Cold-Stored Platelet Transfusions for Acute Post-Surgical Hemorrhage

Article Impact Level: HIGH
Data Quality: STRONG
Summary of  JAMA. https://doi.org/10.1001/jama.2026.13328  
Dr. Philip C. Spinella  et al.

Points

University of Western Australia researchers demonstrated that cold-stored platelets effectively treat bleeding during complex cardiac surgical procedures.
Refrigerating apheresis platelets at four degrees Celsius triples their maximum storage duration from seven days to twenty-one days.
Post-operative evaluations showed equivalent hemostatic performance and bleeding control between cold-stored and standard room-temperature platelet products.
Clinical safety profiles proved similar across both patient groups with no observed increase in thrombotic events or other complications.
Extending platelet shelf life through cold storage reduces product wastage and improves blood distribution to remote medical facilities.

Summary

This study evaluated the hemostatic efficacy, safety, and logistical feasibility of utilizing cold-stored platelets (1°C to 6°C) compared with standard room-temperature platelets (20°C to 24°C) in patients experiencing acute bleeding following complex cardiac surgery with cardiopulmonary bypass. Given that room-temperature storage limits platelet shelf life to 5 to 7 days due to bacterial contamination risks, clinical access remains constrained outside major urban centers. The research sought to determine if extending platelet storage to 21 days at 4°C could maintain hemostatic function without increasing adverse event rates.

Comparative clinical evaluations assessed bleeding-related outcomes and complication rates among surgical cohorts receiving either apheresis platelets stored at 4°C for up to 21 days or room-temperature platelets stored for up to 7 days. Quantitative trial endpoints demonstrated no statistically significant differences in post-operative bleeding, overall hemostatic efficacy, or total transfusion requirements between treatment arms. Furthermore, safety profile analyses revealed equivalent incidence rates of adverse events, including thrombotic complications, between cold-stored and room-temperature platelet recipient groups.

Prolonged refrigerated storage represents a viable strategy to triple platelet shelf life from 7 to 21 days while preserving full hemostatic capacity during active cardiac surgical hemorrhage. The authors conclude that adopting 4°C cold storage can mitigate product wastage, maintain blood bank inventory, and resolve geographical supply disparities in decentralized health systems without compromising patient safety or therapeutic efficacy.

Link to the article: https://jamanetwork.com/journals/jama/article-abstract/2852953

References

Spinella, P. C., Zantek, N. D., VanBuren, J. M., Nicolson, S. C., Khanna, A. K., Klompas, A. M., Boisen, M. L., Williams, T. M., Monteleone, M., Bashir, D. A., Pavey, W., Smith, B. B., Ahmed, M. I., Niebler, R. A., Jeng, E., Flynn, B. C., Joshi, R. V., Preuss, J. F., Goswami, D., … Stubbs, J. (2026). Cold and room-temperature platelets in cardiac surgery: The chips randomized clinical trial. JAMA. https://doi.org/10.1001/jama.2026.13328