(P-TS-22) Cryoprecipitate Usage, Policy, and Practices among Blood Banks in the United States

Background/Case Studies: Over the past few years, there has been extra-ordinary demand for blood products concomitantly with significant decrease in donations due to the COVID-19 pandemic. Blood banks (BB) across the United States (US), in turn, experienced shortages in the supply of these products. Institutional policies regarding the administration of blood products may influence the availability of these products. We aimed to assess the policies/practices regarding compatibility testing for antihemophilic factor (AHF) at various BB and the experiences of these institutions with the administration, supply, and wastage of AHF.

Study

Design/Methods: An online survey was deployed to BB within the US via Qualtrics. The survey comprised of 10 structured and 2 open-ended questions. Collected data was synthesized with Qualtrics and reported as frequencies and percentages.

Results/Findings: A total of 82 BB responded. 45% serve community hospitals and 38% serve academic hospitals. Most BB serve either an urban (39%) or sub-urban (38%) population. 67% serve both adult and pediatric populations.
37% of BB preferred type specific AHF administration. 22% limited the number of out-of-group AHF administered to a patient within a 24-hour period. 50% experienced AHF shortage in the prior two years, and 17% experienced this at least 3-5 times annually. In periods of AHF shortage, 51% BB adopted proactive screening of orders, 37% limited the number of units administered to a patient at a time, and 34% used fibrinogen concentrate instead.
The average annual AHF wastage varied significantly with 15% of BB wasting more than 50 pre-pooled units while 45% wasted no more than 5 units. Tactics employed during shortages include using fibrinogen concentrate and either solely using or supplementing AHF with pathogen reduced cryoprecipitated fibrinogen complex (IFC). A notable cause of wastage is reportedly due to units thawed for massive transfusion protocols (MTP) that were ultimately not transfused.

Conclusions: Despite AHF shortage being experienced by 50% of BB, 15% experienced significant AHF wastage (>50 units) annually. Adoption of multiple strategies targeted at limiting the units administered, screening orders proactively, giving out-of-group AHF in lieu of type-specific AHF, supplementation of AHF use with alternatives such as fibrinogen concentrate and IFC, as well as policy changes regarding when to thaw units for MTP may be pivotal in reducing product wastage and improving efficiency.

Importance of research: We are looking at factors that effect the efficiency of product management among Blood Banks in the United States.