(P-TS-35) Group O Red Blood Cell Utilization in Group A recipients with Neonatal Congenital Diaphragmatic Hernia Surgical Repair: A Patient Blood Management Opportunity

Background/Case Studies: Patient blood management (PBM) to prevent misutilization of group O RBCs is a main tenant of blood centers and transfusion services. In October 2020, our free-standing children’s hospital transfusion service’s laboratory information system (LIS) was harmonized to standardize practice across a six-hospital healthcare system. A standard operating procedure combining the special requirements of group O RBCs, irradiation, and leukoreduction for neonatal patients < 120 days old was set as a global default. Consequently, all neonatal patients were switched from receiving ABO-type specific and/or type compatible RBCs to receiving group O RBC products only. This investigative team hypothesized that the SOP change in Group O RBC transfusion to all neonates undergoing CDH repair with and without ECMO support would result in a misutilization of group O RBCs in recipients who are group A and could easily receive group A RBCs.

Study

Design/Methods: Group O RBC unit transfusion data was evaluated in Group A neonatal CDH repair patients < 120 days old with and without ECMO support. Transfusion data was collected and analyzed from Oct 2020-Dec 2022. In order to calculate the volume of O RBCs transfused to group A CDH repair neonates, and translate that to units, one AS-3 RBC unit was assumed to be 320 mls. The total volume of group O RBCs transfused to non-group O CDH repair neonates was calculated to help estimate the number of group O full RBC unit transfused. The total volume of O RBCs not transfused (wasted) after preparation for all CDH repair patients was estimated.

Results/Findings: Over the 2-year period, N=166 CDH repair patients, with 33%, N=55 placed on ECMO. Sixty-seven CDH repair patients were group A and of those 43% required ECMO. The total volume of group O RBCs transfused to non-group O CDH repair patients was ≈122.6 group O RBC units. Furthermore, 83.7 units of group O RBCs was transfused to group A CDH repair patients. This consisted of 37.4% group O transfusions to group A CDH repair patients.

Conclusions: Transfusing group O RBC units to group A neonates requiring CDH repair with or without ECMO leads to misutilization of group O RBC resources. Group A patients can utilize group A RBCs, which are readily available, and is a prudent PBM strategy. A re-evaluation of protocols that require group O RBCs be transfused to all neonates < 120 days is needed.

Importance of research: Patient conservation and management of group O as a resource. Implications for transfusion practice in neonates.