Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Front Public Health. 2023 Jan 20;10:1073318. doi: 10.3389/fpubh.2022.1073318. eCollection 2022.
Balanced transfusions, including platelets, are critical for bleeding patients to maintain hemostasis. Many rural hospitals have no or limited platelet inventory, with several hours of transport time from larger hospitals. This study aimed to evaluate the feasibility of using cryopreserved platelets that can be stored for years, in remote hospitals with no or limited platelet inventory.
Three remote hospitals participated in a prospective study including adult bleeding patients where platelet transfusions were indicated. Cryopreserved platelets were prepared in a university hospital, concentrated in 10 ml, transported on dry ice, and stored at -80°C at the receiving hospital. At request, the concentrated platelet units were thawed and diluted in fresh frozen plasma. The indications, blood transfusion needs, and laboratory parameters pre- and post-transfusion, as well as logistics, such as time from request to transfusion and work efforts in preparing cryopreserved platelets, were evaluated.
Twenty-three bleeding patients were included. Nine patients (39%) were treated for gastrointestinal bleeding, five (22%) for perioperative bleeding, and four (17%) for trauma bleeding. The transfusion needs were 4.9 ± 3.3 red blood cell units, 3.2 ± 2.3 plasma units, and 1.9 ± 2.2 platelet units, whereof cryopreserved were 1.5 ± 1.1 (mean ± SD). One patient had a mild allergic reaction. We could not show the difference in laboratory results between pre- and post-transfusion of the cryopreserved units in the bleeding patients. The mean time from the order of cryopreserved platelets to transfusion was 64 min, with a range from 25 to 180 min.
Cryopreserved platelets in remote hospitals are logistically feasible in the treatment of bleeding. The ability to have platelets in stock reduces the time to platelet transfusion in bleeding patients where the alternative often is many hours delay. Clinical effectiveness and safety previously shown in other studies are supported in this small feasibility study.
平衡输血，包括血小板，对出血患者维持止血至关重要。许多农村医院血小板库存不足或有限，与较大医院之间有几个小时的运输时间。本研究旨在评估在血小板库存不足或有限的偏远医院使用可储存多年的冷冻血小板的可行性。
三家偏远医院参与了一项前瞻性研究，包括需要血小板输注的成年出血患者。在一所大学医院制备冷冻血小板，浓缩至 10ml，在干冰上运输，并在接收医院储存于-80°C。应要求，浓缩血小板单位解冻并在新鲜冷冻血浆中稀释。评估了输注的适应证、输血需求和输血前后的实验室参数，以及物流情况，如从请求到输血的时间和准备冷冻血小板的工作努力。
共纳入 23 例出血患者。9 例（39%）患者因胃肠道出血、5 例（22%）因围手术期出血、4 例（17%）因创伤出血而接受治疗。输血需求为 4.9±3.3 个红细胞单位、3.2±2.3 个血浆单位和 1.9±2.2 个血小板单位，其中冷冻保存的为 1.5±1.1（平均值±标准差）。1 例患者出现轻度过敏反应。我们无法显示出血患者输注冷冻保存血小板前后实验室结果的差异。从冷冻血小板订单到输血的平均时间为 64 分钟，范围为 25 至 180 分钟。
在偏远医院，冷冻血小板在治疗出血方面在物流上是可行的。在血小板替代治疗往往延迟数小时的情况下，库存中有血小板可减少出血患者的血小板输注时间。本小型可行性研究支持先前在其他研究中显示的临床效果和安全性。
