Riley Brian C, Phuong Jimmy, Hasan Rida A, Stansbury Lynn G, Hess John R, Roubik Daniel J
University of Washington School of Medicine, Seattle, Washington, USA.
Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA.
Transfusion. 2025 Jul;65(7):1344-1351. doi: 10.1111/trf.18292. Epub 2025 Jun 3.
The United States military has transfused room temperature platelets (RTPs) in combat since 2004, but distribution to far-forward locations is limited. To expand access, cold-stored platelets (CSPs) were approved for 10-day storage in 2017, increased to 14 days in 2019, but clinical outcome reporting has been limited. This study assessed whether CSPs were associated with mortality in combat trauma patients when compared with RTPs.
A retrospective analysis of military databases evaluated combat casualty records 2001-2023. The intervention of interest was the transfusion of at least one unit of CSPs under a 10-day or 14-day expiration protocol. The outcome of interest was mortality at discharge. Logistic regression compared the treatment groups with a control cohort that only received RTPs.
Over the study period, 159 patients received 341 CSP units. Records were located for 124 patients: 57 received 10-day CSPs and 67 received 14-day CSPs. Overall mortality was 16.1% in the CSP cohort and 13.9% in the control group. Exposure to 10-day CSPs (adjOR = 0.39 [0.18-0.86]; p = .02) or 14-day CSPs (adjOR = 0.41 [0.20-0.83]; p = .01) was associated with decreased mortality. The outdating rate was 75.2% for RTPs and 93.4% for CSPs.
CSPs up to 14 days old appear non-inferior to 5-day RTPs. CSP age at transfusion trended toward the end of shelf life, indicating demand previously unmet by RTPs. Patients do well when they receive platelets as close to injury as possible; CSPs better facilitate this intervention in remote locations. CSPs should be further evaluated for use in a broader range of emergent transfusion scenarios.
自2004年以来，美国军方在战斗中输注室温血小板（RTP），但向偏远前沿地点的分发有限。为了扩大可及性，冷储存血小板（CSP）于2017年被批准可储存10天，2019年延长至14天，但临床结果报告有限。本研究评估了与RTP相比，CSP是否与战斗创伤患者的死亡率相关。
对军事数据库进行回顾性分析，评估2001 - 2023年的战斗伤亡记录。感兴趣的干预措施是在10天或14天有效期方案下输注至少一个单位的CSP。感兴趣的结果是出院时的死亡率。逻辑回归将治疗组与仅接受RTP的对照队列进行比较。
在研究期间，159例患者接受了341个CSP单位。找到了124例患者的记录：57例接受10天的CSP，67例接受14天的CSP。CSP队列的总体死亡率为16.1%，对照组为13.9%。输注10天的CSP（校正比值比[adjOR]=0.39[0.18 - 0.86]；p = 0.02）或14天的CSP（adjOR = 0.41[0.20 - 0.83]；p = 0.01）与死亡率降低相关。RTP的过期率为75.2%，CSP为93.4%。
长达14天的CSP似乎不劣于5天的RTP。输注时CSP的保存期限趋向于保质期结束，表明此前RTP无法满足这一需求。患者在尽可能接近受伤时接受血小板治疗效果良好；CSP能更好地在偏远地区促成这种干预。应进一步评估CSP在更广泛的紧急输血场景中的应用。
