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Which of the following blood products is MOST likely to be delivered to the operating room at room temperature?
A. Platelets ✔
B. Plasma X
C. Red blood cells X
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With the advent of massive transfusion protocols in most trauma centers and large hospitals, there is an increased need to understand the storage requirements of blood products. Units that are returned to the blood bank after incorrect handling in the operating room (OR) may need to be discarded. This is especially true regarding those products that are kept cool. Red blood cells (RBCs) are stored in the blood bank and delivered to the OR at 4 °C to limit the proliferation of bacteria and slow the breakdown of proteins. Units that become too warm during transport and storage in the OR prior to return must be discarded. Plasma is usually frozen immediately after collection and thawed just before delivery to the bedside. When prethawed expectantly before need—as in busy hospitals—plasma is maintained refrigerated at 4 °C until delivery for the same reasons as RBCs. The same is true for cryoprecipitate units, which are prepared from plasma (Table 1).
Table 1. Storage and delivery temperatures of various blood products
| Product | Storage Temperature | Delivery Temperature |
| Red blood cells | 4°C | 4°C |
| Plasma | < 0°C | 4°C |
| Platelets | Room temperature | Room temperature |
| Cryoprecipitate | 4°C | 4°C |
Platelets are the exception to this rule. Cooling platelets causes them to activate and then aggregate, reducing the effective number administered in each unit. For this reason, platelets are stored and delivered to the OR at room temperature. This also explains why platelets are associated with a greater risk for bacterial infection, and have a much shorter shelf life in the blood bank—usually no more than 5 days—before they become outdated and must be discarded. This recommendation, however, may soon be changing. Recent research in the trauma community indicates that cold-stored platelets may have increased functionality when given during hemorrhage, precisely because they are already activated. Newer storage mechanisms designed to prevent aggregation at low temperatures are being tested with the hope of extending the shelf life of viable platelet units.
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