(P-PB-3) Implementing Plasma and Platelet Transfusion Thresholds as Part of a Patient Blood Management Program to Improve Blood Product Utilization at an Academic Medical Center

Background/Case Studies:
Patient Blood Management (PBM) programs aim to optimize patient care with evidence-based transfusion practices focused on improving patients’ blood health. Although red blood cell (RBC) transfusions are most commonly studied, opportunities for improvement also exist in optimizing plasma and platelet use. This study describes the implementation of a PBM initiative focused on plasma and platelet utilization at a large academic medical center, building upon established PBM principles. The goal was to create a sustainable process to reduce inappropriate plasma and platelet transfusions through a data-driven, multidisciplinary approach.

Study

Design/Methods:
The PBM team designed a structured process including:

1) Comprehensive data acquisition which includes pre-transfusion laboratory values, ordering physician ID, transfusion time and location.

2) Formation of a multidisciplinary team with representatives from high-utilization areas to discuss clinical needs and establish consensus transfusion thresholds, including a hospital-wide International Normalized Ratio (INR) value for plasma transfusion and specific platelet count thresholds for various clinical indications.

3) Development and implementation of Clinical Decision Support (CDS) within the Electronic Health Record (EHR).

4) Establishment of provider feedback mechanisms, including weekly reports on potentially avoidable transfusions shared with clinical unit representatives.

Results/Findings:
A comprehensive PBM framework focused on plasma and platelet transfusion was established. After formation of a multidisciplinary team, a consensus for transfusion thresholds was established, including a hospital-wide INR value of ≥2.0 for plasma transfusions and platelet count thresholds tailored to clinical scenarios. A prototype CDS tool was designed and is pending full implementation.



Preliminary analysis of transfusion practices revealed that 69 plasma units per quarter were administered at INR values < 2.0, with an estimated annual cost of $41,400. Similarly, 31 platelet transfusions per quarter occurred at platelet counts >100K/μL, with an estimated annual cost of $124,000. These findings suggest substantial opportunity to reduce avoidable transfusions and associated costs.

Conclusions:
This structured, data-driven PBM intervention demonstrates the feasibility of building a sustainable system to improve plasma and platelet transfusion practices. Consensus-based thresholds, and enhanced data infrastructure represent significant progress toward reducing avoidable transfusions. Ongoing implementation of INR- and clinical scenario-based CDS along with provider feedback will aid in education of PBM best practices and facilitate durability of the intervention. This approach not only supports safer and more effective patient care but also serves as a replicable model for institutions seeking to extend PBM impact beyond RBCs.