How do we maintain a dual inventory of room temperature stored platelets with cold-stored platelets?

BACKGROUND: There has been renewed interest in cold-stored platelets (CSPs) for the management of bleeding patients. CSPs might offer advantages over conventional room temperature stored platelet units (RTP), such as a lower risk of bacterial growth during storage, a longer shelf lf life, and possibly improved hemostatic effectiveness. However, CSPs have reduced in vivo survival compared to RTP. In 2023, the FDA issued guidance allowing 14-day storage of CSPs for the treatment of active bleeding when conventional platelets are not available or their use is not practical. This How Do We describes various scenarios of CSP use, followed by the authors' assessment regarding consistency with FDA recommendations.

METHODS: The authors contributed scenarios that reflected their institutions' unique settings or more generalized scenarios common to other centers. The authors offered their interpretation of the guidance for each specific situation.

RESULTS: Seven scenarios are provided that demonstrate potentially appropriate or clearly inappropriate CSP use across a variety of settings. The authors' interpretations aim to help hospital transfusion services develop standard operating procedures (SOPs) that are suitable for their own unique circumstances.

DISCUSSION: Each hospital has a unique setting and set of conditions that influence CSP use. This How Do We provides the authors' assessments regarding how CSPs may be used in certain scenarios; however, this is not a guide and does not offer official recommendations. Every center must develop SOPs that account for usage patterns and inventory constraints specific to its own environment.