parameters, with consistent fixed biases noted in Bland-Altman analysis and a proportional bias with fibrinogen between the two methods.

Our experimental in vitro study of stored WB exhibits steady, time-dependent hemostatic deterioration, particularly in platelet function and clot initiation. These in-vitro observations reveal early declines in platelet-driven clot stiffness in our model and are hypothesis-generating for further laboratory and clinical evaluation.