The short shelf-life of liquid-stored platelets (LP) at 20–24°C poses shortage and wastage challenges. Cryopreserved platelets have significantly extended shelf-life, and were safe and efficacious for therapeutic transfusions of bleeding patients in the Afghanistan conflict and phase 2 randomized studies. Although hematology patients account for half of platelets demand, there is no randomized study on prophylactic cryopreserved platelet transfusions in them.

Methods

We performed a phase 1b/2a randomized cross-over study comparing the safety and efficacy of cryopreserved buffy coat-derived pooled platelets (CP) to LP in the prophylactic transfusions of thrombocytopenic hematology patients.

Results

A total of 18 adults were randomly assigned 1:1 to CP and LP for their first thrombocytopenic period (TP) of up to 28-days. A total of 14 crossed over to the other platelet-arm for the second TP. Overall, 17 subjects received 51 CP and 15 received 52 LP. CP-arm had more treatment emergent adverse event (29.4% vs. 13.3% of subjects, 9.8% vs. 3.8% of transfusions) than LP-arm but all were mild. No thromboembolism was observed. Both arms had similar bleeding rates (23.5% vs. 26.7% of subjects) which were all mild. Subjects in CP-arm had lower average corrected count increments than LP-arm (mean [SD] 5.6 [4.20] vs. 22.6 [9.68] ×10⁹/L at 1–4 h, p < .001; 5.3 [4.84] vs. 18.2 [9.52] ×10⁹/L at 18–30 h, p < .001). All TEG parameters at 1–4 h and maximum amplitude (MA) at 18–30 h improved from baseline post-CP transfusion (p < .05) though improvements in K-time and MA were lower than LP (p < .05).

Discussion

During shortages, CP may supplement LP in prophylactic transfusions of thrombocytopenic patients.

CONFLICT OF INTEREST STATEMENT

The authors have disclosed no conflicts of interest.

Supporting Information

REFERENCES

1Stubbs JR, Shaz BH, Vasallo RR, et al. Expanding the platelet inventory to mitigate the impact of severe shortages. Hematology Am Soc Hematol Educ Program. 2022; 424-429: 424–429.
10.1182/hematology.2022000379
Google Scholar
2Milford EM, Reade MC. Comprehensive review of platelet storage methods for use in the treatment of active hemorrhage. Transfusion. 2016; 56: S140–S180.
10.1111/trf.13504
PubMed Web of Science® Google Scholar
3Noorman F, van Dongen TT, Plat MJ, et al. Transfusion: −80°C frozen blood products are safe and effective in military casualty care. PloS One. 2016; 11:e0168401. https://doi.org/10.1371/journal.pone.0168401
10.1371/journal.pone.0168401
PubMed Web of Science® Google Scholar
4Khuri SF, Healey N, MacGregor H, Barnard MR, Szymanski IO, Birjiniuk V, et al. Comparison of the effects of transfusions of cryopreserved and liquid-preserved platelets on hemostasis and blood loss after cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1999; 117: 172–183.
10.1016/S0022-5223(99)70483-6
CAS PubMed Web of Science® Google Scholar
5Reade MC, Marks DC, Bellomo R, Deans R, Faulke DJ, Fraser JF, et al. A randomized, controlled pilot clinical trial of cryopreserved platelets for perioperative surgical bleeding: the CLIP-I trial. Transfusion. 2019; 59: 2794–2804.
10.1111/trf.15423
PubMed Web of Science® Google Scholar
6Slichter SJ, Dumont LJ, Cancelas JA, Jones ML, Gernsheimer TB, Szczepiorkowski ZM, et al. Safety and efficacy of cryopreserved platelets in bleeding patients with thrombocytopenia. Transfusion. 2018; 58: 2129–2138.
10.1111/trf.14780
CAS PubMed Web of Science® Google Scholar
7Lelkens CCM, Koning JG, de Kort B, Floot IBG, Noorman F. Experiences with frozen blood products in The Netherlands military. Transfus Apher Sci. 2006; 34: 289–298.
10.1016/j.transci.2005.11.008
CAS PubMed Web of Science® Google Scholar
8Slichter SJ, Jones M, Ransom J, Gettinger I, Jones MK, Christoffel T, et al. Review of In vivo studies of dimethyl sulfoxide cryopreserved platelets. Transfus Med Rev. 2014; 28: 212–225.
10.1016/j.tmrv.2014.09.001
PubMed Web of Science® Google Scholar
9Johnson L, Tan S, Jenkins E, Wood B, Marks DC. Characterization of biologic response modifiers in the supernatant of conventional, refrigerated, and cryopreserved platelets. Transfusion. 2018; 58: 927–937.
10.1111/trf.14475
CAS PubMed Web of Science® Google Scholar
10Gerber B, Alberio L, Rochat S, Stenner F, Manz MG, Buser A, et al. Safety and efficacy of cryopreserved autologous platelet concentrates in HLA-alloimmunized patients with hematologic malignancies. Transfusion. 2016; 56: 2426–2437.
10.1111/trf.13690
CAS PubMed Web of Science® Google Scholar
11Napolitano M, Mancuso S, Raso S, LoCoco L, Arfò PS, de Francisci G, et al. Buffy coat-derived platelets cryopreserved using a new method: results from a pivotal clinical trial on thrombocytopenic patients with acute leukaemia. Tranfus Apher Sci. 2019; 58:102666. https://doi.org/10.1016/j.transci.2019.10.008
10.1016/j.transci.2019.10.008
PubMed Web of Science® Google Scholar
12Bohonek M, Kutac D, Landova L, Koranova M, Sladkova E, Staskova E, et al. The use of cryopreserved platelets in the treatment of polytraumatic patients and patients with massive bleeding. Transfusion. 2019; 59: 1474–1478.
10.1111/trf.15177
CAS PubMed Web of Science® Google Scholar
13Dyer C, Alquist CR, Cole-Sinclair M, Curnow E, Dunbar NM, Estcourt LJ, et al. A multicentred study to validate a consensus bleeding assessment tool developed by the biomedical excellence for safer transfusion collaborative for use in patients with haematological malignancy. Vox Sang. 2018; 113: 251–259.
10.1111/vox.12627
CAS PubMed Web of Science® Google Scholar
14Gottschall J, Wu YY, Triulzi D, Kleinman S, Strauss R, Zimrin AB, et al. The epidemiology of platelet transfusions: analysis of platelet use at 12 US hospitals. Transfusion. 2020; 60: 46–53.
10.1111/trf.15637
PubMed Web of Science® Google Scholar
15Schiffer CA, Aisner J, Wiernik PH. Clinical experience with transfusion of cryopreserved platelets. Br J Haematol. 1976; 34: 377–385.
10.1111/j.1365-2141.1976.tb03584.x
CAS PubMed Web of Science® Google Scholar
16Daly PA, Schiffer CA, Aisner J, Wiernik PH. Successful transfusion of platelets cryopreserved for more than 3 years. Blood. 1979; 54: 1023–1027.
10.1182/blood.V54.5.1023.1023
CAS PubMed Web of Science® Google Scholar
17Lazarus HM, Kaniecki-Green EA, Warm SE, Aikawa M, Herzig RH. Therapeutic effectiveness of frozen platelet concentrates for transfusion. Blood. 1981; 57: 243–249.
10.1182/blood.V57.2.243.243
CAS PubMed Web of Science® Google Scholar
18Melaragno AJ, Carciero R, Feingold H, Talarico L, Weintraub L, Valeri CR. Cryopreservation of human platelets using 6% dimethyl sulfoxide and storage at −80 degrees C. Effects of 2 years of frozen storage at −80 degrees C and transportation in dry ice. Vox Sang. 1985; 49: 245–258.
10.1111/j.1423-0410.1985.tb01119.x
CAS PubMed Web of Science® Google Scholar
19Stanworth SJ, Estcourt LJ, Powter G, Kahan BC, Dyer C, Choo L, et al. A no-prophylaxis platelet-transfusion strategy for hematologic cancers. N Engl J Med. 2013; 368: 1771–1780.
10.1056/NEJMoa1212772
CAS PubMed Web of Science® Google Scholar
20Slichter SJ, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med. 2010; 362: 600–613.
10.1056/NEJMoa0904084
CAS PubMed Web of Science® Google Scholar

Volume63, Issue9

September 2023

Pages 1649-1660

A randomized cross-over study of cryopreserved platelets in prophylactic transfusions of thrombocytopenic patients

Abstract

Background

Methods

Results

Discussion

CONFLICT OF INTEREST STATEMENT

Supporting Information

REFERENCES

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

A randomized cross-over study of cryopreserved platelets in prophylactic transfusions of thrombocytopenic patients

Abstract

Background

Methods

Results

Discussion

CONFLICT OF INTEREST STATEMENT

Supporting Information

REFERENCES

References

Related

Information