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Stored Platelet Functionality Is Not Decreased After Warming with a Fluid Warmer

Konig, Gerhardt MD*; Yazer, Mark H. MD; Waters, Jonathan H. MD

doi: 10.1213/ANE.0b013e31829cfdfa
Cardiovascular Anesthesiology: Research Report

BACKGROUND: Warming of IV-administered fluids and blood products is routinely performed in the operating room to help maintain normothermia. Current guidelines recommend against the warming of platelets (PLTs), although there is no evidence for this prohibition in the literature. Our goal in this pilot study was to determine whether the warming of stored PLTs had any effect on their function.

METHODS: Ten units of 3-day-old, PLT-rich plasma–derived whole blood PLTs were acquired from the transfusion service. A 5-mL aliquot was taken from each unit before warming (control samples). The remainder of the unit was then passed into a blood-warming device and held there for 2 minutes. Postwarming (warmed) PLT samples were then collected from the effluent end of the warming device. PLT aggregometry assays with adenosine diphosphate, collagen, and arachidonic acid as agonists were performed on the control and warmed samples. Thromboelastography tests were also performed on the control and warmed samples from 6 of the 10 PLT units.

RESULTS: The mean temperature of the control and warmed samples was 22.4°C ± 0.5°C and 37.8°C ± 2.3°C, respectively. There was no significant difference (all P ≥ 0.13) in any of the PLT aggregometry assays or in the maximum amplitude of the thromboelastography test between the control and the warmed samples. The observed mean of only 1 parameter decreased (PLT aggregometry with 5 μM adenosine diphosphate) by 5% (95% confidence interval, −115% to 105%). The maximum change observed was PLT aggregometry with arachidonic acid as agonist, which increased by 116% (95% confidence interval, −91% to 323%).

CONCLUSION: Although small in size, the results of this study do not support the prohibition against mechanical PLT warming. Studies of PLT activation after warming are also warranted.

Published ahead of print August 6, 2013

From the *Department of Anesthesiology, University of Pittsburgh School of Medicine; Department of Pathology, University of Pittsburgh and the Institute for Transfusion Medicine; and Departments of Anesthesiology & Bioengineering, University of Pittsburgh School of Medicine and the McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Accepted for publication April 17, 2013.

Published ahead of print August 6, 2013

Funding: This research was supported by a grant from the National Institutes of Health (T32GM075770).

This study was supported by a grant from the Blood Sciences Foundation, Pittsburgh, PA.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Gerhardt Konig, MD, Department of Anesthesiology, Magee Womens Hospital, 300 Halket St., Suite 3510, Pittsburgh, PA 15213. Address e-mail to

© 2013 International Anesthesia Research Society