Effect of Severe Acute Respiratory Syndrome Coronavirus 2 on Blood Product Utilization in the Community Hospital Setting

Abstract Introduction/Objective Blood products are a major expense for the laboratory, with an intricate balance between maintaining adequate supply and expiring products. Blood product wastage rates are typically less than 2%. The SARS-CoV-2 (SARS-CoV-2) pandemic has created a multifaceted challenge in blood utilization. Difficulties in predicting product usage, decreased supply, and transportation delays put hospitals at risk of increased blood product destruction. In this study, we analyze the effect of the SARS-CoV-2 pandemic on blood utilization in the community hospital setting, in order to develop improved laboratory management strategies for decreasing unit wastage. Methods/Case Report Quality indicators of blood utilization from 2012 to 2021 were retrospectively reviewed. Data was collected for packed red blood cells (pRBCs), platelets, and plasma. Units transfused, expired/destroyed, and total percent discarded were recorded for each month. Average transfusion and destruction rates were calculated for each product. Blood product utilization from 2020 was compared to years 2012-2019 using Pearson correlation, linear regression, and student paired t-tests. Results (if a Case Study enter NA) 1,042 units were reviewed. For pRBCs, there was a strong correlation between 2020 and increased destruction compared to 2012-2019 (R= 0.8, p=0.005). There was no significant change in pRBC transfusions in 2020 compared to 2018 and 2019 (p= 0.3, p= 0.2). There were fewer pRBC transfusions in 2020 compared to 2016 and 2017 (p= 0.006, p=0.01). For platelets, there was increased destruction in 2020 compared to 2012-2019 (p= 0.01-0.04) and no significant change in usage (p= 0.3-0.5). Conclusion During the 2020 SARS-CoV-2 pandemic, there was a significant increase in blood product wastage. There was no significant increase in transfused pRBCs or platelet units, suggesting the increased destruction was not due to an overall increase in transfusions. Blood products are a major cost for laboratory and further investigation of these findings is warranted to mitigate continued wastage.

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Effect of tranexamic acid administration time on blood product use in urban trauma patients

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa074 ◽

2020 ◽

Vol 77 (Supplement_2) ◽

pp. S46-S53 ◽

Cited By ~ 1

Author(s):

Elizabeth Tencza ◽

Andrew J Harrell ◽

Preeyaporn Sarangarm

Keyword(s):

Tranexamic Acid ◽

Blood Product ◽

Trauma Patients ◽

Loading Dose ◽

Blood Products ◽

Ambulance Personnel ◽

Product Usage ◽

Packed Red Blood Cells ◽

Product Use ◽

Acid Administration

Abstract Purpose To evaluate the effect of time to tranexamic acid administration on blood product usage in trauma patients and to assess the potential benefit of initiating a protocol for field administration by ground ambulance personnel. Methods Adult patients with traumatic injuries who received 1 g of tranexamic acid during the period January 2014 through June 2016 were retrospectively identified via review of automated dispensing cabinet and electronic medical record data and cross-referencing with the New Mexico Trauma Registry. Exclusion criteria included tranexamic acid use for nontrauma indications, previous admission for trauma during the study period, and a lack of pertinent information regarding the time, type, or severity of trauma in available records. The primary outcome was blood product use (aggregate of units of platelets, packed red blood cells [pRBCs], and fresh frozen plasma [FFP]) in the first 24 hours of hospital admission. Results The analysis included 107 patient cases, with a median transport time of 20 minutes (range, 7-103 minutes); 73% of reported transport times were less than 30 minutes. All patients received a loading dose of tranexamic acid in the hospital, with the exception of 2 patients who received tranexamic acid in the field. Administration of a tranexamic acid loading dose was documented within 3 hours for 90.7% of patients, with a mean time to administration of 91.9 minutes. A mean (SD) total of 14.8 (16.0) units of blood products (range, 0-91 units) were administered, consisting of a mean (SD) of 8.0 (8.4) units of pRBCs (range, 0-48 units), 5.6 (7.5) units of FFP (range, 0-38 units), and 1.2 (1.7) units of platelets (range, 0-7 units). Time to tranexamic acid administration did not affect blood product usage in the first 24 hours of admission after adjusting for potential confounders. Conclusion Earlier administration of tranexamic acid was not associated with a decrease in use of blood products. This finding, paired with the relatively short ground transport times typical for our institution, makes it unlikely that field administration of tranexamic acid would benefit the evaluated patient population.

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Transfusion Medicine Informatics: Analysis of User Burden from Clinical Decision Support Alerts in Promoting Patient Blood Management

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.270 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S123-S124

Author(s):

H C Tsang ◽

P Mathias ◽

N Hoffman ◽

M B Pagano

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Blood Product ◽

Clinical Decision ◽

Blood Products ◽

Blood Management ◽

Before And After ◽

Blood Utilization ◽

Transfusion Ratio ◽

Major Project

Abstract Introduction/Objective To increase efficiency of blood product ordering and delivery processes and improve appropriateness of orders, a major project to implement clinical decision support (CDS) alerts in the electronic medical record (EMR) was undertaken. A design team was assembled including hospital and laboratory medicine information technology and clinical informatics, transfusion services, nursing and clinical services from medical and surgical specialties. Methods Consensus-derived thresholds in hemoglobin/hematocrit, platelet count, INR, and fibrinogen for red blood cell (RBC), platelet, plasma, and cryoprecipitate blood products CDS alerts were determined. Data from the EMR and laboratory information system were queried from the 12-month period before and after implementation and the data was analyzed. Results During the analysis period, 5813 RBC (avg. monthly = 484), 1040 platelet (avg. monthly = 87), 423 plasma (avg. monthly = 35), and 88 cryoprecipitate (avg. monthly = 7) alerts fired. The average time it took for a user to respond was 5.175 seconds. The total amount of time alerts displayed over 12 months was 5813 seconds (~97 minutes of user time) compared to 56503 blood products transfused. Of active CDS alerts, hemoglobin/RBC alerts fired most often with ~1:5 (31141 RBC units) alert to transfusion ratio and 4% of orders canceled (n=231) when viewing the alert, platelet alerts fired with ~1:15 (15385 platelet units) alert to transfusion ratio and 6% orders canceled (n=66), INR/plasma alerts fired with ~1:21 (8793 plasma units) alert to transfusion ratio and 10% orders canceled (n=41), cryoprecipitate alerts fired with ~1:13 (1184 cryoprecipitate units) alert to transfusion ratio and 10% orders canceled (n=9). Overall monthly blood utilization normalized to 1000 patient discharges did not appear to have statistically significant differences comparing pre- versus post-go-live, except a potentially significant increase in monthly plasma usage at one facility with p = 0.34, although possibly due to an outlier single month of heavy usage. Conclusion Clinical decision support alerts can guide provider ordering with minimal user burden. This resulted in increased safety and quality use of the ordering process, although overall blood utilization did not appear to change significantly.

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Blood Utilization at Regional Hospitals

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz131.000 ◽

2019 ◽

Vol 152 (Supplement_1) ◽

pp. S151-S151

Author(s):

Ryan Demkowicz ◽

Josephine Dermawan ◽

Sindu Shetty ◽

Richard Scarborough ◽

Haiyan Lu ◽

...

Keyword(s):

Decision Process ◽

Blood Cells ◽

Chart Review ◽

Blood Product ◽

Transfusion Medicine ◽

Screening Criteria ◽

Packed Red Blood Cells ◽

Blood Utilization ◽

Regional Hospitals ◽

Multiple Units

Abstract Introduction Transfusion medicine is unique to lab medicine. While it still involves testing and reporting of results, it is one of the few areas where the laboratory is providing treatment. The risk of providing a blood product must be weighed against the benefit before the decision is made to transfuse a patient. Our study looked at blood utilization at our regional hospitals to assess if there were areas where we need to improve this decision process. Methods Chart reviews were performed for patients who received packed red blood cells (RBCs) in the regional hospitals over a 2-month period. Using the AABB and Choosing Wisely recommendations, we created two screening criteria: hemoglobin (Hb) >8 g/dL or greater than 1 unit RBC ordered when Hb is >6 g/dL to screen for outliers among RBC orders. A more in-depth chart review including information on clinical diagnosis, indications, bleeding status, and blood loss during surgery was performed on cases that met these criteria. Using this information, a decision was made on the appropriateness of the transfusion. Results In total, 1,592 RBC units were screened at eight regional hospitals. Sixty-eight (4%) were flagged as inappropriate, 57 (83.8%) due to multiple units, and 11 (16.2%) for an Hb >8 g/dL. The percentage of inappropriate transfusions at a hospital ranged from 5.2% to 13.6%. However, all hospitals except one were under 5.5%. Discussion In general, regional physicians are transfusing RBCs appropriately. When a unit is ordered inappropriately, it is most likely due to ordering multiple units upfront. To further improve blood utilization, these data were presented to hospital administration and a new alert in the EMR was created. A repeat study will be performed to see if the alerts and awareness of these data has had an effect on blood utilization.

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Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol

The American Surgeon ◽

10.1177/000313482008600120 ◽

2020 ◽

Vol 86 (1) ◽

pp. 35-41

Author(s):

L. Andrew May ◽

Kevin N. Harrell ◽

Christopher M. Bell ◽

Angela Basham-Saif ◽

Donald E. Barker ◽

...

Keyword(s):

Blood Product ◽

Trauma Registry ◽

Massive Transfusion ◽

Blood Products ◽

Packed Red Blood Cells ◽

Massive Blood Loss ◽

Massive Transfusion Protocol ◽

Nurse Clinicians ◽

Level I ◽

Transfusion Protocol

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007–2015) or TNCs (2015–2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.

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Management of Major Obstetric Haemorrhage using ROTEM Point-of-Care Haemostasis Analysers Can Reduce Blood Product usage Without Increasing Fibrinogen Replacement Therapy

Biomedical & Pharmacology Journal ◽

10.13005/bpj/1478 ◽

2018 ◽

Vol 11 (3) ◽

pp. 1167-1176

Author(s):

Beatrice O. Ondondo

Keyword(s):

Blood Loss ◽

Replacement Therapy ◽

Blood Product ◽

Point Of Care ◽

Blood Products ◽

Transfusion Therapy ◽

Product Usage ◽

Obstetric Haemorrhage ◽

Coagulation Tests ◽

Fibrinogen Replacement Therapy

Major obstetric haemorrhage (MOH) is a leading cause of maternal death and morbidity, with the majority of deaths occurring within four hours of delivery. Therefore, prompt identification of women at risk of MOH is crucial for the rapid assessment and management of blood loss to urgently restore haemodynamic stability. Furthermore, as the rate of blood loss during MOH can increase rapidly in the time when laboratory results are awaited, the management of MOH could benefit from point-of-care coagulation testing by the ROTEM analyser which has a quicker turnaround time compared to standard laboratory coagulation tests. A number of studies indicate that ROTEM-based management of MOH has resulted in a significant reduction in massive transfusions and decreased transfusion of concentrated red cells (CRC) and fresh frozen plasma (FFP) due to a reduction in total blood loss. Several reports which have linked MOH to the depletion of fibrinogen reserves indicate that the reduction in CRC and FFP transfusions is largely due to an increase in early fibrinogen replacement therapy which corrects hypofibrinogenemia. This short report discusses preliminary findings on the impact of ROTEM point-of-care haemostasis analyser on the transfusion of various blood products to obstetric women experiencing MOH at the Royal Gwent Hospital in South wales. The number of blood products transfused following decisions based on the ROTEM analyser measurements (ROTEM group) was compared to historical transfusion data before the ROTEM analyser became available (Pre-ROTEM group). Blood product transfusion in the Pre-ROTEM group was guided by measurements of standard laboratory coagulation tests in conjunction with the established major haemorrhage protocols at the time. The findings indicate that the ROTEM analyser was effective in managing MOH at point-of-care and led to a reduction in the transfusion of CRC, FFP and platelets. However, contrary to published studies, the reduction in blood product usage was not accompanied by an increase in fibrinogen replacement transfusion therapy, suggesting that the ROTEM’s FIBTEM assay accurately quantified fibrinogen levels based on fibrin-clot firmness to enable an early diagnosis of hypofibrinogenemia. Early establishment of the absence of hypofibrinogenemia helped to prevent unnecessary transfusion of fibrinogen concentrate in this study. These findings support the adoption of routine use of ROTEM analysers at point-of-care on labour wards to manage MOH and reduce fibrinogen replacement therapy. The ease of use and rapidity of ROTEM tests could enable departure from globally directed correction of coagulopathy during MOH to a more focussed and precise target transfusion therapy, which will ultimately reduce blood product wastage (including fibrinogen concentrate) whilst minimising transfusion-associated side effects such as alloimmunisation, circulatory overload and dilutional coagulopathy.

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Rate and reasons for discarding blood and blood product units at the Northern Zone Blood Transfusion Centre in Tanzania

GSC Advanced Research and Reviews ◽

10.30574/gscarr.2021.8.3.0191 ◽

2021 ◽

Vol 8 (3) ◽

pp. 102-107

Author(s):

Ibrahimu Sugwa Mathias ◽

Mhembe Malongo Tanu ◽

Swabra Mohammed Issa ◽

Orgeness Jasper Mbwambo

Keyword(s):

Blood Transfusion ◽

Blood Product ◽

Blood Component ◽

Blood Products ◽

Packed Red Blood Cells ◽

Resource Needs ◽

Northern Tanzania ◽

Zero Rate ◽

Northern Zone ◽

The Common

Blood transfusion is an essential component in modern healthcare. Blood being an irreplaceable resource needs to be appropriately utilized with preferably minimal or zero percent wastage. Only one third of required blood units are collected in a Northern Tanzania Hospital, demanding the need for zero rate of discard of blood and blood products. This study aimed to determine the rate and reasons for discarding blood and blood products at Northern Zone Blood Transfusion Centre in Tanzania. From the current study the discard rate of blood and blood component units was 2.48% and the main reason for discarding blood and blood components was Transfusion Transmitted infections, followed by plasma prepared after 24 hours of collection of blood. . Furthermore, the common discarded blood product was packed red blood cells in Northern Tanzania.

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UK Helicopter Emergency Medical Services’ use of circulatory access devices, blood product transfusion and fluid warmers – a cross-sectional survey

Trauma ◽

10.1177/1460408618819642 ◽

2018 ◽

Vol 22 (1) ◽

pp. 45-50

Author(s):

Jonathan Morris ◽

Simon Hughes

Keyword(s):

Red Blood Cells ◽

Blood Cells ◽

Blood Product ◽

Central Venous Access ◽

Venous Access ◽

Blood Product Transfusion ◽

Blood Products ◽

Central Venous ◽

Packed Red Blood Cells ◽

Warming Devices

Introduction The pre-hospital environment provides significant challenges to clinicians who wish to rapidly administer warmed blood products and fluids to patients with haemorrhagic shock. Large-bore circulatory access is required with the use of devices that will successfully warm cold blood with minimal impact on flow rates. Until now, no information has been available that defines UK Helicopter Emergency Medical Services’ (HEMS) use of circulatory access and fluid warming devices, nor the recent adoption of pre-hospital blood product transfusion. Methods A survey was sent to all 22 UK HEMS asking which circulatory access devices crews have available, whether blood products are being transfused and if fluid warming devices are used as part of their resuscitations. Results All services responded. All UK HEMS use peripheral intravenous cannulae and intraosseous access. In addition, seven use central venous catheters and three use large-bore peripheral access (the Arrow Rapid Infusion Catheter®). Three services use landmark technique alone to gain central venous access, whereas four use a combination of landmark and ultrasound-guided techniques. Different sites for central venous access are used: subclavian (seven services), internal jugular (four) and femoral (four). Fourteen services carry pre-hospital blood products of which six transfuse packed red blood cells; four transfuse packed red blood cells and fresh frozen plasma; four transfuse packed red blood cells and lyophilised plasma. Eight services carry no pre-hospital blood products. Seventeen HEMS use fluid warmers; 13 use the Belmont® buddy lite™ and four use the QinFlow Warrior. Conclusion The use of a variety of policies and range of equipment has evolved across UK HEMS, demonstrating a lack of consensus on best practice. This is the first study to record a complete picture of current UK HEMS practice with regard to the use of circulatory access devices, fluid warmers and blood product administration.

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Optimizing blood product utilization: A whole lot to gain and nothing to lose!

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18669 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18669-e18669

Author(s):

Adam F Binder ◽

Katy Loos ◽

Alexis Peedin ◽

Julie Karp ◽

Usama Gergis ◽

...

Keyword(s):

Blood Product ◽

Baseline Period ◽

Unintended Consequences ◽

P Value ◽

Blood Product Transfusion ◽

Inpatient Setting ◽

Blood Products ◽

Intervention Period ◽

Post Intervention ◽

Packed Red Blood Cells

e18669 Background: Transfusion stewardship is a vital part of managing patients with hematologic malignancies (HM). Blood products are limited resources and blood product transfusion (txn) is costly and poses complications. Randomized trials in different clinical settings have shown that a conservative txn strategy is not inferior to more liberal txn strategy. As a result, the AABB and ASCO have recommended following a conservative txn strategy in patients with cancer (hemoglobin (hg) <7-8g/dL and platelets (plt) <10K in stable non-bleeding patients). Here we report our early outpatient institution’s experience implementing a contemporary txn approach in patients with HM. Methods: We formed a multi-disciplinary team to analyze blood product utilization. Overutilization was defined as orders for multi-units, packed red blood cells (pRBC) for hg >8 or plt for plt >10K in stable non-bleeding patients. Patients’ charts were audited during the baseline period to understand practice patterns. Data were collected using Qlik database. The baseline period (May 1, 2019-Feb 29, 2020) was compared to the intervention period (March 1 – December 31, 2020). A root cause analysis was performed. When possible 2-sided paired T-test was performed. If not possible, descriptive statistics were performed. Three interventions were developed and implemented sequentially: March 2020 – Blood bank began real-time review of blood products overutilization. May 2020 – Electronic Medical Record txn order set was revised to reflect recommended best practices. October 2020 –Txn guidelines revised for patients with HM. Results: During the study period, there were 3,227 pRBC and 2,817 plt transfused units in the outpatient setting. Monthly pRBC txn decreased from (mean(SD)) 168.5 (16.6) to 154.2(16.4) (p value: 0.14). Monthly plt txn decreased from 166.5 (26.5) to 115.2 (26.2) (p value: 0.001). Rates of multi-unit orders decreased significantly. Average monthly multi-unit orders decreased for pRBC (pre-48.6(5.9);post-24.3(7.6);p value 0.00007) and plts (pre-67.4(11.8);post-21.3(23.3);p value: 0.0002). Average hb at time of txn in the pre- and post-intervention period was 7.47 and 7.22. The percentage of txn in which the indication for txn was hb <7, 7-8, >8 changed from 34.6% to 56.3%, 52.6% to 32.8%, and 12.8% to 10.9% respectively. There was no significant increase in admissions for bleeding or increase in number of outpatient visits during the study period. Conclusions: Over 10-months, we significantly reduced outpatient blood product. Robust quality improvement methodology, engaging key stakeholders, and changing the culture of outpatient management were keys to success. To date, we have not seen any unintended consequences of these changes. These results are encouraging, as outpatient transfusion stewardship is thought to be harder given concerns about patients not being monitored as closely as in the inpatient setting.

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Evaluation of the Use of Blood Products in ICU Hospitalized COVID-19 Patients

Surgeries ◽

10.3390/surgeries2040039 ◽

2021 ◽

Vol 2 (4) ◽

pp. 391-398

Author(s):

Branislava Vasiljević-Jovanović ◽

Marija Milenković ◽

Lidija Mijović ◽

Zoran Bukumirić ◽

Milena Šantrić-Milićević ◽

...

Keyword(s):

Median Time ◽

Blood Product ◽

Medical Center ◽

Severity Of Illness ◽

University Hospital ◽

Blood Products ◽

Product Usage ◽

The Public ◽

The University ◽

Second Wave

(1) Background: The COVID-19 pandemic tested the public health system’s readiness for crises and highlighted the importance of knowing the demand for blood products and the maintenance of the blood supply chain. The aim of this study was to evaluate blood product usage in a series of patients that were hospitalized due to COVID-19 and to analyze their demographics and clinical characteristics. (2) Methods: In this retrospective cohort study, we analyzed data from transfused COVID-19 patients that were treated in the University Hospital Medical Center Bezanijska Kosa in Belgrade, Serbia during the second wave of the epidemic. (3) Results: This study included 90 patients. The median age of the patients was 72 (range 23–95) years. The median time of hospitalization was 23 days (range 3–73 days). In intensive care units (ICUs) the median time of hospitalization was 9 days (range 0–73). One or more comorbidities were observed in 86 individuals (95.6%). The total number of transfused red blood cell concetrates (RBC) was 304 (139 in ICU, 165 in other wards), with a mean of 3 units/patient (range 1–14). Comorbidities, severity of illness and hospital duration in the ICU were statistically significant predictors of higher RBC use. (4) Conclusion: Knowledge of the transfusion profile of COVID-19 patients allowed better management of the hospital’s blood stocks during the COVID-19 pandemic.

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Maximal Conservation and Minimal Usage of Blood Products in Open Heart Surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x8000800214 ◽

1980 ◽

Vol 8 (2) ◽

pp. 178-182 ◽

Cited By ~ 11

Author(s):

P. E. Newland ◽

J. Pastoriza-Pinol ◽

J. McMillan ◽

B. F. Smith ◽

G. R. Stirling

Keyword(s):

Heart Surgery ◽

Blood Product ◽

Open Heart Surgery ◽

Blood Bank ◽

Open Heart ◽

Blood Products ◽

Blood Conservation ◽

Simple Method ◽

Product Usage ◽

Intraoperative Autotransfusion

Open heart surgery has previously been associated with the use of large volumes of blood products. This paper describes methods of blood conservation and a simple method of intraoperative autotransfusion that together have resulted in minimal blood product usage in elective open heart surgery cases. This has reduced our dependence on blood bank supplies for the performance of elective open heart surgery.

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