Cleveland Clinic Foundation Cleveland, Ohio, United States
Background/Case Studies: Patients with antibodies against Class I human leukocyte antigens (HLA) may become refractory to platelet transfusions and require platelets which are HLA-compatible. A 1-hour post-transfusion platelet count is utilized to calculate the corrected count increment (CCI). The CCI is used to determine the clinical response to transfusion and to assist in distinguishing other causes of platelet refractoriness. However, the post-transfusion count is frequently not obtained within the 1-hour window. One proposal to increase the likelihood of obtaining 1 hour post-transfusion platelet counts is to interface directly with the clinical staff by including a tag on the platelet unit reminding them to obtain a post-transfusion platelet count.
Study
Design/Methods: The number of transfused HLA-compatible platelets at a hospital-based blood bank was tracked over a period of eight weeks. The number of these transfusions where a 1-hour post-transfusion platelet count was collected was tallied. Subsequently, manila tags measuring 5” x 2.5” with the statement ‘Please obtain a post-transfusion platelet count after every HLA matched platelet transfusion’ were added to every HLA-compatible platelet unit. The number of units transfused and the frequency of obtaining a post-transfusion count was monitored for 12 weeks after this implementation (increased from the originally planned 8 weeks due to lower than expected number of transfusions). The transfusion medicine service did not otherwise remind the clinical team to collect post-transfusion counts. The number of HLA-compatible platelets transfused, and the number of those with a post-transfusion platelet count were compared between the two periods.
Results/Findings: During the baseline period observed, there were 86 HLA-compatible platelet units transfused and 23 of these units had a 1-hour post-transfusion platelet count collected (26.7%). After the implementation of adding the reminder tags to the units, there were 44 HLA-compatible platelet units transfused and 37 of these were associated with a post-transfusion platelet count (84.1%) Conclusions: There is a startling improvement in the number of transfusions where a 1-hour post-transfusion platelet count was obtained after the implementation of a reminder tag. A possible limitation of this study is that it is somewhat difficult to compare the data from these two time periods because of the decrease in overall transfusions in the second period necessitating an increase in the number of weeks considered. However, the overall proportion of transfusions where a post-transfusion count was obtained shows an improvement of over fifty percent. Based on these limited results, this type of intervention shows serious promise for addressing this gap in patient care.
Importance of research: Accuracy in the 1-hour post-transfusion platelet count is vital for obtaining an appropriate corrected count increment and guiding clinical decision making. This study involves a direct intervention with the clinical staff and demonstrates a cross-disciplinary approach holds promise to improve this gap in patient care.
