Changes in plasma unit distributions to hospitals over a 10‐year period

Seheult, Jansen N.; Shaz, Beth H.; Bravo, Marjorie; Croxon, Harry; Devine, Dana V.; Doncaster, Cheryl; Field, Stephen; Flanagan, Peter; Germain, Marc; Grégoire, Yves; Kamel, Hany; Karafin, Matthew S.; Kelting, Nancy; Lewis, Marc S.; O'Brien, Cath; Murphy, Michael; Rossmann, Susan N.; Sayers, Merlyn; Shinar, Eilat; Takanashi, Minoko; Titlestad, Kjell; Yazer, Mark H.

doi:10.1111/trf.14526

Cited by 7 publications

(8 citation statements)

References 24 publications

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“…Similarly, although the quantity of transfused plasma continues to decrease, the proportion that is group AB increased. This observation has also been reported in other countries . The proportional increase might be attributable to massive transfusion protocols which require an available reserve supply of thawed plasma, which is often group AB plasma reserved for potential recipients with unknown ABO type …”

Section: Discussionsupporting

confidence: 73%

“…48 The proportional increase might be attributable to massive transfusion protocols which require an available reserve supply of thawed plasma, which is often group AB plasma reserved for potential recipients with unknown ABO type. 48 During 2017, the majority of PLT units were transfused 4-5 days after collection. This contrasts with 2015, when the majority of PLT units were transfused ≤3 days after collection.…”

Section: Inventorymentioning

confidence: 99%

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Supplemental findings of the 2017 National Blood Collection and Utilization Survey

et al. 2020

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INTRODUCTION This report provides supplemental results from the 2017 National Blood Collection and Utilization Survey on characteristics of the donor population, autologous and directed donations and transfusions, platelets, plasma and granulocyte transfusions, pediatric transfusions, severe donor‐related adverse events, cost of blood units, hospitals policies and practices, and inventory, dosing, and supply. METHODS Weighting and imputation were used to generate national estimates including number of donors, donations, donor deferrals, autologous and directed donations and transfusions, severe donor‐related adverse events, platelet and plasma collections and transfusions, number of cross‐match procedures, irradiation and leukoreduction, and pediatric transfusions. RESULTS Between 2015 and 2017, successful donations decreased slightly by 2.1% with a 10.3% decrease in donations by persons aged 16‐18 years and a 14.4% increase in donations by donors aged >65 years. The median price paid for blood components by hospitals decreased from $211 to $207 for leukoreduced red blood cell units, from $523 to $517 for leukoreduced apheresis platelet units, and from $54 to $51 for fresh frozen plasma units. Plasma transfusions decreased 13.6%, but group AB plasma units transfused increased 24.7%. CONCLUSION Between 2015 and 2017, blood donations declined slightly because of decreases in donations from younger donors, but the number of donations from older donors increased. The price hospitals pay for blood has continued to decrease. Plasma transfusions have decreased, but the proportion of plasma transfusions involving group AB plasma have increased.

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Section: Discussionsupporting

confidence: 73%

Section: Inventorymentioning

confidence: 99%

Supplemental findings of the 2017 National Blood Collection and Utilization Survey

et al. 2020

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“…Group AB plasma has traditionally been considered the ‘universal donor’ plasma product, analogous to group O red cells. However, it is a scarce resource that has been in increasing demand, placing strain on blood donors and suppliers, which prompts the need for quality improvement initiatives to improve on its usage (Seheult et al ., ). Our study developed the use of the ABAI as a KQI to assess group AB plasma utilisation, which suggested inappropriate use and justified the need for intervention.…”

Section: Discussionmentioning

confidence: 97%

“…A recent study of blood product utilisation demonstrated that plasma transfusion represents approximately half of blood products used during MTPs (Dunbar et al ., ). Blood centres worldwide have observed a relative increase in the proportion of AB plasma used despite an overall decrease in plasma units distributed over the last decade (Seheult et al ., ). An international study also demonstrates that the majority of AB plasma is administered to non‐group AB patients, mostly in settings where acutely bleeding patients are managed (Zeller et al ., ).…”

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confidence: 97%

Reducing AB plasma utilisation through the AB plasma appropriateness index

Khan

Rosinski

Petraszko

et al. 2019

Transfusion Medicine

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Objectives:We hypothesised that there was inappropriate group AB plasma used in our hospital, identifiable by a novel key quality indicator (KQI) and mitigable through massive transfusion protocol (MTP) modification.Background: Group AB plasma is a scarce resource strained by increasing usage worldwide when used as universal donor plasma in non-group AB patients. To reduce inappropriate use and to promote benchmarking to the best practice, we developed the AB plasma appropriateness index (ABAI). ABAI is the ratio of AB plasma transfused to group AB or unknown blood group patients to all AB plasma utilised, where values closer to 1 are better.Methods: Data collected included AB plasma disposition by blood group, indications for transfusion, total blood utilisation, patient clinical characteristics and outcomes. ABAI during a 12-month period was retrospectively assessed, which led to implementation of pre-thawed group A plasma instead of group AB plasma for trauma patients starting in July 2017. Results:The ABAI retrospectively showed inappropriate use in non-group AB patients in our hospital, the majority used to avoid expiry after thaw. When comparing 1-year pre-and post-implementation periods, ABAI improved from 0·464 to 0·900 (P < 0·0001). After exclusion of therapeutic plasma exchange, ABAI still improved (0·486-0·720, P < 0·0001). No differences in the length of stay or mortality associated in 32 patients receiving group A plasma for emergency release were observed. Conclusion:The ABAI is a novel KQI to indicate inappropriate AB plasma usage for quality improvement. This led to thawed A plasma use for MTPs, reducing inappropriate AB plasma usage.

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“…Additionally, the uniform method did not reduce the interlaboratory titer variability in comparison to other methods per College of American Pathologists proficiency testing. Finally, various thresholds for what is considered a “high” titer for plasma‐containing products have been reported . Thus, the goals of this study were to survey the titer testing methods, the definitions of high‐titer antibodies that are currently in use, and the blood products being tested for high‐titer antibodies, and to elucidate the prevalence of high‐titer units that are identified using the local definition.…”

mentioning

confidence: 99%

Seasonal variability is not observed in the rates of high anti‐A and anti‐B titers in plasma, apheresis platelet, and whole blood units tested by different methods

et al. 2018

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BACKGROUND: ABO-incompatible platelet transfusions are common, and transfusions with ABOincompatible plasma are increasing with the use of group A plasma and group O whole blood (WB) in emergencies. Many centers screen blood products for anti-A and/or anti-B titers to help prevent hemolysis from ABO-incompatible transfusions, yet titer methods and definition of high titers are not standardized. STUDY DESIGN AND METHODS: This internationalmulticenter study collected data on anti-A and anti-B titer practices for plasma, apheresis platelet (AP), and WB units from January 2015 through December 2017 to determine the prevalence of high-titer units using local definitions. RESULTS:A total of 87,701 plasma, AP and WB units were screened for high-titer anti-A and/or anti-B. Hightiter detection rates for group A plasma ranged 0%-13.6%; group A AP 2.7%-9.3%; group O AP 2.3%-65.7%; and group O WB 6.4%-20.7%. At the one center that collected group B AP, the high-titer rate was 10.9%. High-titer rates varied from month to month, as well as between years for a given month. There was no clear pattern of when high-titer units were donated. CONCLUSION:The prevalence of high-titer plasma, AP, and WB units varies by titer method and local definition of high titer. Even at the lowest titer threshold of 50, a significant proportion of units had a high-titer antibody, although the clinical relevance of this finding needs further investigation. P latelet transfusions containing incompatible plasma are common practice in the United States, yet plasma transfusions have historically been provided in a strictly ABO-compatible manner. Recent transfusion and resuscitation practices have incorporated the use of group A plasma and group O whole blood (WB) to recipients of unknown blood group in bleeding emergencies, thereby creating situations in which an ABO incompatibility might exist. 1,2 ABBREVIATIONS: AHG = anti-human globulin; AP = apheresis platelet; WB = whole blood.From the

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Changes in plasma unit distributions to hospitals over a 10‐year period

Abstract: Although the number of plasma unit distributions has decreased at many blood collectors over time, the proportion of AB units has increased at both ABCs and NPBS.

Cited by 7 publications

References 24 publications

Supplemental findings of the 2017 National Blood Collection and Utilization Survey

Supplemental findings of the 2017 National Blood Collection and Utilization Survey

Reducing AB plasma utilisation through the AB plasma appropriateness index

Seasonal variability is not observed in the rates of high anti‐A and anti‐B titers in plasma, apheresis platelet, and whole blood units tested by different methods

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