What is the ideal temperature for platelet storage and transfusion?

Ideal Temperature for Platelet Storage and Transfusion

Platelets should be stored at room temperature (20-24°C) with continuous gentle agitation for up to 5 days from collection to transfusion. 1

Standard Storage Protocol

The established standard for platelet storage is room temperature (20-24°C) under continuous gentle horizontal agitation in specialized gas-permeable storage bags. 1 This temperature range must be maintained because:

• Colder storage at 4°C leads to irreversible clustering of GPIbα receptors on the platelet surface, resulting in rapid clearance by liver macrophages after transfusion 2, 3
• The exposed terminal β-GlcNAc residues on clustered GPIbα are recognized by complement receptors, leading to phagocytosis and poor platelet survival 2
• Storage at warmer temperatures increases bacterial proliferation risk 3

Storage Duration Limitations

The 5-day storage limit exists primarily due to bacterial contamination risk, which represents a critical patient safety concern for morbidity and mortality. 1 Room temperature storage creates ideal conditions for bacterial growth, and transfusion-associated bacteremia is a potentially fatal complication 1, 4

Extended Storage Options:

• Pathogen reduction technologies (UV irradiation with photosensitizers or riboflavin) can permit 7-day storage 1
• Bacterial detection testing may allow extension to 7 days with specific regulatory approval 1

Alternative Storage Temperatures: Current Evidence

Cold-Stored Platelets (2-6°C):

The European Society of Intensive Care Medicine makes no recommendation for or against cold-stored platelets due to very low certainty of evidence. 5 The available data shows:

• Cold-stored platelets may demonstrate enhanced hemostatic activity in vitro 6
• However, GPVI levels are significantly reduced after 5-7 days of cold storage, resulting in decreased response to collagen-mediated aggregation 7
• A pilot RCT in cardiothoracic surgery showed no mortality difference but insufficient sample size for definitive conclusions 5

Cryopreserved Platelets (-80°C):

No recommendation can be made for cryopreserved platelets in bleeding patients due to very low certainty of evidence. 5 A single observational study showed no appreciable difference in 30-day mortality (RR 1.26,95% CI 0.41-3.88) 5

Critical Handling Requirements

Once removed from temperature-controlled storage, platelets require specific time constraints:

• Platelets need continuous agitation at 20-24°C throughout storage 1, 3
• Transportation periods without agitation must be limited to a total of 24 hours per component, with no individual period exceeding 8 hours 3
• Gas-permeable bags are essential to maintain aerobic respiration 3
• Approximately 50 mL of plasma per unit is required to maintain platelet viability 1

Common Pitfalls to Avoid

• Never over-wrap platelets during any resting period, as this compromises gas exchange 3
• Do not exceed manufacturer-assigned limits for platelet concentration 3
• Suspect transfusion-associated bacteremia if patients develop severe febrile reactions during or shortly after platelet transfusion 1
• Recognize that both pooled platelet concentrates and single-donor apheresis platelets follow the same 5-day storage limit 1