Primary Hemostatic Capacity of Whole Blood: A Comprehensive Analysis of Pathogen Reduction and Refrigeration Effects Over Time
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND Whole blood WB has been used in combat since World War I as it is readily available and replaces every element of shed blood. Component therapy has become standard however, recent military successes with WB resuscitation have revived the debate regarding wider WB use. Characterization of optimal WB storage is needed. We hypothesized that refrigeration preserves WB function and that a pathogen reduction technology PRT based on riboflavin and ultraviolet light has no deleterious effect over 21 days of storage. STUDY DESIGN AND METHODS WB units were stored for 21 days either at 4 C or 22 C. Half of each temperature group underwent PRT, yielding four final treatment groups n 8 each CON 4 WB at 4 C CON 22 WB at 22 C PRT 4 PRT WB at 4 C and PRT 22 PRT WB at 22 C. Testing was at baseline, Days 1-7, 10, 14, and 21. Assays included coagulation factors platelet activation, aggregation, and adhesion and thromboelastography TEG. RESULTS Prothrombin time PT and partial thromboplastin time increased over time refrigeration attenuated the effects on PT p 0.009. Aggregation decreased over time p 0.001 losses were attenuated by refrigeration p 0.001. Refrigeration preserved TEG parameters p 0.001 and PRT 4 samples remained within normal limits throughout the study. Refrigeration in combination with PRT inhibited fibrinolysis p 0.001 and microparticle formation p 0.031. Cold storage increased shear-induced platelet aggregation and ristocetin-induced platelet agglutination p 0.032, as well as GPIb-expressing platelets p 0.009. CONCLUSION The in vitro hemostatic function of WB is largely unaffected by PRT treatment and better preserved by cold storage over 21 days. Refrigerated PRT WB may be suitable for trauma resuscitation. Clinical studies are warranted.
- Medicine and Medical Research