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Comparative Study
. 2025 May;65 Suppl 1(Suppl 1):S265-S275.
doi: 10.1111/trf.18197. Epub 2025 Mar 23.

Comparative analysis of cold-stored platelets using Golden Hour transport boxes: Function and quality

Jamie Nash  1 , Christine Saunders  1 , Nicola Pearce  1 , Michael Cahillane  1 , Edward J Sayers  1 , Victoria Stokes  2 , David Rawlinson  2 , Christopher Hingston  2 , Tom Scorer  3 , David Lockey  2   4 , Chloe George  1
Affiliations
Comparative Study

Comparative analysis of cold-stored platelets using Golden Hour transport boxes: Function and quality

Jamie Nash et al. Transfusion. 2025 May.

Abstract

Background: The Emergency Medical Retrieval and Transfer Service in Wales provides prehospital critical care, including the transfusion of red blood cells and plasma. However, the logistical challenges of storing platelet concentrates (PCs) at 22°C with constant agitation limit their prehospital use. Cold-stored platelets (CSP) at 4°C without agitation offer a potential solution, demonstrating superior hemostatic capabilities in vitro and longer storage potential. This study investigated the viability of storing CSP in Golden Hour boxes for up to 96 h, followed by refrigeration, to enhance prehospital damage control resuscitation.

Methods: Two buffy-coat-derived PCs were combined and split into two: one PC was refrigerated at 4°C ± 2°C without agitation (CSP) for 15 days, and the other was stored in a Golden Hour cold box from days 2 to 6 (GH-CSP) before being rotated back into refrigeration. In vitro assessments included aggregometry, thrombin generation, thromboelastography, and platelet activation via P-selectin and annexin V binding.

Results: Temperature data demonstrated that a Golden Hour box can maintain a temperature of 2-6°C for up to 84 h with a CSP and two red cell concentrates. Platelet function was not significantly different between the two storage conditions. GH-CSP displayed increased annexin V binding on day 8 compared with CSP (32.31 ± 3.27% vs 26.36 ± 2.17%, p = .0026) and day 15 (41.76 ± 6.13% vs 38.41 ± 3.99%, p = .0199).

Conclusion: CSP stored in a Golden Hour box was comparable with conventional CSP, suggesting this method may be viable for prehospital use.

Keywords: air ambulance; cold stored platelets; platelet storage; platelet transfusion; prehospital major hemorrhage.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Maximal aggregation responses in platelets. (A) aggregation response to ADP (20 μM). (B) aggregation response to Collagen (10 μg/mL). (C) aggregation to TRAP‐6 (50 μM). (D) aggregation response to a lower dose of TRAP‐6 (25 μM). Error bars denote median ± interquartile range. Blue squares—cold‐stored platelets. Red triangles—Golden Hour box cold‐stored platelets, n = 11.
FIGURE 2
FIGURE 2
Platelet activation assays. (A) CD62P surface expression as measured by flow cytometry. (B) Phosphatidylserine surface expression measured using Annexin V binding. (C) median fluorescence intensity (MFI) for CD62P surface expression. (D) MFI values for Phosphatidylserine surface expression. (E) soluble CD62P concentration in PC supernatants. Error bars denote median ± interquartile range. Blue squares—cold‐stored platelets. Red triangles—Golden Hour box cold‐stored platelets, n = 11.
FIGURE 3
FIGURE 3
Thromboelastography of platelet concentrates. (A) R value; (B) angle; (C) maximal amplitude. Error bars denote median ± interquartile range. Blue squares—cold‐stored platelets. Red triangles—Golden Hour box cold‐stored platelets, n = 11.
FIGURE 4
FIGURE 4
Thrombin generation with the presence of platelets. (A) lag time. (B) peak thrombin. (C) time to peak thrombin. (D) exogenous thrombin potential (ETP). Error bars denote median ± interquartile range. Blue squares—cold‐stored platelets. Red triangles—Golden Hour box cold‐stored platelets, n = 11.
FIGURE 5
FIGURE 5
Thrombin generation with the absence of platelets. (A) lag time. (B) peak thrombin. (C) time to peak thrombin. (D) exogenous thrombin potential (ETP). Error bars denote median ± interquartile range. Blue squares—cold‐stored platelets. Red triangles—Golden Hour box cold‐stored platelets, n = 11.
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