Is Platelet Expiring Out of Date? A Systematic Review

Flint, Andrew W. J.; McQuilten, Zoe; Irwin, Gregory; Rushford, Kylie; Haysom, Helen E; Wood, Erica M.

doi:10.1016/j.tmrv.2019.08.006

Cited by 20 publications

(16 citation statements)

References 40 publications

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“…A recent review of modelling of perishable blood product inventory, in that case platelets, notes that many modelling methods have been attempted. 12 Our future work will concentrate on a deeper level of analysis and modelling for our situation. In particular: ► Analysis of demand:…”

Section: Discussionmentioning

confidence: 99%

Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients

et al. 2021

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Recent research demonstrates that transfusing whole blood (WB=red blood cells (RBC)+plasma+platelets) rather than just RBC (which is current National Health Service (NHS) practice) may improve outcomes for major trauma patients. As part of a programme to investigate provision of WB, NHS Blood and Transplant undertook a 2-year feasibility study to supply the Royal London Hospital (RLH) with (group O negative, ‘O neg’) leucodepleted red cell and plasma (LD-RCP) for transfusion of trauma patients with major haemorrhage in prehospital settings.Incidents requiring such prehospital transfusion occur randomly, with very high variation. Availability is critical, but O neg LD-RCP is a scarce resource and has a limited shelf life (14 days) after which it must be disposed of. The consequences of wastage are the opportunity cost of loss of overall treatment capacity across the NHS and reputational damage.The context was this feasibility study, set up to assess deliverability to RLH and subsequent wastage levels. Within this, we conducted a quality improvement project, which aimed to reduce the wastage of LD-RCP to no more than 8% (ie, 1 of the 12 units delivered per week).Over this 2-year period, we reduced wastage from a weekly average of 70%–27%. This was achieved over four improvement cycles. The largest improvement came from moving near-expiry LD-RCP to the emergency department (ED) for use with their trauma patients, with subsequent improvements from embedding use in ED as routine practice, introducing a dedicated LD-RCP delivery schedule (which increased the units ≤2 days old at delivery from 42% to 83%) and aligning this delivery schedule to cover two cycles of peak demand (Fridays and Saturdays).

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Section: Discussionmentioning

confidence: 99%

Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients

et al. 2021

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“…Numerous hospitals have applied interventions to change the ordering system, apply the "order-up-to" rule, inform daily PLT discard status, and facilitate exchanges between local hospitals to reduce PLT discard rates owing to expiration. As a result, PLT discard due to expiration has decreased, depending on the hospitals [5]. In hospitals that use the "order-up-to" rule and the "automatic dashboard" (a program that monitors the hospital's PLT inventory and patients' PLT orders), the PLT discard rate decreased after using the dashboard, and the mean PLT age at transfusion decreased from 3.60 days before dashboard use to 3.46 days after dashboard use (approximately 3.4 hours) [6].…”

Section: Discussionmentioning

confidence: 99%

“…Maintaining adequate PLT supply to meet demands is hindered by the short shelf life of PLTs. Additionally, PLT discard rate needs to be reduced to prevent resource waste and patient endangerment owing to PLT deficiency [4,5]. Numerous efforts-"up-to-order" rule, automatic dashboard, cooperation with blood supplier, etc.-have been made to reduce PLT discard rates by as much as 1-5% [1,4,6,7]; however, PLT expiration continues to be an important cause of PLT discard [5].…”

Section: Introductionmentioning

confidence: 99%

Platelet Inventory Management Program: Development and Practical Experience

Lee

et al. 2021

Ann Lab Med

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Background Patients with ongoing or expected bleeding require platelet (PLT) transfusions; however, owing to the testing required after a blood donation, manufacturing PLT products may take 1.5–2.0 days after a request is made. This supply-demand mismatch leads clinicians to retain spare PLTs for transfusions, leading to increased PLT discard rates. We developed a PLT inventory management program to supply PLTs more efficiently to patients requiring PLT transfusions within the expiration date, while reducing PLT discard rates. Methods PLT concentrates (58,863 and 58,357 units) and apheresis products (7,905 and 8,441 units) were analyzed from May 2015 to November 2017 and from December 2017 to January 2020, respectively. We developed a program to manage total PLT inventories and prospective PLT transfusion patients based on blood type, blood product, and remaining period of efficacy; the program facilitates PLT preparation transfer to non-designated patients within the remaining period of efficacy. Results The overall PLT concentrate discard rate was 3,254 (2.78%): 1,811 (3.07%) units before and 1,443 units (2.41%) after program application ( P <0.001). The discard rate owing to expiration was reduced from 69 units (3.81%) before to two units (0.14%) after program application ( P <0.001). Conclusions This program can guide the allocation of PLT preparations based on the remaining period of efficacy, enabling PLT products to be used before their expiration date and reducing PLT product discard rate.

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“…Currently, the source of PLTs comes uniquely from donations. The half-life of PLTs is short, thus their storage time or shelf life is limited to a few days [9]. They are generally stored shaking at room temperature in order to prevent loss of PLT functional integrity, which also poses a risk of bacterial or viral contamination [10,11].…”

Section: Background: Platelet Transfusion Over the Yearsmentioning

confidence: 99%

On the Quest for In Vitro Platelet Production by Re-Tailoring the Concepts of Megakaryocyte Differentiation

et al. 2020

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The demand of platelet transfusions is steadily growing worldwide, inter-donor variation, donor dependency, or storability/viability being the main contributing factors to the current global, donor-dependent platelet concentrate shortage concern. In vitro platelet production has been proposed as a plausible alternative to cover, at least partially, the increasing demand. However, in practice, such a logical production strategy does not lack complexity, and hence, efforts are focused internationally on developing large scale industrial methods and technologies to provide efficient, viable, and functional platelet production. This would allow obtaining not only sufficient numbers of platelets but also functional ones fit for all clinical purposes and civil scenarios. In this review, we cover the evolution around the in vitro culture and differentiation of megakaryocytes into platelets, the progress made thus far to bring the culture concept from basic research towards good manufacturing practices certified production, and subsequent clinical trial studies. However, little is known about how these in vitro products should be stored or whether any safety measure should be implemented (e.g., pathogen reduction technology), as well as their quality assessment (how to isolate platelets from the rest of the culture cells, debris, microvesicles, or what their molecular and functional profile is). Importantly, we highlight how the scientific community has overcome the old dogmas and how the new perspectives influence the future of platelet-based therapy for transfusion purposes.

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Is Platelet Expiring Out of Date? A Systematic Review

Cited by 20 publications

References 40 publications

Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients

Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients

Platelet Inventory Management Program: Development and Practical Experience

On the Quest for In Vitro Platelet Production by Re-Tailoring the Concepts of Megakaryocyte Differentiation

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