A Scoping Review of Cold-Stored Apheresis Platelets for Hemorrhage

Introduction: Room-temperature stored platelets (RTSP) have been the standard in component-based resuscitation. Its use in the austere deployed setting though is challenging for deployed and austere supply chains due to its limited shelf-life, need for constant agitation, and strict temperature parameters. More recent scientific advancements have enabled the re-implementation of apheresis cold-stored platelets (CSP) which would greatly improve the ability to deliver this lifesaving intervention across the battlespace. We conducted a scoping review to describe the current state of the art with apheresis CSP which were developed, in part, by the US military for deployed combat use. Methods: We conducted a scoping review using the PRISMA-ScR checklist. We used PubMed and Google Scholar to identify relevant literature from 2000 to 2025. Studies were eligible if they reported on the use of CSP and focused on trauma, surgical, or transfusion-related contexts in human subjects as well as addressing feasibility, safety, function, storage duration, or clinical outcomes. Results: We identified 7 studies that met inclusion criteria. Study designs included randomized controlled trials, crossover trials, and retrospective cohort studies. Populations ranged from healthy volunteers to patients with traumatic injuries, traumatic brain injury, or those undergoing surgery. Storage temperatures were between 1°C and 6°C for CSP against the control of RTSP at 22°C, with storage durations ranging from 5 to 20 days. Key outcomes assessed included platelet function, clot strength, safety, in vivo recovery, and clinical endpoints such as survival, need for neurosurgical intervention, and bleeding control. Overall, apheresis CSP demonstrated preserved or enhanced hemostatic function compared to RTSP with favorable outcomes. Conclusions: There is a limited yet growing body of literature on CSP use to enable wide implementation across the current and future battlespace.