# Presentation: 001476

## 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 Medical Center**
**Lebanon, New Hampshire**

## Safer, Cheaper and Just as Good:

***Making Sterile, 7-Day Platelets a Reality***

**1:  Why we are interested in this**
**2:  Whether it is feasible**

## Comparison of Residual Risks

**HIV**

**HBV**

**HCV**

**1996**

**1994**

**1992**

**1990**

**1988**

**1986**

**1984**

**1:100**

**1:1000**

**1:10 000**

**1:100 000**

**1:1 000 000**

**1998**

**2000**

**Transmission risk, ****per unit**

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

## Comparison of Residual Risks

**Bacterial**
**Contamination**
**(platelets)**

**Septic**
**Fatalities**
**(platelets)**

**HIV**

**HBV**

**HCV**

**1996**

**1994**

**1992**

**1990**

**1988**

**1986**

**1984**

**1:100**

**1:1000**

**1:10 000**

**1:100 000**

**1:1 000 000**

**1998**

**2000**

**Transmission risk, ****per unit**

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

## Slide 5

## Slide 6

## What Are You Transfusing?

- Red Blood
- Cells

- Platelets

**200 mL red cells**
**30 mL plasma**
**110 mL additive solution**

**4 x 10****11**** platelets**
**300 mL plasma**

**What Are You Transfusing?**

## What Are You Transfusing?

- Red Blood
- Cells

- Platelets

**200 mL red cells**
**30 mL plasma**
**110 mL additive solution**
**10****9**** *****Yersinia***** per mL + endotoxin**

**4 x 10****11**** platelets**
**300 mL plasma**
**10****8**** *****Staph***** per mL**

**What Are You Transfusing?**

## The Problem with Platelets...

**Bacterial contamination is **
**	****- frequent**
**	****- initially at very low concentration**
**	****- very difficult to detect**
**	****	****- in unit**
**	****	****- in patient**

## Bacterial Contamination Risks 

**	****	****  ****Confirmed Report of****	**_**Fatality**_
**	****	**_**Bacterial Contamination**_
**Red Blood Cells****	****	****  6.0****	****	****1.0**
**Plateletpheresis units****	****	****32****	****	****7.1**
**TOTAL, all units****	****	****  7.4****	****	****1.1**

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

**Bacterial Contamination Risks **

## Bacterial Contamination Risks 

**	****	****  ****Confirmed Report of****	**_**Fatality**_
**	****	**_**Bacterial Contamination**_
**Red Blood Cells****	****	****  6.0****	****	****1.0**
**Plateletpheresis units****	****	****32****	****	****7.1**
**TOTAL, all units****	****	****  7.4****	****	****1.1**

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

**Bacterial Contamination Risks **

**1/140,000**

## U.S. Bacterial Contamination Estimates

**Fatalities****	****	****	****4.5 - 18 per year**

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

**U.S. Bacterial Contamination Estimates**
***Based on BaCon Preliminary Data***

## Frequency of Contamination

**	****US****	****	****	****	****  670/million units****	****(Transfusion 1999;39:36S)**
**	****Germany****	****	****1300  ****	****	****	****	****(Transfusion 1999;39:34S)**
**	****Spain****	****	****	****  320  ****	****	****	****	****(Transfusion 1999;39:75S)**

**Frequency of Contamination**
***Other Reports***

## Frequency of Contamination

***Other Reports***

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

**	****	****  **_**Plt Conc**_**	****   **_**SDP**_
**Post-transfusion sepsis ****	****402/million****	****75/million**
**Fatalities****	****  62/million****	****14/million**

***Based on Johns Hopkins’ Data***

## Detecting Bacteria in Platelets: Inspection

**Changes Associated with Contamination**
**	****Clots**
**	****Discoloration**
**	****Gas bubbles**

## Detecting Bacteria in Platelets: Microscopic Review

**Sensitivity:**
**	****Gram stain****	****	****10****5**** - 10****6****/mL**
**	****Acridine orange****	****10****4**** - 10****6****/mL**

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

## Detecting Bacteria in Platelets: Microscopic Review

**Sensitivity:**
**	****Gram stain****	****	****10****5**** - 10****6****/mL**
**	****Acridine orange****	****10****4**** - 10****6****/mL**
**But: Significant ****false positive**** rate**

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

## Detecting Bacteria in Platelets: Biochemical Changes

**GLUCOSE**

**ACID + CO****2**

**Decreased glucose**
**Decreased pH**
**Decreased/absent swirling**

**Direct detection**

## GLUCOSE

**ACID + CO****2**

**Decreased glucose**
**Decreased pH**
**Decreased/absent swirling**

**• ****Automated testing**
**• ****Biochemical strips**

**Direct detection**

**• ****Sensitive labels**
**• ****Automated culture**

**Detecting Bacteria in Platelets: Biochemical Changes**

## Detecting Bacteria in Platelets: Biochemical Changes

**	****No change with****	*****Staph. epi***
***	******	******	******	******Staph. aureus***
***	******	******	******	******Ps. aeruginosa***
***	******	******	******	******Bacillus cereus***
**	****Change only with****	*****Ent. aerogenes***
**	****	****• ****at > 10****6**** CFU/mL**
**	****	****• ****sensitivity = 20%****	****	****	**

**Specificity problem: Platelets produce CO****2**** also.**

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

**Detecting Bacteria in Platelets: Biochemical Changes**

## Detecting Bacteria in Platelets: Biochemical Changes

**Glucose, % Day 0**

**Storage Time, d**

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

**Detecting Bacteria in Platelets: Biochemical Changes**

## -2 SD

**Glucose, % Day 0**

**Storage Time, d**

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

**-2 SD**

**Detecting Bacteria in Platelets: Biochemical Changes**

## Swirling

**Swirling**

**Low pH**
**Metabolic disturbance**

**No alignment with flow**

**Alignment with flow**

## Detecting Bacteria in Platelets: Biochemical Changes

***	******Swirling to detect contamination***
***	******	******  ***_**Sensitivity**_**	****	**_**Specificity**_
***S. epi.******	******	******  *****25% ****(Day 5)****	****     ****	****      75%**
***S. aureus******	*****100% ****(Day 2-3)****	****    100%**
***Salmonella******	******  *****75% ****(Day 3-5)****	****    100%**

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

## Detecting Bacteria in Platelets: Biochemical Changes

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

_**False positive rates **__**(sterile units)**_
**	****Glucose:****	****5%**
**	****pH:****	****	****4%**
**	****Swirling:****	****5%**

**based on ±2 SD reference intervals**

## Detecting Bacteria in Platelets: Future Developments

**Fenwick *****et al. Lancet***** 1991;337:496-7**

**Detecting Bacteria in Platelets: Future Developments**

**PCR**
**EIA**
**%O****2**
**Others....**

## BLOOD CENTER

**BLOOD CENTER**

**Culture: Day 1**
**Hold until negative**

**HOSPITAL**

**Day 2 or 3**

**Detecting Bacteria in Platelets: Culturing**

## BLOOD CENTER

**BLOOD CENTER**

**Culture: Day 1**
**Hold until negative**

**HOSPITAL**

**Day 2 or 3**

**Detecting Bacteria in Platelets: Culturing**

**- Currently in routine use in blood centers in Belgium**
**	****and the Netherlands**
**- Potential difficulties with recall, outdating.**

## Detecting Bacteria in Platelets: Culturing

**Detecting Bacteria in Platelets: Culturing**

## Detecting Bacteria in Platelets: Culturing

**(5 mL via SCD)**

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

**Detecting Bacteria in Platelets: Culturing**

- BacT Alert

**ENTRY INTO INVENTORY**

**DAY 2: CULTURE**

**TRANSFUSION ORDER: **
**RELEASE UNIT**

## Detecting Bacteria in Platelets: Culturing

**Organisms Involved in Blood Unit Contamination**
**1998 - 2000**

_**Gram-positive (60%)**_**	****	**_**Gram-negative (40%)**_
***Staph. epi****** ****(8)****	****	****	*****E. coli***** ****(5)**
***Staph. aureus***** ****(4)****	****	****	*****Serratia marcescens****** ****(3)**
***Staph. agalactiae***** ****(2)****	****	*****Serratia liquifaciens****** ****(2)**
***Grp G Strep.***** ****(1)****	****	****	*****Enterobacter aerogenes***** ****(1)**
***Staph. lugdensis***** ****(1)**** ****	****	*****Enterobacter cloacae***** ****(1)**
***Staph. saprophyticus***** ****(1)**** ****	****	*****P. rettgeri***** ****(1)**
***Bacillus cereus***** ****(1)**** ****	****	****	*****Y. enterocolitica***** ****(1)**
***E. faecalis***** ****(1)**
***Strep. pneumoniae***** ****(1)**

***includes isolates from RBCs**

**Kuehnert *****et al. Transfusion***** 2001;41:1493-9.**

## Bacterial Growth Kinetics in Platelets

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

**Bacterial Growth Kinetics in Platelets**

**Storage time, d**

**Bacterial concentration/mL**

**Inoculation:**
** ****1 CFU/mL**

**Detecting Bacteria in Platelets: Culturing**

## Detecting Bacteria in Platelets: Culturing

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

**Detecting Bacteria in Platelets: Culturing**

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

**Inoculum: 4 mL**

## Detecting Bacteria in Platelets: Culturing

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

**Detecting Bacteria in Platelets: Culturing**

- BacT Alert

**ENTRY INTO INVENTORY**

**DAY 2: CULTURE**

**TRANSFUSION ORDER: **
**RELEASE UNIT**

**POSITIVE AUTOMATED **
**CULTURE**

**Interdiction of release**

## Detecting Bacteria in Platelets: Culturing

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

**Detecting Bacteria in Platelets: Culturing**

- BacT Alert

**ENTRY INTO INVENTORY**

**DAY 2: CULTURE**

**TRANSFUSION ORDER: **
**RELEASE UNIT**

**POSITIVE AUTOMATED **
**CULTURE**

**Interdiction of release**

**Providing:**
**	****Assurance of sterility**
**	****Storage to 7 days **
**	****Storage after pooling**
**	****Reduced cost for leukoreduction**
**	**

## Practical Application of Culturing 

**in a Transfusion Service Laboratory**

**Experience in first 2 years:**
**	****2,569 units cultured **
**	****(5 mL into aerobic bottle, BacT/Alert automated system)**
**	****16 initial positives ****(0.6%)**
**	****	****11 not confirmed on repeat culture**
**	****	****5 not able to be recultured**
**	****	****   ****(1: positive after transfusion)**

**May, 1999 - April, 2001**

## Practical Application of Culturing 

**in a Transfusion Service Laboratory**

**Recent experience:**
**	****Split double SDP unit received ****(external source)**
**	**
**	****Day 2: Culture**
**	****Day 3 AM: Split A’s culture     growth**
**	****	****	****(recultured)**
**	****Day 3 PM: Split B’s culture     growth**
**	****Same *****Staph. epi*****. in each unit.**

**July, 2001**

## Practical Application of Culturing 

**in a Transfusion Service Laboratory**

**Costs:**
**	****Material costs: $11.05/plateletpheresis unit**
**	****Tech time: 7 minutes**
**	****Workup of positives: $50-100**

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

## Practical Application of Culturing 

**in a Transfusion Service Laboratory**

**Cost (for 100 units):**

**Material costs: ****	****	****$1105**
**Tech time: 700 minutes ****	****  $467**
**Workup of positive: ****	****   **_**$75**_
_**	**__**	**__**	**__**	**_**$1647**
**Units not outdated:**
**	****15**** @ $500****	****	****$7500**

## Practical Application of Culturing 

**in a Transfusion Service Laboratory**

***Potential payback: Outdate extension***

_**Units expiring**_**	****Units requested**
**	****	****	****    **_**on next day**_
**      ****2.4±1.4****	****	****      4.8±2.4**
**        ****(1-5)****	****	****        (2-9)**

**In all cases, more units were requested than expired.**** **

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

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

- Storage Time (d)

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

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

_**Dartmouth-Hitchcock Medical Center**_**	****	**_**American Red Cross, Norfolk**_
**James P. AuBuchon, MD****	****	****	****John B. Nobiletti, MD**
**Louise Herschel, BS, MLT(ASCP), CCRC ****	****Deanna A. McNeil,MLT(ASCP) **
**Jill Roger, MT(ASCP), CCRC****	****	****	****Sherrie L. Sawyer, MS**
**	****	****	****	****	****Adrienne Johnson, BS**
_**Gambro **__**	**__**	**__**	**__**	**__**	**_**Pamela H. Whitley, MT(ASCP)SBB**
**Larry Dumont**
**Art Hamstra**
**Tania VandenBroeke, MT(ASCP)**

**TrimaTM**
**SpectraTM LRS Turbo**

**LR SDP**

**Day**
**1**

**Day**
**5**

**Day**
**7**

**Flatbed agitation, 22-24°C**

**Biochemical assays**
**Functional assays**
**51****Cr/****111****In recovery**
**	**** ****and survival**

**X**
**X**
**X**

**X**
**X**
**X**

**X**
**X**

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

**Unit contents**
**	****Platelets:****	****	****4.1±1.1x10****11****	**
**	****Leukocytes:****	****	****5.0x10****4    ****(median)**
**	****Volume:****	****	****269±68 mL**

**Mean ± 1 SD**

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

**pCO****2**

**pO****2**

**pH ****(22°C)**

- Storage Time (d)

- mm Hg

- Storage Time (d)

*****

*****

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

**Gluc, Lact, Rate**

**Mean± 1 SEM**

*****

*****

**Rates: No difference**

- Storage Time (d)

- 12

- 12

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

- Storage Time (d)

- %

*****

*****

*****

**Mean± 1 SEM**

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

- Day 5

- Day 7

*****

*****

**Mean± 1 SEM**

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

**	****	****	****	****	****	****	****	**_**5 Days**_**	****	**_**7 Days**_
_**Recovery**_
**	****This study****	****	****	****	****	****63±11%****	****54±14%**
**	****Archer et al., 1983****	****	****	****59±17%****	****46±8%**
_**Survival**_
**	****This study****	****	****	****	****	****6.7±1.6d****	****5.6±1.9d**
**	****Archer et al., 1983****	****	****	****3.4±1.5d****	****2.7±0.5d**

**Archer *****et al. Vox Sang***** 1982; 43:223-30.**

**Mean ± 1SD**

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

**	****	****	****	****	****	****	****	**_**5 Days**_**	****	**_**7 Days**_
_**Recovery**_
**	****This study****	****	****	****	****	****63±11%****	****54±14%**
**	****Archer *****et al.*****	****	****	****	****59±17%****	****46±8%**
_**Survival**_
**	****This study****	****	****	****	****	****6.7±1.6d****	****5.6±1.9d**
**	****Archer *****et al.*****	****	****	****	****3.4±1.5d****	****2.7±0.5d**

**Archer *****et al. Vox Sang***** 1982; 43:223-30.**

**Mean ± 1SD**

**THIS STUDY: **
**Better results than**
**accepted previously**

**6**

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

**	****	****	****	****	****	****	****	**_**5 Days**_**	****	**_**7 Days**_
_**Recovery**_
**	****This study****	****	****	****	****	****63±11%****	****54±14%**
**	****Archer et al., 1983****	****	****	****59±17%****	****46±8%**
_**Survival**_
**	****This study****	****	****	****	****	****6.7±1.6d****	****5.6±1.9d**
**	****Archer et al., 1983****	****	****	****3.4±1.5d****	****2.7±0.5d**

**Archer *****et al. Vox Sang***** 1982; 43:223-30.**

**Mean ± 1SD**

**THIS STUDY: **
**Better results than**
**accepted previously**

**THIS STUDY: **
**Less reduction**
**D5     D7**

**14 vs. 22%**

**18 vs. 21%**

**6**

## Practical Application of Culturing 

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

**Day**
**2**

**Day**
**5**

**Day**
**7**

**Flatbed agitation, 22-24°C**

**Day**
**6**

**LR**
**SDP**

**OUTDATE**

**Day**
**8**

**Transfuse**
**if no other**
**units **
**available**

**pH and**
**swirling**
**checks**

**Determine**
**CCI**

## Practical Application of Culturing 

**in a Transfusion Service Laboratory**

_**Day 8 analysis**_** ****(n = 91)**
**	****Swirling:****	****	****96%**
**	****pH:****	****	****	****6.86±0.245**
**	****	****	****	****> 6.2 in 97%**
**	****	****	****	****Max = 7.26**

**All units collected on SpectraTM LRS Turbo**

## Practical Application of Culturing 

**in a Transfusion Service Laboratory**

_**Transfusions beyond Day 5**_**  ****(n=40)**
**	****All with expected clinical results**
**	****Stable patients with 10-60 min CCI: 21**

**All units collected on SpectraTM LRS Turbo**

## 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 5**

## Clinical Effect of Transfusing Platelets Beyond Day 5

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

**Cumulative Proportion (%)**

**90% > 7,500**

**(All but 1: > 5,000)**

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

**	**** ****Plt****	****	****HIV****	****	****  Septic****	****	****Total****	****	****Units’****	****Culturing****	****Total Direct**
_**	**__**Trxn**_**	****	**_**Risk**_**	****	**_**Mortality**_**	**** **_**Risk**_**	****	**_**Cost**_**	****	****   **_**Cost**_**	****	**** ****	**_**Cost**_
**	****  ****10****	****	**
**	****  ****11****	**

**CULTURE**
**+ 7d**

**NO **
**CULTURE**

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

**	**** ****Plt****	****	****HIV****	****	****  Septic****	****	****Total****	****	****Units’****	****Culturing****	****Total Direct**
_**	**__**Trxn**_**	****	**_**Risk**_**	****	**_**Mortality**_**	**** **_**Risk**_**	****	**_**Cost**_**	****	****   **_**Cost**_**	****	**** ****	**_**Cost**_
**	****  ****10****	****	****  10****	****	****	**
**	****  ****11****	****	****  11****	****	****	**

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

***Risks expressed per million***

**NO **
**CULTURE**

**CULTURE**
**+ 7d**

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

**	**** ****Plt****	****	****HIV****	****	****  Septic****	****	****Total****	****	****Units’****	****Culturing****	****Total Direct**
_**	**__**Trxn**_**	****	**_**Risk**_**	****	**_**Mortality**_**	**** **_**Risk**_**	****	**_**Cost**_**	****	****   **_**Cost**_**	****	**** ****	**_**Cost**_
**	****  ****10****	****	****  10****	****	****	****70****	****	****	****   ****80****	****	**
**	****  ****11****	****	****  11****	****	****	****  0****	****	****	****   ****11****	****	**

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

***Risks expressed per million***

**NO **
**CULTURE**

**CULTURE**
**+ 7d**

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

**	**** ****Plt****	****	****HIV****	****	****  Septic****	****	****Total****	****	****Units’****	****Culturing****	****Total Direct**
_**	**__**Trxn**_**	****	**_**Risk**_**	****	**_**Mortality**_**	**** **_**Risk**_**	****	**_**Cost**_**	****	****   **_**Cost**_**	****	**** ****	**_**Cost**_
**	****  ****10****	****	****  10****	****	****	****70****	****	****	****   ****80****	****	****$5,000****	****	****      0****	****	****	****$5,000**
**	****  ****11****	****	****  11****	****	****	****  0****	****	****	****   ****11****	****	****$5,500****	****	****$220****	****	****	****$5,720**

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

***Risks expressed per million***

**NO **
**CULTURE**

**CULTURE**
**+ 7d**

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

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

**	**** ****Plt****	****	****HIV****	****	****  Septic****	****	****Total****	****	****Units’****	****Culturing****	****Total Direct**
_**	**__**Trxn**_**	****	**_**Risk**_**	****	**_**Mortality**_**	**** **_**Risk**_**	****	**_**Cost**_**	****	****   **_**Cost**_**	****	**** ****	**_**Cost**_
**	****  ****10****	****	****  10****	****	****	****70****	****	****	****   ****80****	****	****$5,000****	****	****      0****	****	****	****$5,000**
**	****  ****11****	****	****  11****	****	****	****  0****	****	****	****   ****11****	****	****$5,500****	****	****$220****	****	****	****$5,720**

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

***Risks expressed per million***

**$65/unit**

**NO **
**CULTURE**

**CULTURE**
**+ 7d**

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

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

_**	**__**Trxn**_**	****	**_**Risk**_**	****	**_**Mortality**_**	**** **_**Risk**_**	****	**_**Cost**_**	****	****   **_**Cost**_**	****	**** ****	**_**Cost**_
**	****  ****10****	****	****  10****	****	****	****70****	****	****	****   ****80****	****	****$5,000****	****	****      0****	****	****	****$5,000**
**	****  ****11****	****	****  11****	****	****	****  0****	****	****	****   ****11****	****	****$5,500****	****	****$220****	****	****	****$5,720**

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

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

***Risks expressed per million***

**$65/unit**

**OUTDATE**
**REDUCTIONS**

**NO **
**CULTURE**

**CULTURE**
**+ 7d**

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

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

**Prestorage pooling of platelet concentrates**
**	****- simplicity for transfusion service**
**	****- *****pre*****storage leukoreduction**
**	****- reduction in filtration cost**
**	****- sterility assessment in highest-risk component**
**	****- reduced outdating**

## Safer, Cheaper and Just as Good

**Platelet storage for 7d **_**is feasible**_
**	****- Adequate maintenance of function**
**	****- Expected recovery and survival**
**	****- Adequate clinical efficacy**
**	****	*****indistinguishable from shorter storage***
**	****- Bacterial culturing to reduce septic risk**
**	****- Reduction in overall risk**
**	****- No increase in cost *****-- therefore practical***

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

## Slide 64