Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden
BackgroundBalanced 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...
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Frontiers Media S.A.
2023-01-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2022.1073318/full |
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| author | Agneta Wikman Agneta Wikman Beatrice Diedrich Beatrice Diedrich Karl Björling Per-Olof Forsberg Anna-Maria Harstad Ragnar Henningsson Petter Höglund Petter Höglund Hans Sköld Lars Östman Per Sandgren Per Sandgren |
| author_facet | Agneta Wikman Agneta Wikman Beatrice Diedrich Beatrice Diedrich Karl Björling Per-Olof Forsberg Anna-Maria Harstad Ragnar Henningsson Petter Höglund Petter Höglund Hans Sköld Lars Östman Per Sandgren Per Sandgren |
| author_sort | Agneta Wikman |
| collection | DOAJ |
| description | BackgroundBalanced 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.Material and methodsThree 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.ResultsTwenty-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.ConclusionCryopreserved 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. |
| first_indexed | 2024-04-10T21:21:03Z |
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| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-10T21:21:03Z |
| publishDate | 2023-01-01 |
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| series | Frontiers in Public Health |
| spelling | doaj.art-c095ccffe4a84377b389af7ed2c28b472023-01-20T05:13:55ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-01-011010.3389/fpubh.2022.10733181073318Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in SwedenAgneta Wikman0Agneta Wikman1Beatrice Diedrich2Beatrice Diedrich3Karl Björling4Per-Olof Forsberg5Anna-Maria Harstad6Ragnar Henningsson7Petter Höglund8Petter Höglund9Hans Sköld10Lars Östman11Per Sandgren12Per Sandgren13Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, SwedenClinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, SwedenDepartment of Anaesthesiology and Intensive Care, Visby Hospital, Visby, SwedenDepartment Laboratory Medicine, Central Hospital of Karlstad, Karlstad, SwedenDepartment of Anaesthesiology and Intensive Care, Central Hospital of Karlstad, Karlstad, SwedenDepartment of Anaesthesiology and Intensive Care, Central Hospital of Karlstad, Karlstad, SwedenClinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, SwedenCenter for Hematology and Regenerative Medicine, Department of Medicine, Huddinge Karolinska Institutet, Stockholm, SwedenDepartment of Anaesthesiology and Intensive Care, Torsby Hospital, Torsby, SwedenDepartment of Anaesthesiology and Intensive Care, Visby Hospital, Visby, SwedenClinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, SwedenBackgroundBalanced 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.Material and methodsThree 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.ResultsTwenty-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.ConclusionCryopreserved 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.https://www.frontiersin.org/articles/10.3389/fpubh.2022.1073318/fullBLEE-bleedingplatelets (PLT)blood transfusionurban or ruralcryopreservationpreparedness activities |
| spellingShingle | Agneta Wikman Agneta Wikman Beatrice Diedrich Beatrice Diedrich Karl Björling Per-Olof Forsberg Anna-Maria Harstad Ragnar Henningsson Petter Höglund Petter Höglund Hans Sköld Lars Östman Per Sandgren Per Sandgren Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden Frontiers in Public Health BLEE-bleeding platelets (PLT) blood transfusion urban or rural cryopreservation preparedness activities |
| title | Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden |
| title_full | Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden |
| title_fullStr | Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden |
| title_full_unstemmed | Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden |
| title_short | Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden |
| title_sort | cryopreserved platelets in bleeding management in remote hospitals a clinical feasibility study in sweden |
| topic | BLEE-bleeding platelets (PLT) blood transfusion urban or rural cryopreservation preparedness activities |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2022.1073318/full |
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