Platelet Preservation and Functionality in Blood Treated for Autotransfusion: A Comparative In Vitro Study on Human Blood and In Vivo Study Using a Massive Hemorrhage Swine Model

During hemorrhagic procedures, autotransfusion is one of the main strategies for patient blood management. While conventional cell savers only concentrate red blood cells due to the centrifugation method, the innovative same™ autotransfusion medical device (i-SEP, Nantes, France), based on a hollow-fiber filtration technology, has the ability to preserve red blood cells along with the majority of platelets. Background/Objectives: The present study aimed at comparing the functionality of preserved platelets in the clot formation by using Quantra® and/or ROTEM® Point-Of-Care coagulation tests, after blood treatment for autotransfusion with either a standard centrifugation-based system (Xtra® device, LivaNova, London, UK), or the filtration-based same™ device. Methods: First, coagulation was assessed in an in vitro experiment, where human blood samples were used to obtain ten treated blood products by each autotransfusion device that were evaluated with or without supplementation of plasma poor or rich in platelets. Then, to confirm the potential clinical benefit of the platelet preservation in a surgical context, coagulation was studied in vivo using a massive surgical hemorrhagic model on eight minipigs per device. Samples were collected after reinfusion steps and during a 6 h post-operative follow-up. Results: Both in vitro and in vivo, the same™ device consistently retained more platelets compared to the Xtra® device. This enhanced preservation resulted in significantly stronger clot formation, likely due to higher platelet concentration and superior functional integrity. Conclusions: These findings highlight the potential clinical benefit of same™-recovered platelets for improving hemostasis during hemorrhagic surgery.