(P-PB-4) Minimizing Wastage for Good Platelet Stewardship, It Is All About the Numbers

Background/Case Studies: Due to short shelf-life of platelets cost and wastage remain concerns.

Study

Design/Methods: The problem was defined at this 5-hospital center by calculating total platelets received by product code, ABO, and available shelf life (date/time product scanned into inventory to expiration); and by determining total number of products wasted (reserved for a patient but not used) by product code and ABO. To forecast platelet demand: total number of platelets transfused was subdivided by product code, ABO, location, and date of transfusion. Platelets used were large volume delayed sampling at 48 hours (48-LVDS) maximum usable shelf life 4.5 days, 36-hour LVDS maximum usable shelf life 3.0 days, pathogen reduced (PR) maximum usable shelf life 4.5 days and whole blood-derived (WBD) platelet pools. The study was for the entire 2024.

Results/Findings: In 2024 this cancer center received 16,787 platelets: 8,420 (50.2%) 48-LVDS, 5,215 (31.1%) PR, 3,028 (18.0%) WBD, 124 (0.7%) 36-LVDS which were group: O 40%, A 41%, B 12%, AB 7%. Mean usable shelf life was: 48-LVDS 80.8 hours, 3.4 days, PR 67.6 hours, 2.8 days, WBD 63.4 hours, 2.6 days, 36-LVDS 56.6 hours, 2.4 days. Mean usable shelf life varied by blood center. (Table 1) There were 13,667 platelets transfused: 7,045 (52%) 48-LVDS, 3,826 (28%) PR, 2,631 WBD (19%), 165 (1%) 36-LVDS, ABO was 39% O, 42% A, 12% B, 7% AB. Five locations transfused 5,954 (43.6%) platelets. Platelet transfusions varied by day of week with most on Tuesdays and Fridays (mean 2,027/year) and least on weekend (mean 1,007/year). There were 1,438/16,787 (8.6%) platelets wasted. This varied by product: 48-LVDS 729/8,420 (8.7%), PR 560/5,215 (10.7%), WBD 139/3,028 (4.6%), 36-LVDS 10/124 (8.1%) and blood type: O 51%, A 30%, B 14%, AB 5%. Cost of platelet wastage was $991,320 US dollars: 48-LVDS, $481,140; PR $414,400, WBD $88,890, and 36-LVDS $6,890.

Conclusions: At this institution, mean usable shelf life of platelets was greater than 1 day less than maximum. Almost one in ten platelets was wasted with group O highest. Mitigation strategies based on usage of 13,140 platelets/year included changing the platelet mix to 9,855 (75%) PR, 1,971 (15%) 48-LVDS, 657 (5%) 36-LVDS, and 657 (5%) WBD. Top five transfusion locations notified transfusion service of scheduled platelet transfusion allowing lower inventory levels. Standing orders were adjusted to receive more platelets on days of highest use (Tuesday and Friday). Prioritizing PR usage minimized wastage of the highest cost product. Pilot titer testing for group O platelets maximizes use in incompatible patients. Product sharing among the hospitals was optimized. Reducing target wastage to 2% results in cost savings of $802,523. Reliable numbers (data) allowed for reduction in platelet wastage, cost savings, good stewardship of a donated product and ultimately benefiting the patient.