(P-TS-8) An Evaluation of Product Usage and Wastage After Implementation of Low-Titer Group O Whole Blood Products Issued for Patients Under Massive Transfusion Protocol

Background/Case Studies: Transfusion of Low-Titer Group O Whole Blood (LTOWB) for trauma resuscitation is becoming a more common practice. Hospital Emergency rooms now stock LTOWB for patients under Massive Transfusion Protocol (MTP) as research data has reflected a trend in improved outcomes when LTOWB is administered in patients with traumatic injuries. An 892 bed, Level 2 Trauma Center changed their MTP protocol to incorporate the use of LTOWB. Prior to implementation of LTOWB, MTP packs included 4 RBC and 4 Plasma in each round. Platelet Apheresis or equivalent (PLTS) and Cryoprecipitate (CRYO) pool of 10 were added in round 2 and every other round thereafter. In October 2019, a Phase 1 change to 2 units of LTOWB for the first round of a trauma MTP was implemented. In March 2022, the hospital expanded this policy. In the Phase 2 process, 2 units of LTOWB were issued for the 1st and 2nd rounds of MTP. With implementation of each Phase, after the LTOWB were issued, additional MTP rounds reverted back to previous component therapy.

Study

Design/Methods: The Transfusion Service evaluated the impact of this change on product usage and wastage. Wastage occurs when issued products are returned and expire or stock LTOWB products are not used and expire. Thawed CRYO, having a short expiration, is a frequent wastage product. The usage and wastage percentage data were evaluated for 78 MTP initiated during each Phase. Trauma severity was not reported.

Results/Findings: The total percent reduction between the Original and Phase 2 MTP protocol for product usage was: RBC (64%), PLASMA (64%), PLTS (57%), CRYO (58%). The total percent reduction between the Original and Phase 2 MTP protocol for product wastage was: RBC (100%), PLASMA (92%), CRYO (67%). A total of 62 LTOWB were wasted as these products were not used and expired. (TABLE 1)

Conclusions: Analysis of the data revealed significant reduction in component product usage and wastage post implementation of each Phase of the MTP LTOWB process change. These reductions have resulted in an overall cost savings for the hospital of approximately $572,000 or 51% of total product usage and wastage from the Original MTP process to the Phase 2 process

Importance of research: Importance of the Research: Massive transfusions can often result in large amounts of blood product usage and wastage, not thought about during life-saving situations. It is important for hospital transfusion services to evaluate the amount of blood products and cost associated with massive transfusion protocols. Sharing the outcome of these studies provide other hospital transfusion services the opportunities to evaluate their massive transfusion procedures.