Friedman Mark, Costa Victoria, Rafiee Behnam, Hilbert Timothy, Jafri Mansab, Wu Ding Wen
Department of Pathology, New York University Grossman Long Island School of Medicine, Mineola, NY 11501, USA.
Department of Pathology, New York University Grossman School of Medicine, New York, NY 10016, USA.
Life (Basel). 2025 Jun 19;15(6):985. doi: 10.3390/life15060985.
Platelet transfusions are a cornerstone of hemorrhage management in patients with thrombocytopenia or platelet dysfunction, yet their indications and dosing are largely based on expert opinion and low-quality evidence. This review offers a timely and comprehensive analysis of platelet transfusion practices in the United States (U.S.), uniquely integrating clinical evidence, such as the pivotal PLADO trial, with emerging technological advancements. Using a holistic approach, this manuscript addresses not only conventional practices (such as dosing standards and storage methods), but also cutting-edge alternatives like cold-stored and freeze-dried platelets, pathogen reduction technologies, and synthetic platelet substitutes. By juxtaposing U.S. practices with international standards, it highlights inefficiencies in dosing and supply management, proposing actionable solutions like lower-dose transfusions and diversified platelet inventories. Furthermore, the manuscript's exploration of whole blood-derived platelets and the ethical debate surrounding paid donors adds a forward-looking perspective. By examining these innovations alongside strategies to optimize supply, this work aims to provide a comprehensive overview of how transfusion medicine is adapting to meet clinical and logistical demands.
血小板输注是血小板减少症或血小板功能障碍患者出血管理的基石，但其适应症和剂量主要基于专家意见和低质量证据。本综述对美国的血小板输注实践进行了及时且全面的分析，独特地将临床证据（如关键的PLADO试验）与新兴技术进步相结合。本手稿采用整体方法，不仅探讨了传统做法（如剂量标准和储存方法），还涉及前沿替代方案，如冷储存和冻干血小板、病原体灭活技术以及合成血小板替代品。通过将美国的做法与国际标准并列比较，突出了剂量和供应管理方面的低效问题，提出了如低剂量输注和多样化血小板库存等可采取行动的解决方案。此外，该手稿对全血来源血小板的探索以及围绕有偿献血者的伦理辩论增加了前瞻性视角。通过将这些创新与优化供应的策略一起审视，这项工作旨在全面概述输血医学如何适应以满足临床和后勤需求。
