Background/Case Studies: In 2022, several locations in our Level I trauma hospital had a large increase in platelet (PLT) transfusions, when compared to pre-COVID (2018) transfusions. This strained daily PLT inventory and instigated investigation into the causes.
Study
Design/Methods: PLT transfusions, census, and data on number of patients undergoing extracorporeal membrane oxygenation (ECMO) in 2022 versus 2018 were examined. Transfusions were separated by location to confirm high use areas; medical directors and nursing staff in those locations were surveyed online (Qualtrics, Seattle, WA) about the cause of increased transfusions.
Results/Findings: Three hospital locations (pediatric intensive care unit [Peds ICU], medical ICU [MICU], cardiac ICU [Cards ICU]) had large increases in PLT transfusions in 2022 vs. 2018 (Table 1). None of these 3 locations demonstrated an increase in census; however, a fourth location (liver ICU) did have a large increase (42%, 12.6 patients per day in 2022 vs. 8.9 in 2018) in census. Survey results from these 4 areas indicated the perceived reasons for increased PLT transfusions were sicker patients, increased ECMO utilization, and increased census. Data demonstrated a 37% increase in ECMO patients in 2022 vs. 2018 (191 vs. 139 patients) as well as a 2-fold increase in the number of ECMO days (2447 days vs. 1094). ECMO days were defined as number of days each patient was on ECMO; a high number can represent a patient on ECMO for a long duration, a large number of ECMO patients or a combination of both. ECMO patients were primarily located in the pediatric, medical and cardiac ICUs. The average number of PLT transfusions per patient increased in the Peds, MICU and cards ICUs. The liver ICU had a smaller increase in number of transfusions per patient. Conclusions: In 2022, our center saw an increase in ECMO patients, ECMO days, PLT transfusions per patient in ICUs housing ECMO patients, and daily patient census in the liver ICU compared to the pre-COVID baseline (2018). Additionally, a mobile ECMO program to transport patients from lower acuity facilities to our institution was started in 2018 and continued to grow through 2022, likely contributing to the increase in ECMO patients. These data are consistent with the clinical survey indicating that increased census, ECMO patients and sicker patients accounted for the increase in PLT transfusion. Understanding these causes led us to increase daily PLT inventory levels through donor recruitment/collection and platelet purchases from outside blood suppliers to meet the needs of our changing patient population.
Importance of research: COVID pandemic presented significant challenges to blood inventory levels during the height of the pandemic. However, our institution has seen increases in transfusions after the height of the pandemic and investigation into the causes may help others address the same issue at their institution.
