Safer, Cheaper and Just as Good: Making Sterile, 7-Day Platelets a Reality James P. AuBuchon, MD E. Elizabeth French Professor and Chair of Pathology Dartmouth-Hitchcock

Safer, Cheaper and Just as Good:Safer, Cheaper and Just as Good:Making Sterile, 7-Day Platelets a RealityMaking Sterile, 7-Day Platelets a Reality

James P. AuBuchon, MDJames P. AuBuchon, MDE. Elizabeth French Professor and Chair of PathologyE. Elizabeth French Professor and Chair of Pathology

Dartmouth-Hitchcock Medical CenterDartmouth-Hitchcock Medical CenterLebanon, New HampshireLebanon, New Hampshire

Safer, Cheaper and Just as Good:Safer, Cheaper and Just as Good:Making Sterile, 7-Day Platelets a RealityMaking Sterile, 7-Day Platelets a Reality

1: Why we are interested in this1: Why we are interested in this2: Whether it is feasible2: Whether it is feasible

Comparison of Residual RisksComparison of Residual Risks

HIVHIV

HBVHBV

HCVHCV

19961996199419941992199219901990198819881986198619841984

1:1001:100

1:10001:1000

1:10 0001:10 000

1:100 0001:100 000

1:1 000 0001:1 000 000

19981998 20002000

Transmission risk, Transmission risk, per unitper unit

Updated from: Goodnough LT Updated from: Goodnough LT e t al. NEJMe t al. NEJM 1999;341:126-7 1999;341:126-7

Comparison of Residual RisksComparison of Residual Risks

BacterialBacterialContaminationContamination

(platelets)(platelets)

SepticSepticFatalitiesFatalities(platelets)(platelets)

HIVHIV

HBVHBV

HCVHCV

19961996199419941992199219901990198819881986198619841984

1:1001:100

1:10001:1000

1:10 0001:10 000

1:100 0001:100 000

1:1 000 0001:1 000 000

19981998 20002000

Transmission risk, Transmission risk, per unitper unit

Updated from: Goodnough LT Updated from: Goodnough LT e t al. NEJMe t al. NEJM 1999;341:126-7 1999;341:126-7

Frequency of Transfusion-Related Fatalities FDA Data: 1990-1998


Adverse Event Cases Hemolysis 161 (50%) Bacterial contamination 46 (10%) TRALI 29 (9%) Non-bacterial infections 23 (7%) Transfusion-associated GvHD 18 (6%)


J-H Lee, MD, CBER, FDA, 9/24/99J-H Lee, MD, CBER, FDA, 9/24/99





J-H Lee, MD, CBER, FDA, 9/24/99J-H Lee, MD, CBER, FDA, 9/24/99

Red Blood Cells

Platelets

200 mL red cells200 mL red cells30 mL plasma30 mL plasma110 mL additive solution110 mL additive solution

4 x 104 x 101111 platelets platelets300 mL plasma300 mL plasma

What Are You Transfusing?What Are You Transfusing?

Red Blood Cells

Platelets

200 mL red cells200 mL red cells30 mL plasma30 mL plasma110 mL additive solution110 mL additive solution101099 YersiniaYersinia per mL + endotoxin per mL + endotoxin

4 x 104 x 101111 platelets platelets300 mL plasma300 mL plasma101088 StaphStaph per mL per mL

What Are You Transfusing?What Are You Transfusing?

The Problem with Platelets…The Problem with Platelets…

Bacterial contamination is Bacterial contamination is - frequent- frequent- initially at very low concentration- initially at very low concentration- very difficult to detect- very difficult to detect

- in unit- in unit- in patient- in patient

Unit TransfusedUnit Transfused Risk per Million UnitsRisk per Million Units Confirmed Report ofConfirmed Report of FatalityFatalityBacterial ContaminationBacterial Contamination

Red Blood CellsRed Blood Cells 6.0 6.0 1.01.0Plateletpheresis unitsPlateletpheresis units 3232 7.17.1TOTAL, all unitsTOTAL, all units 7.4 7.4 1.11.1

Perez P Perez P et al. Transfusionet al. Transfusion 1999;39:2S. 1999;39:2S.

Bacterial Contamination Risks Bacterial Contamination Risks

Unit TransfusedUnit Transfused Risk per Million UnitsRisk per Million Units Confirmed Report ofConfirmed Report of FatalityFatalityBacterial ContaminationBacterial Contamination

Red Blood CellsRed Blood Cells 6.0 6.0 1.01.0Plateletpheresis unitsPlateletpheresis units 3232 7.17.1TOTAL, all unitsTOTAL, all units 7.4 7.4 1.11.1

Perez P Perez P et al. Transfusionet al. Transfusion 1999;39:2S. 1999;39:2S.

Bacterial Contamination Risks Bacterial Contamination Risks

1/140,000

Clinical cases of post-transfusion sepsis Clinical cases of post-transfusion sepsis 162 - 288 per year162 - 288 per year

FatalitiesFatalities 4.5 - 18 per year4.5 - 18 per year

BaCon Report, 1999 AABB Annual Meeting.BaCon Report, 1999 AABB Annual Meeting.Kuehnert Kuehnert et al. Transfusionet al. Transfusion 2001;41:1493-9. 2001;41:1493-9.

U.S. Bacterial Contamination EstimatesU.S. Bacterial Contamination EstimatesBased on BaCon Preliminary DataBased on BaCon Preliminary Data

Platelet contamination rate:Platelet contamination rate:USUS 670/million units 670/million units (Transfusion 1999;39:36S)(Transfusion 1999;39:36S)GermanyGermany 1300 1300 (Transfusion 1999;39:34S)(Transfusion 1999;39:34S)SpainSpain 320 320 (Transfusion 1999;39:75S)(Transfusion 1999;39:75S)

Frequency of ContaminationFrequency of ContaminationOther ReportsOther Reports

Frequency of ContaminationFrequency of ContaminationOther ReportsOther Reports

Ness PM Ness PM et al. Transfusionet al. Transfusion 2001;41:857-61. 2001;41:857-61.Recalculation: LJ Dumont.Recalculation: LJ Dumont.

Plt ConcPlt Conc SDPSDPPost-transfusion sepsis Post-transfusion sepsis 402/million402/million 75/million75/millionFatalitiesFatalities 62/million 62/million 14/million14/million

Based on Johns Hopkins’ DataBased on Johns Hopkins’ Data

Detecting Bacteria in Platelets: InspectionDetecting Bacteria in Platelets: Inspection

Changes Associated with ContaminationChanges Associated with Contamination

ClotsClotsDiscolorationDiscolorationGas bubblesGas bubbles

Detecting Bacteria in Platelets: Microscopic ReviewDetecting Bacteria in Platelets: Microscopic Review

Sensitivity:Sensitivity:Gram stainGram stain 101055 - 10 - 1066/mL/mLAcridine orangeAcridine orange 101044 - 10 - 1066/mL/mL

Barrett Barrett et al. Transfusionet al. Transfusion 1993;33:228-4. 1993;33:228-4.

Detecting Bacteria in Platelets: Microscopic ReviewDetecting Bacteria in Platelets: Microscopic Review

Sensitivity:Sensitivity:Gram stainGram stain 101055 - 10 - 1066/mL/mLAcridine orangeAcridine orange 101044 - 10 - 1066/mL/mL

But: Significant But: Significant false positivefalse positive rate rate

Barrett Barrett et al. Transfusionet al. Transfusion 1993;33:228-34. 1993;33:228-34.

Detecting Bacteria in Platelets: Biochemical ChangesDetecting Bacteria in Platelets: Biochemical Changes

GLUCOSEGLUCOSE ACID + COACID + CO22

Decreased glucoseDecreased glucoseDecreased pHDecreased pHDecreased/absent swirlingDecreased/absent swirling

Direct detectionDirect detection

GLUCOSEGLUCOSE ACID + COACID + CO22

Decreased glucoseDecreased glucoseDecreased pHDecreased pHDecreased/absent swirlingDecreased/absent swirling

• • Automated testingAutomated testing• • Biochemical stripsBiochemical strips

Direct detectionDirect detection

• • Sensitive labelsSensitive labels• • Automated cultureAutomated culture


COCO22-sensitive labels on platelet bags:-sensitive labels on platelet bags:No change withNo change with Staph. epiStaph. epi

Staph. aureusStaph. aureusPs. aeruginosaPs. aeruginosaBacillus cereusBacillus cereus

Change only withChange only with Ent. aerogenesEnt. aerogenes• • at > 10at > 1066 CFU/mL CFU/mL• • sensitivity = 20%sensitivity = 20%

Specificity problem: Platelets produce COSpecificity problem: Platelets produce CO22 also. also.

Hogman CF, Gong J. Hogman CF, Gong J. Vox SangVox Sang 1994;67:351-5. 1994;67:351-5.


0102030405060708090

100

0 1 2 3 4 5

ControlBacillusKlebsiella

Glucose, % Day 0

Storage Time, d

data from Burstain JM data from Burstain JM et al. Transfusionet al. Transfusion 1997;37:255-8. 1997;37:255-8.


0102030405060708090

100

0 1 2 3 4 5

ControlBacillusKlebsiella

Glucose, % Day 0

Storage Time, d

after Burstain JM after Burstain JM et al. Transfusionet al. Transfusion 1997;37:255-8. 1997;37:255-8.

-2 SD-2 SD


SwirlingSwirling

Low pHLow pHMetabolic disturbanceMetabolic disturbance

No alignment with flowNo alignment with flow

Alignment with flowAlignment with flow


Swirling to detect contaminationSwirling to detect contamination SensitivitySensitivity SpecificitySpecificity

S. epi.S. epi. 25% 25% (Day 5)(Day 5) 75% 75%S. aureusS. aureus 100% 100% (Day 2-3)(Day 2-3) 100% 100%SalmonellaSalmonella 75% 75% (Day 3-5)(Day 3-5) 100% 100%

Leach MF Leach MF et al. Vox Sanget al. Vox Sang 1998;74(suppl 1):1180. 1998;74(suppl 1):1180.


Wagner SJ, Robinette D.Wagner SJ, Robinette D. Transfusion Transfusion 1996;36:989-93. 1996;36:989-93.

False positive rates False positive rates (sterile units)(sterile units)

Glucose:Glucose: 5%5%pH:pH: 4%4%Swirling:Swirling: 5%5%

based on ±2 SD reference intervalsbased on ±2 SD reference intervals

Brecher Brecher et al. Transfusionet al. Transfusion 1993;33:450-7. 1993;33:450-7.Fenwick Fenwick et al. Lancetet al. Lancet 1991;337:496-7 1991;337:496-7

Detecting Bacteria in Platelets: Future DevelopmentsDetecting Bacteria in Platelets: Future Developments

PCRPCREIAEIA%O%O22

Others….Others….

Traditional ConceptTraditional Concept

BLOOD CENTER

Culture: Day 1Culture: Day 1Hold until negativeHold until negative

HOSPITALDay 2 or 3Day 2 or 3

Detecting Bacteria in Platelets: CulturingDetecting Bacteria in Platelets: Culturing

Traditional ConceptTraditional Concept

BLOOD CENTER

Culture: Day 1Culture: Day 1Hold until negativeHold until negative

HOSPITALDay 2 or 3Day 2 or 3


- Currently in routine use in blood centers in Belgium- Currently in routine use in blood centers in Belgiumand the Netherlandsand the Netherlands

- Potential difficulties with recall, outdating.- Potential difficulties with recall, outdating.

New Concept: New Concept: Hospital-BasedHospital-Based Verification of Sterility Verification of Sterility


(5 mL via SCD)(5 mL via SCD)

New Concept: Hospital-Based Verification of SterilityNew Concept: Hospital-Based Verification of Sterility


BacT Alert

ENTRY INTO INVENTORY

DAY 2: CULTURE

TRANSFUSION ORDER: RELEASE UNIT


Organisms Involved in Blood Unit ContaminationOrganisms Involved in Blood Unit Contamination1998 - 20001998 - 2000

Gram-positive (60%)Gram-positive (60%) Gram-negative (40%)Gram-negative (40%)Staph. epiStaph. epi* * (8)(8) E. coliE. coli (5)(5)

Staph. aureusStaph. aureus (4)(4) Serratia marcescensSerratia marcescens* * (3)(3)

Staph. agalactiaeStaph. agalactiae (2)(2) Serratia liquifaciensSerratia liquifaciens* * (2)(2)

Grp G Strep.Grp G Strep. (1)(1) Enterobacter aerogenesEnterobacter aerogenes (1)(1)

Staph. lugdensisStaph. lugdensis (1)(1) Enterobacter cloacaeEnterobacter cloacae (1)(1)

Staph. saprophyticusStaph. saprophyticus (1)(1) P. rettgeriP. rettgeri (1)(1)

Bacillus cereusBacillus cereus (1)(1) Y. enterocoliticaY. enterocolitica (1)(1)

E. faecalisE. faecalis (1)(1)

Strep. pneumoniaeStrep. pneumoniae (1)(1)

*includes isolates from RBCs*includes isolates from RBCs Kuehnert Kuehnert et al. Transfusionet al. Transfusion 2001;41:1493-9. 2001;41:1493-9.

Leach MF Leach MF et al. Vox Sanget al. Vox Sang 1998;74(suppl 1):1180. 1998;74(suppl 1):1180.

Bacterial Growth Kinetics in PlateletsBacterial Growth Kinetics in Platelets

1.E+00

1.E+01

1.E+021.E+03

1.E+04

1.E+051.E+06

1.E+07

1.E+081.E+09

0 1 2 3 4 5

S. epi.S. aureusSalmonella

Storage time, d

Bacterial concentration/mL

Inoculation: 1 CFU/mL


Brecher M Brecher M et al. Transfusionet al. Transfusion 2001;41:477-82. 2001;41:477-82.


Time to Detection in an Automated Culturing SystemTime to Detection in an Automated Culturing System

Inoculum: 4 mLInoculum: 4 mL



BacT Alert


DAY 2: CULTURE


POSITIVE AUTOMATED CULTURE

Interdiction of release



BacT Alert


DAY 2: CULTURE


POSITIVE AUTOMATED CULTURE

Interdiction of release

Providing:Providing:Assurance of sterilityAssurance of sterilityStorage to 7 days Storage to 7 days Storage after poolingStorage after poolingReduced cost for leukoreductionReduced cost for leukoreduction

Practical Application of Culturing Practical Application of Culturing in a Transfusion Service Laboratoryin a Transfusion Service Laboratory

Experience in first 2 years:Experience in first 2 years:2,569 units cultured 2,569 units cultured (5 mL into aerobic bottle, BacT/Alert automated system)(5 mL into aerobic bottle, BacT/Alert automated system)

16 initial positives 16 initial positives (0.6%)(0.6%)

11 not confirmed on repeat culture11 not confirmed on repeat culture5 not able to be recultured5 not able to be recultured (1: positive after transfusion)(1: positive after transfusion)

May, 1999 - April, 2001May, 1999 - April, 2001


Recent experience:Recent experience:Split double SDP unit received Split double SDP unit received (external source)(external source)

Day 2: CultureDay 2: CultureDay 3 AM: Split A’s culture growthDay 3 AM: Split A’s culture growth

(recultured)(recultured)

Day 3 PM: Split B’s culture growthDay 3 PM: Split B’s culture growth

Same Same Staph. epiStaph. epi. in each unit.. in each unit.

July, 2001July, 2001


Costs:Costs:

Material costs: $11.05/plateletpheresis unitMaterial costs: $11.05/plateletpheresis unitTech time: 7 minutesTech time: 7 minutesWorkup of positives: $50-100Workup of positives: $50-100

Cooper L Cooper L et al. Transfusionet al. Transfusion 1999;39:119-20S. 1999;39:119-20S.


Cost (for 100 units):Cost (for 100 units):

Material costs: Material costs: $1105$1105Tech time: 700 minutes Tech time: 700 minutes $467 $467Workup of positive: Workup of positive: $75$75

$1647$1647

Units not outdated:Units not outdated:1515 @ $500 @ $500 $7500$7500


Potential payback: Outdate extensionPotential payback: Outdate extension

Units expiringUnits expiring Units requestedUnits requested on next dayon next day

2.4±1.42.4±1.4 4.8±2.4 4.8±2.4 (1-5)(1-5) (2-9) (2-9)

In all cases, more units were requested than expired.

BUT: Do 7 day old platelets survive and function?BUT: Do 7 day old platelets survive and function?

Leach MF, AuBuchon JP. Leach MF, AuBuchon JP. TransfusionTransfusion 1993;33:661-4. 1993;33:661-4.

0

2000

4000

6000

8000

10000

12000

1 2 3 4 5

15 min CCI

Storage Time (d)

A Controlled Trial of 5 vs. 7 Day Platelet StorageA Controlled Trial of 5 vs. 7 Day Platelet Storage

Dartmouth-Hitchcock Medical CenterDartmouth-Hitchcock Medical Center American Red Cross, NorfolkAmerican Red Cross, NorfolkJames P. AuBuchon, MDJames P. AuBuchon, MD John B. Nobiletti, MDJohn B. Nobiletti, MDLouise Herschel, BS, MLT(ASCP), CCRC Louise Herschel, BS, MLT(ASCP), CCRC Deanna A. McNeil,MLT(ASCP) Deanna A. McNeil,MLT(ASCP) Jill Roger, MT(ASCP), CCRCJill Roger, MT(ASCP), CCRC Sherrie L. Sawyer, MSSherrie L. Sawyer, MS

Adrienne Johnson, BSAdrienne Johnson, BSGambro Gambro Pamela H. Whitley, MT(ASCP)SBBPamela H. Whitley, MT(ASCP)SBBLarry DumontLarry DumontArt HamstraArt HamstraTania VandenBroeke, MT(ASCP)Tania VandenBroeke, MT(ASCP)

Trima™Trima™Spectra™ LRS TurboSpectra™ LRS Turbo

LR SDPLR SDP

Day

1Day

5Day

7

Flatbed agitation, 22-24°C

Biochemical assaysBiochemical assaysFunctional assaysFunctional assays5151Cr/Cr/111111In recoveryIn recovery

and survivaland survival

XXXXXX

XXXXXX

XXXX


Unit contentsUnit contentsPlatelets:Platelets: 4.1±1.1x104.1±1.1x101111

Leukocytes:Leukocytes: 5.0x105.0x104 4 (median)(median)

Volume:Volume: 269±68 mL269±68 mL

Mean ± 1 SDMean ± 1 SD


0

20

40

60

80

100

120

140

1 5 7

pCO2

pO2

6

6.2

6.4

6.6

6.8

7

7.2

7.4

7.6

1 5 7

pH (22C)

pCO2

pO2

pH (22°C)

Storage Time (d)

mm

Hg

Storage Time (d)

*

*


Gluc, Lact, RateGluc, Lact, Rate

0

2

4

6

8

10

12

14

1 5 7

Lactate (mmol/10 plt)

Glucose (mmol/10 plt)

Mean± 1 SEMMean± 1 SEM

*

*

Rates: No difference

Storage Time (d)

12

12


0

10

20

30

40

50

60

1 5 7

P-Selectin

HSR

ESC

Storage Time (d)

%

*

*

*



0

20

40

60

80

100

120

140

160

180

Recovery (%)Survival (h)

Day 5 Day 7

*

*



5 Days5 Days 7 Days7 DaysRecoveryRecovery

This studyThis study 63±11%63±11% 54±14%54±14%Archer et al., 1983Archer et al., 1983 59±17%59±17% 46±8%46±8%

SurvivalSurvivalThis studyThis study 6.7±1.6d6.7±1.6d 5.6±1.9d5.6±1.9dArcher et al., 1983Archer et al., 1983 3.4±1.5d3.4±1.5d 2.7±0.5d2.7±0.5d

Archer Archer et al. Vox Sanget al. Vox Sang 1982; 43:223-30. 1982; 43:223-30.Mean ± 1SDMean ± 1SD



This studyThis study 63±11%63±11% 54±14%54±14%Archer Archer et al.et al. 59±17%59±17% 46±8%46±8%

SurvivalSurvivalThis studyThis study 6.7±1.6d6.7±1.6d 5.6±1.9d5.6±1.9dArcher Archer et al.et al. 3.4±1.5d3.4±1.5d 2.7±0.5d2.7±0.5d


THIS STUDY: THIS STUDY: Better results thanBetter results than

accepted previouslyaccepted previously

66



This studyThis study 63±11%63±11% 54±14%54±14%Archer et al., 1983Archer et al., 1983 59±17%59±17% 46±8%46±8%

SurvivalSurvivalThis studyThis study 6.7±1.6d6.7±1.6d 5.6±1.9d5.6±1.9dArcher et al., 1983Archer et al., 1983 3.4±1.5d3.4±1.5d 2.7±0.5d2.7±0.5d


THIS STUDY: THIS STUDY: Better results thanBetter results than

accepted previouslyaccepted previouslyTHIS STUDY: THIS STUDY:

Less reductionLess reductionD5 D7D5 D7

14 vs. 22%14 vs. 22%

18 vs. 21%18 vs. 21%

66


Day

2Day

5Day

7

Flatbed agitation, 22-24°CDay

6

LRSDP

OUTDATEOUTDATE

Day

8

TransfuseTransfuseif no otherif no other

units units availableavailable

pH andswirlingchecks

DetermineDetermineCCICCI


Day 8 analysisDay 8 analysis (n = 91)(n = 91)

Swirling:Swirling: 96%96%pH:pH: 6.86±0.2456.86±0.245

> 6.2 in 97%> 6.2 in 97%Max = 7.26Max = 7.26

All units collected on Spectra™ LRS TurboAll units collected on Spectra™ LRS Turbo


Transfusions beyond Day 5Transfusions beyond Day 5 (n=40)(n=40)

All with expected clinical resultsAll with expected clinical results

Stable patients with 10-60 min CCI: 21Stable patients with 10-60 min CCI: 21

All units collected on Spectra™ LRS TurboAll units collected on Spectra™ LRS Turbo

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

CCI

CCI at Day 6-7: 14,400±8,800 Median: 12,191 (n=21)CCI at Day 6-7: 14,400±8,800 Median: 12,191 (n=21)

Clinical Effect of Transfusing Platelets Beyond Day 5Clinical Effect of Transfusing Platelets Beyond Day 5

0

10

20

30

40

50

60

70

80

90

100

5000

1000

0

1500

0

2000

0

2500

0

3000

0

3500

0

4000

0

4500

0

CCI

Clinical Effect of Transfusing Platelets Beyond Day 5Clinical Effect of Transfusing Platelets Beyond Day 5

Cu

mu

l at i

ve

Pr o

po

rtio

n (

%)

90% > 7,50090% > 7,500 (All but 1: > 5,000)(All but 1: > 5,000)

What if 7d platelets aren’t quite as good? What if 7d platelets aren’t quite as good?

PltPlt HIVHIV Septic Septic TotalTotal Units’Units’ CulturingCulturing Total DirectTotal DirectTrxnTrxn RiskRisk MortalityMortality RiskRisk CostCost CostCost CostCost

1010 1111CULTURECULTURE

+ 7d+ 7d

NO NO CULTURECULTURE



1010 10 10 1111 11 11

Per-unit HIV risk: 1/1,000,000Per-unit HIV risk: 1/1,000,000

Risks expressed per millionRisks expressed per million


CULTURECULTURE+ 7d+ 7d



1010 10 10 7070 8080 1111 11 11 0 0 1111

Per-unit HIV risk: 1/1,000,000Per-unit HIV risk: 1/1,000,000Septic mortality: 1/140,000Septic mortality: 1/140,000






1010 10 10 7070 8080 $5,000$5,000 0 0 $5,000$5,000 1111 11 11 0 0 1111 $5,500$5,500 $220$220 $5,720$5,720

Per-unit costs:Per-unit costs:SDP:SDP: $500$500Culture:Culture: $20$20







1010 10 10 7070 8080 $5,000$5,000 0 0 $5,000$5,000 1111 11 11 0 0 1111 $5,500$5,500 $220$220 $5,720$5,720



$65/unit$65/unitNO NO

CULTURECULTURE




1010 10 10 7070 8080 $5,000$5,000 0 0 $5,000$5,000 1111 11 11 0 0 1111 $5,500$5,500 $220$220 $5,720$5,720




$65/unit$65/unit

OUTDATEREDUCTIONS




Other applications of culturing + 7d dating --Other applications of culturing + 7d dating --

Prestorage pooling of platelet concentratesPrestorage pooling of platelet concentrates- simplicity for transfusion service- simplicity for transfusion service- - preprestorage leukoreductionstorage leukoreduction- reduction in filtration cost- reduction in filtration cost- sterility assessment in highest-risk component- sterility assessment in highest-risk component- reduced outdating- reduced outdating

Therefore -Therefore -

Platelet storage for 7d Platelet storage for 7d is feasibleis feasible- Adequate maintenance of function- Adequate maintenance of function- Expected recovery and survival- Expected recovery and survival- Adequate clinical efficacy- Adequate clinical efficacy

indistinguishable from shorter storageindistinguishable from shorter storage- Bacterial culturing to reduce septic risk- Bacterial culturing to reduce septic risk- Reduction in overall risk- Reduction in overall risk- No increase in cost - No increase in cost -- therefore practical-- therefore practical

Safer, Cheaper and Just as GoodSafer, Cheaper and Just as GoodMaking Sterile, 7-Day Platelets a RealityMaking Sterile, 7-Day Platelets a Reality

Documents

Safer, Cheaper and Just as Good: Making Sterile, 7-Day Platelets a Reality James P. AuBuchon, MD E. Elizabeth French Professor and Chair of Pathology Dartmouth-Hitchcock