Optimizing O‐negative RBC utilization using a data‐driven approach

Abstract

BACKGROUND O‐negative red blood cells (ON‐RBC) are a precious resource and the international blood banking community has become increasingly concerned with its inappropriate utilization. AABB recently made several recommendations to address the issue. Solutions must be multifaceted and involve donor centers, blood banks, and clinical departments. From the perspective of a hospital blood bank, it is difficult to rely solely on increased donor recruitment and ubiquitous blood typing of the entire in‐patient population. We therefore focused on interventions within the blood bank to optimize inventory and policies to ensure appropriate ON‐RBC utilization. STUDY DESIGN AND METHODS Transfusion data over one year was examined for the rate of out‐of‐group/inappropriate ON‐RBC. Furthermore, we assessed whether that rate was related to product life on the day of transfusion. We also examined our stock inventory levels and how excess inventory can contribute to inappropriate ON‐RBC usage. RESULTS The ON‐RBC inventory level was decreased in order to reduce the rate of inappropriate transfusions while maintaining a safe level for optimal patient care. Compared to baseline, our intervention caused ON‐RBCs to be transfused earlier in their shelf‐life (9.27 vs. 11.15 days from expiration [DFE], p = 0.0012). This reduced the overall rate of inappropriate ON‐RBC transfusions (67% vs. 54%, p = 0.0035), approximating 185 units of ON‐RBC saved over the course of 6 months. CONCLUSIONS A data‐driven approach to optimize stock inventory levels is widely applicable; it can be adopted by numerous institutions to improve utilization and establish a benchmark for the broader blood banking community.

Analysis of red blood cell irradiation practices from South India

“… RBC age: Days to irradiation from collection date Days from expiry (DFE): Subtracting transfusion date from the expiration date[ 10 ] Late transfusions: Units transfused in the past 2 weeks of RBC's shelf-life Percentage of irradiated RBC issued out of the group Percentage of irradiated RBC issued for nonhemato-oncology patients. …”

Use of O RhD‐negative red blood cells: A nationwide, prospective audit

“…By far, the most common reason for issuing an O RhD-negative unit to a non-O RhD-negative patient was inventory management: A third (33%) of all O RhD-negative units issued to non-O RhD-negative patients were issued purely to prevent outdating, mostly for non-urgent care in regular hospital wards. Other studies have also identified inventory management as a frequent cause of unnecessary use of O RhD-negative RBCs [2,3,5,7]. Understandably, to ensure patient safety in a country where geographical distances are a major issue, many remote blood banks wish to stock enough O RhD-negative units.…”

“…Worldwide, the use of red blood cells (RBCs) is decreasing as clinicians increasingly adopt patient blood management principles and follow restrictive transfusion guidelines. Simultaneously, demand for O RhD-negative units has increased, and the proportion of transfused O RhD-negative units is generally up to twice as high as the proportion of the O RhD-negative blood group in the population [1][2][3][4][5]. Problems in recruiting enough O RhD-negative donors from an ageing donor population are universal, and the overutilization of O RhD-negative RBCs leads to supply shortages [3] and ultimately to situations where O RhD-negative RBCs are not available to patients who need them [6].…”

“…Furthermore, smaller or remote hospitals may simply lean their inventory management by storing only O RhD-negative units compatible with any patient. Therefore, one-to two-thirds of O RhD-negative RBCs are transfused to patients of other blood groups [2,[5][6][7].…”

“…Too small an inventory may set O RhD-negative patients and those females of childbearing age in need of emergency transfusion at risk of RhD immunization, and too large an inventory may lead to transfusion of O RhD-negative units to patients of other blood groups to avoid wastage. Indeed, an important factor driving the use of O RhD-negative RBCs seems to be transfusion near the expiry date solely for stock management purposes [5,7]. In their 2019 recommendation on the use of group O red blood cells, Association for the Advancement of Blood & Biotherapies (AABB) called for transfusion services to monitor and audit the utilization of group O red blood cells to limit the unnecessary use of O RhD-negative RBCs [4].…”