October 19, 2026
For a hospital facing a patient with life-threatening bleeding, having platelets available at the right moment is critical. But conventional platelets have a short shelf life, making it difficult for some hospitals to maintain an inventory without risking outdates.
At Sunday’s AABB-THOR joint session, “Implementation of Cold Stored Platelets for Active Bleeding,” experts explored the clinical evidence for cold-stored platelets and shared lessons from hospitals and blood suppliers working to make the product more widely available.
Phil Spinella, MD, co-director of the Trauma and Transfusion Medicine Center at the University of Pittsburgh, reviewed findings from the CHIPS trial, a phase 3, randomized, multicenter study comparing cold-stored platelets with room-temperature platelets in children and adults undergoing complex cardiac surgery.
The trial evaluated whether cold-stored platelets could provide comparable bleeding control when stored for longer periods. Its adaptive design allowed the maximum storage duration to increase as the study progressed, from seven days initially to as long as 21 days.
The primary outcome was a hemostatic efficacy score on a five-point scale, with a prespecified noninferiority margin of one point. Cold-stored platelets met the noninferiority criterion at every storage duration studied, including 21 days. Investigators also found no significant difference between the groups in 24-hour chest tube output, a key secondary outcome. However, the primary trial report found higher total blood product use and a higher rate of reexploration for bleeding in the cold-stored platelet group.
Although CHIPS evaluated cold-stored platelets stored for up to 21 days, the current FDA pathway permits storage for up to 14 days for use in actively bleeding patients when conventional platelets are unavailable or impractical.
For Sarah Ilstrup, MD, medical director at Intermountain Health, the question is how to make platelets available where they are needed, particularly at smaller hospitals that may struggle to maintain conventional inventory.
Intermountain introduced cold-stored platelets at four pilot sites in Utah, including Intermountain Medical Center and smaller community hospitals. Clinician demand, room-temperature platelet shortages, increasing transfusion needs and the challenges of caring for severely bleeding patients before transfer all helped drive the initiative.
The health system incorporated cold-stored platelets into trauma packs and massive transfusion protocols. At its main medical center, cold-stored platelets were also used in selected cases involving liver transplantation and other bleeding situations. At smaller hospitals, they offered another option for treating trauma and postpartum hemorrhage.
Inventory management proved to be a significant challenge. Initially, the American Red Cross supplied cold-stored platelets through standing orders rather than as a regular inventory product, but that arrangement limited hospitals’ ability to adjust orders to their immediate needs.
After the Red Cross began offering cold-stored platelets as a regular inventory product in 2025, Intermountain was able to reduce its standing orders. Intermountain reported an overall wastage rate of 19.4%, which declined to 11.7% to date in 2026.
Courtney Hopkins, DO, vice president and corporate medical director at Vitalant, described how cold-stored platelets could also change the way blood suppliers manage collection, manufacturing and distribution.
Conventional platelets have a shelf life of five to seven days, but the time available for transfusion at the hospital is shorter after testing, processing and transportation. That can make it difficult to maintain inventory at hospitals with low transfusion volumes or long distances from a blood supplier.
Vitalant’s pilot program found that cold-stored platelets provided substantially more usable shelf life at hospitals: nearly twice as much as large-volume delayed-sampling apheresis platelets and three times as much as pathogen-reduced platelets. Among 193 documented transfusions assessed in the pilot, the average age of the cold-stored platelets at transfusion was 8.8 days, and nearly one-third were transfused at 12 days or later.
The pilot also showed that how hospitals incorporate cold-stored platelets into their inventory can influence wastage. At a participating hospital that replaced some room-temperature backup inventory with cold-stored platelets and actively redesigned its inventory practices, Vitalant observed an approximately 46% reduction in monthly platelet distributions and an estimated 60% reduction in monthly outdates. Adding cold-stored platelets without changing the existing inventory model did not consistently reduce outdates.
Implementation also brings operational challenges. Vitalant currently uses standing orders to coordinate donor collection with hospital needs, and the platelets must be cooled within four hours of collection. That requirement limits collection locations and requires close coordination among collection, manufacturing and distribution teams. Hospitals also need staff education on storage, handling and the management of platelet aggregates.
Hopkins said Vitalant wants to explore ways to extend the time allowed before cooling, expand the permitted storage period and work with hospitals to develop inventory models that reduce wastage while keeping platelets available for patients who need them.
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