Development and performance characteristics of Platelet Virtual Crossmatch (PLT VXM), a software application for the evaluation and management of platelet transfusion–refractory patients

Abstract

Background: Platelet (PLT) transfusion refractoriness increases bleeding complications, hospital stays, and PLT inventory usage. Immune-mediated refractoriness can be evaluated for using a physical PLT crossmatch with ABO-compatible inventory and, if positive, managed with HLA-compatible PLT inventory and donors. Manual completion of these complex tasks can be time-consuming and potentially error-prone. This study was conducted to determine if a Web-based software application could improve process efficiency and accuracy. Study Design and Methods: Workflow analysis was performed to identify process, data, and analytic requirements for a software application for three PLT transfusion-refractoriness associated tasks: (a) physical PLT crossmatch inventory selection, (b) HLA-compatible inventory selection, and (c) HLAcompatible donor selection. After software application development, a comparison study was performed over 10 consecutive days, with each task performed manually and with the software application (Platelet Virtual Crossmatch [PLT VXM]) for a different unique immune-mediated PLT transfusion-refractory recipient. Task completion time, number of incompatible units/donors presented, and number of documentation errors were compared. Results: PLT VXM is a Web-based software application developed using R and the Shiny Web application framework. PLT VXM significantly reduced median task completion times by 4.5 (49%), 11.2 (79%), and 59.1 minutes (94%), respectively. PLT VXM did not present any incompatible PLT units or donors for user consideration. PLT VXM also had a lower number of documentation errors than the manual process, and none of these documentation errors were software generated. Conclusion: Computer-aided evaluation and management of immunemediated PLT transfusion-refractory recipients can significantly improve workflow and reduce manual errors in this complex process.

How do we leverage data through replication and warehousing to meet blood collection and transfusion service needs

“…7 By leveraging replicated blood collection, transfusion service, and EHR data, the Platelet VXM application integrates donor, platelet unit, and intended recipient data with user-defined settings (e.g., HLA antibody strength cutoff) to present HLAcompatible platelet inventory or donors for consideration. 8 This workflow is not supported within the local BECS but is possible using replicated data from those same systems. The final use case for data replication is the creation of data warehouses (data marts) to serve up highly curated data for easy consumption by frontline clinical and business staff.…”

“…Use cases for data replication. (A) O Cell ReAllocation Project data visualization tool demonstrating data replication to optimize business reporting; (B) patient Blood Management data visualization tool demonstrating data replication to combine data from different information system sources; (C) platelet VXM software application demonstrating data replication to supplement clinical applications 8 . Part figure C used with permission of John Wiley & Sons, Inc. [Color figure can be viewed at wileyonlinelibrary.com]…”

“…In this setting, selecting existing platelet inventory or recruiting platelet donors compatible with a patient's HLA antibody repertoire leads to more effective platelet transfusions 7 . By leveraging replicated blood collection, transfusion service, and EHR data, the Platelet VXM application integrates donor, platelet unit, and intended recipient data with user‐defined settings (e.g., HLA antibody strength cutoff) to present HLA‐compatible platelet inventory or donors for consideration 8 . This workflow is not supported within the local BECS but is possible using replicated data from those same systems.…”