Profiling Clinical Platelet and Plasma Use To Inform Blood Supply and Contingency Clanning: Puppy, The Prospective Utilization Of Platelets and Plasma Study
Authors: Polizzotto Mark N. , Grigoriadis George , Waters Neil , Comande Mary , Borosak Marija , McQuilten Zoe K. , Wood Erica M. 
Published: October 2019

Abstract

Background
Meeting clinical requirements for platelets and plasma requires an understanding of usage, in order to plan for evolving demand and ensure supply in emergencies. Current strategies to ensure availability during increased demand or blood shortages include triaging by restricting supply to clinically urgent cases or deferring elective surgery. However, few data regarding urgency of need for different clinical indications are available. We developed a novel approach to clinical profiling of platelets and plasma to inform supply and contingency planning.

Methods
We conducted a random sample survey of platelet and plasma units in the Australian state of Victoria (population 5.3 million). The Australian Red Cross Blood Service produces and distributes all platelets and plasma for the state at a single site. Randomly selected units were tagged with a case report form (CRF) during production and distributed as usual. Institutional blood bank scientists completed the CRF when tagged units were issued for transfusion, reporting recipient demographics, clinical indication for transfusion, and transfusion urgency. Units were tagged over 12 months to minimize seasonal fluctuations.

Results
1252 platelet units were tagged: 752 pooled (60%) and 500 apheresis units (39.9%). This represented 7.6% of issues during the study period (7.4% of pooled and 8.0% of all apheresis platelets). The fate of 1243 platelet units was determined (99.3%). Of these, 94 (7.6%) were discarded during production before issue and were excluded from analysis. 1885 plasma units were tagged, representing 9.6% of units issued. The fate of 1808 units was determined (95.9%).
Transfusion rate for issued platelets was 72.2% (830 units); 71.2% of pooled and 73.7% of apheresis platelets were transfused. Common reasons for discard were expiry (300 units, 26.1%); recall (5, 0.4%), commonly for bacterial flags; and other (14, 1.2%).
Transfusion rate for issued plasma was 87.8% (1587 units). Common reasons for discard were were expiry (48 units, 2.7%), recall (3, 0.2%) and other reasons including breakage and unit thawed but not used (170, 9.4%). Median age of platelets recipients was 58 years (range 0–99); 60.6% were male; for plasma recipients median age was 51 (0-98); 64.1% were male.
For platelets, the clinical urgency of transfusion was reported to be acute (required within one hour) in 126 cases (15.2%); urgent (required within 24h) 527 (63.5%); semi-urgent (required within one week) 130 (15.7%); non-urgent 2 (0.2%); unreported 45 (5.4%). The most common indications for platelet transfusion were hematological and oncological, together 64% of cases (530 units), comprising acute leukemias 260 (31.3%); lymphoma 59 (7.1%); myeloma 35 (4.2%); non-hematologic malignancies 68 (8.2%). Surgical conditions followed: 25.1% (208) of cases, comprising cardiothoracic 91 (11.0%); urological 30 (3.6%); gastrointestinal 18 (2.2%) and solid organ transplantation 16 (1.9%). Clinical condition was not reported in 40 (4.8%). Only 66 platelet units (7.9%) were transfused to support elective surgery.
For plasma, urgency was reported as acute in 566 (35.7%), urgent in 857 (54.0%); semi-urgent in 84 (5.3%) and non-urgent in 13 (0.8%) and unreported in 67 (4.2%). The most common indications for plasma transfusion were surgical: cardiothoracic 249 cases (15.7%); vascular 87 (5.5%); gastrointestinal 58 (3.7%); orthopedic 29 (1.8%). Others included hematology (234 cases, 14.7%), mainly to support TTP patients (139, 8.8% of total); gastroenterology (227, 14.3%), mainly to support chronic liver disease patients (114, 7.2% of total) and trauma (104, 6.6%). Across all areas, 168 plasma units (18.9%) were transfused to support elective surgery and 179 (11%) to reverse warfarin.

Conclusions
The high levels of urgent transfusion and low proportion of platelets and plasma used in elective surgery seen here suggest that in a shortage conventional triage strategies would have little impact on demand. Clinical platelet and plasma usage is highly concentrated in specialized areas, predominantly to support patients with hematologic and malignant disorders, those undergoing major non-elective surgery, and the critically ill. Changes in demand or clinical practice in these areas may have substantial effects on requirements. Additional strategies are required to ensure continued adequacy of supply during blood shortages or demand fluctuations.

Disclosures:
No relevant conflicts of interest to declare.