Executive Physician Director, Therapeutic & Cellular Solutions American Red Cross Baltimore, Maryland, United States
Background/Case Studies: Pathogen-Reduced Platelets (PR-PLT), licensed for 5 days in the US, are stored for up to 7 days in Europe. Our 500-bed Hospital experienced critical acute-on-chronic platelet shortages during the 2022 holiday season that necessitated extreme inventory management measures. Our transfusion service extended PR-PLT shelf life (off-label) to Day 6 as practice of medicine, to assure patient access to an adequate supply of PR-PLT during recurring acute-on-chronic shortages.
Study
Design/Methods: Two periods were studied: Aug 2022–Dec 2022 (TEST) and Aug 2021– Dec 2021 (CONTROL). All patients receiving platelets during the 2 time periods were studied. No extended platelets were produced during the CONTROL period. To extend to Day 6, our SOP required that PR-PLTs be Gram-stained by midnight on storage Day 5. Gram stain negative, PR-PLTs, re-labeled to expire on Day 6, were issued after Blood Bank MD approval. During Aug 2022-Dec 2022, 62 recipients received 90 extended PR-PLTs. Their charts were subsequently audited for RBC use, for additional platelet transfusions, and report of a transfusion reaction, all within 48h following an extended index PR-PLT transfusion. Data analysis used unpaired two-tailed t-tests; significance was p< 0.05. As a QC audit, IRB approval was not sought; data was anonymized.
Results/Findings: During Aug-Dec 2022, a total of 236 PR-PLTs were Gram-stained and extended for 1 additional storage day; 90 extended units were transfused to 62 patients. Within 48h of an extended PR-PLT index transfusion, 37 of the 62 patients (60%) additionally received an average (±1SD, range) of 0.85 (±1.0, 0-4) RBC units, and/or 0.76 (±0.74, 0-3) platelet units. These results are similar to reported literature values. All Gram-stains were reported as ‘no organisms seen’. See Table 1. Conclusions: Extending PR-PLTs to Day 6 storage during times of platelet insecurity, is safe and effective. Availability of extended PR-PLTs during acute-on-chronic platelet shortages, provides a critical supplemental platelet supply needed for patient care, that otherwise would not be available
Importance of research: Blood Bank Directors routinely manage platelet inventory shortages. With acute-on-chronic shortages, inventory controls include: communicating with clinical services, enforcing transfusion triggers, auditing product orders, and use of partial doses. We describe our experience to additionally use 1 Day extended off-label Pathogen Reduced-Platelets, stored to Day 6. Clinical outcomes of such actions must be audited and may be needed more often as platelet insecurity will likely remain a concern.
