Reducing AB plasma utilisation through the AB plasma appropriateness index

Abstract

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.

Rejuvenated and safe: Freeze‐dried plasma for the 21st century

“…In Canada, audits have shown that AB plasma is often thawed for massive hemorrhage protocols, but as it gets closer to outdate, it is used for patients who do not require AB plasma in order to avoid wastage of the thawed product. This approach contributes to the wastage of a limited resource by a ‘flow through’ process 25,26 …”

“…This approach contributes to the wastage of a limited resource by a 'flow through' process. 25,26 Development of novel FDP products-and of many medical innovations-has been delayed by the COVID-19 pandemic. Sheffield et al took advantage of the availability of COVID-19 convalescent plasma to test the reasonable but previously untested assumption that IgG activity in plasma would be conserved after freeze-drying.…”