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Cold Storage Platelets Key to Saving Lives
By Kevin Walston, 10th Mountain Division and Fort Drum Public Affairs
Spc. Lauren O'Neal, a medical laboratory technician assigned to the 153rd Blood Support Detachment at Bagram Air Field's Craig Joint Theater Hospital, prepares to screen blood for platelets count as part of the hospital's new cold storage platelets program. The process, which takes about two hours per patient, removes healthy platelets and stores them away for use during trauma emergencies. (Photo by Kevin Walston, 10th Mountain Division and Fort Drum Public Affairs)
An innovative clinical process begun at Craig Joint Theater Hospital Jan. 18 is paving the way to save more lives of patients suffering from acute trauma, a local official said.
The cold storage platelets program, which involves extracting platelets from a donor’s blood and storing in a refrigerator for up to three days until needed, is a cutting-edge process that medical officials say will help immensely when treating patients suffering from severe trauma with extensive blood loss, said Capt. Jacquelyn Messenger, commander of the 153rd Blood Support Detachment, a unit under the 3rd Multifunctional Medical Battalion.
“This will be especially beneficial for battlefield injuries, because a lot of what we see today is acute trauma,” Messenger, who’s also the area joint blood program officer for Afghanistan, said. “This process alters the structure of the platelets causing activation which then allows them to form the clot faster preventing additional blood loss.”
One of the biggest issues faced when treating serious injuries that can lead to death is severe blood loss, and Messenger explained that if they can’t stop the bleeding, their efforts to save the person’s life can be futile. By getting the bleeding to stop faster, they’re able to take care of whatever else is wrong.
Platelets are cells that circulate within the blood and bind together when they recognize damaged blood vessels. When you get a cut, for example, the platelets bind to the site of the damaged vessel, thereby causing a blood clot. They’re designed to stop the bleeding, and Messenger said being able to extract donor platelets and store them for up to three days may lead to saving the lives of wounded service members.
Cold storage decreases the metabolic changes that occur at room temperature and decreases the potential for bacterial contamination. Standard platelets are kept at room temperature and, if there’s any type of contamination present, room temperature allows it to proliferate and blood cultures are necessary to ensure its safety. Also, metabolic demands are higher at room temperature and the platelets lose function (the ability to stop bleeding) quickly. By putting platelets into the refrigerator, the metabolic function is slowed down so there’s less chance of a bacterial infection, and if there is bacteria present, they wouldn’t survive the refrigerated environment, Messenger explained. Furthermore, platelet function is better preserved.
“Another major benefit of cold storage is that the cold temperatures cause the partial activation of the platelets,” she said. “This causes the platelets, once they come in contact with a wound, to react much faster to clot the blood and stop the bleedings.”
In the refrigerator, the platelets start to leak calcium, which causes chemical changes similar to that of wound exposure. This acts as an artificial stimulant so when they are infused into a patient, they’re already activated and can quickly react to that wound.
Messenger said that platelets were first extracted in Afghanistan in 2007 via a process called apheresis, or extracting blood from the body separating out what is needed (platelets) and returning everything else to the donor. Before that, the only way to get platelets for uncontrolled bleeding was to do a whole blood drive, which can involve more risk.
“There’s a lot more risk involved in performing whole blood collection, because of blood type compatibility and a larger number of donors required for such large volumes of blood,” she said. “We have more than enough red blood cells and plasma available, but what the patient really needs to stop the bleeding is platelets. So what we wanted to do was get to a 1-to-1-to-1 ratio of red blood cells, plasma and platelets without causing fluid overload.”
Messenger’s been involved in this process since 2004, when, while serving as an enlisted medical laboratory technician in Iraq, her unit began platelet apheresis in theater to treat the critically wounded.
Lt. Col. Andre Cap began the research for the cold storage platelets process at the Army Institute of Surgical Research at Joint Base San Antonio, Texas, several years ago. He worked with colleagues at the Mayo Clinic and the Food and Drug Administration to get approval for storing apheresis platelets in the refrigerator for up to three days, Messenger said.
“The Mayo Clinic is also starting a cold platelet program, but nowhere in the Department of Defense has it actually been incorporated until now,” she said. “So we’re the first to use it in DoD, and we’ll be the first to have cold platelets available in a deployed setting.”
Receiving approval to begin the process here wasn’t an easy step. Messenger began briefing her chain of command with the assistance of Lt. Col. Jason Corley, the joint blood program officer in Qatar, in early September. She explained how it could be implemented and created a validation proposal that included gathering platelets, testing pH levels and determining the overall platelet count to ensure that it met FDA quality control criteria. Ten units were tested, and 100 percent of them passed and were still viable at the three-day mark, resulting in approval of the process by the U.S. Central Command surgeon.
At this point, the cold storage platelets will only be used in cases of severe trauma for patients suffering severe loss of blood upon entering the hospital through the emergency room, or will be used by doctors during surgery. Future studies will look at extending the shelf life of cold storage platelets, which will greatly increase the availability, she said.
Eventually, Messenger said the goal is to be able to provide platelets forward to the forward surgical teams and possibly air evacuation missions. In order to do that, the shelf life will have to be extended.
“Research at (Joint Base San Antonio) is being conducted that includes an additive solution for the platelets,” she said. “Now that we’ve proven that the process works, we’re hoping to extend the shelf life for up to two weeks, versus the current three-day period we’re able to do now. This will make a real difference in saving patient’s lives.”
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This story was originally published on the Defense Video and Imagery Distribution System Feb. 14. Republished content may have been edited for length, clarity and to follow the ASBP style guidelines. View the original article
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