Skip to main content

Master of Public Health

HEMOSTATIC POTENTIAL OF COLD-STORED NON-LEUKOREDUCED WHOLE BLOOD OVER TIME: AN ASSESSMENT OF PLATELET FUNCTION AND THROMBIN GENERATION FOR OPTIMAL SHELF-LIFE

AUTHORS

Assen S , Cardenas J , George M , Wand YW , Wade CE , Meyer D , Cotton BA , . The journal of trauma and acute care surgery. 2020 5 26; ().

ABSTRACT

OBJECTIVES: Cold-stored low-titer whole blood (WB) is becoming increasingly used as the preferred product for initial hemorrhagic shock resuscitation. The purpose of this study was to identify whether the current 21-day shelf-life is the optimal duration for storage of WB, maintaining hemostatic efficacy.

METHODS: Five units of fresh low-titer group O WB (non-leukoreduced) were acquired from our regional blood center. These units were stored at 4o C for up to 21 days as per current clinical storage guidelines in our emergency department. Hemostatic parameters were measured in vitro at 0, 7, 14, and 21 days. Assessments of hemostatic potential included cell count, rapid (r-TEG) and kaolin thrombelastography (TEG), Multiplate impedance aggregometry, and calibrated automated thrombogram (CAT). Univariate analysis, including one-way ANOVA with repeated measures, was performed (STATA 12.1).

RESULTS: Compared to baseline product (0 days), both platelet count and platelet function of WB showed sharp decreases at 7 days and again at 14 days. Platelet function deterioration was noted by r-TEG maximal amplitude (MA), TEG-MA, and Multiplate AA and ADP (Figure 1); all p<0.001. With respect to clot initiation, r-TEG ACT and TEG R-time were similar over the 21-day shelf-life; p=0.058 and p=0.620, respectively. Thrombin generation assessed by CAT demonstrated stable endogenous thrombin potential (ETP) over the course of storage (p=0.162), but increased peak thrombin generation and quicker time to peak generation after 7 days (Figure 2).

CONCLUSION: While the platelet function of WB degrades significantly at 7 days (and again at 14-days), clot initiation remains stable over time and thrombin generation appears to be improved at 7 days. This study supports a current storage limit for cold-stored, low-titer WB of 14-days.Study TypeBasic Science.

Tags: