Assistant Professor of Pathology University of Texas Southwestern Medical Center, Texas, United States
Background/Case Studies: Due to the potential risk of infectious transmission, the 4–6 hour shelf-life of CryoAHF prevents thawed storage, often delaying fibrinogen supplementation during major surgical bleeding. The FDA has approved Pathogen Reduced Cryoprecipitated Fibrinogen Complex (PRCFC) manufactured from amotosalen/UVA-treated plasma that can be kept at room temperature for up to 5 days for the treatment/control of bleeding associated with fibrinogen deficiency. Opportunities for rapid dispensing of PRCFC & decreasing CryoAHF wastage were identified.
Study
Design/Methods: PRCFC was implemented in Jan ‘22. The ordering process was not modified to indicate Cryo AHF or PRCFC. Two units of PRCFC were kept thawed at 20-24°C in a labeled box. Turnaround time (TAT) to prepare/allocate & issue cryoprecipitate orders were documented. A retrospective analysis of TATs for CryoAHF vs. PRCFC was performed for orders between Jan ‘22 & Feb ‘23. Outliers, including all orders taking >60 minutes for issue, were excluded from analysis (these reflected non-urgent orders or cryo released as part of massive transfusion protocols that were not released until later shipments).
Results/Findings: A total of 2014 cryoprecipitate orders were included in the analysis. Of these, 398 (19.7%) were PRCFC. Reduction in TAT between PRCFC & CryoAHF was most significant for orders placed from the OR and Labor & Delivery (L&D), with a 48.7% reduction in time from order to prepare (p< 0.001) and 41.3% reduction in time from order to issue (p< 0.001). When adding ICU orders to the analysis, similar reductions in TATs were achieved. When all orders regardless of location were included, time to prepare & issue were reduced by 39.2% & 38.6%, respectively (p< 0.001) (Table 1). After implementing PRCFC, there was a 100% reduction in wastage in the blood bank and a 17.20% reduction in wastage in the patient care areas, with overall cost savings of 30.8% ($19,800). Conclusions: PRCFC is ready to dispense & provides an immediate source of fibrinogen in critically bleeding patients with significant reductions in TAT. There is an added benefit of reduced wastage and thus, cost saving.
Importance of research: CryoAHF has a 4-6 hour shelf life due to the risk of infectious transmission. Pathogen Reduced Cryoprecipitate Fibrinogen Complex (PRCFC) reduces the risk of infectious transmission and has a shelf life of 5-days post thaw. The stability of thawed PRCFC allows for the earlier use of fibrinogen in bleeding patients. PRCFC results in increased patient safety and improved efficiencies for the transfusion service with decreases in turn-around time from order to issue, product wastage, and costs.
