(P-PB-1) Decrease Ordering of HLA Matched Platelet Products

Background/Case Studies: Our hospital site is part of a larger Midwest hospital system but is the site where the Hematopoietic Progenitor Cell (HPC) transplant program is focused. Because of this focus, the majority of HPC transplant patients are treated at our hospital location. Platelet support for HPC transplant patients routinely includes the availability of Human Lymphocyte Antigen (HLA) matched platelet products. Historically there were little or no restrictions for which patients could receive these types of products. The lack of restrictions led to the routine ordering of HLA matched platelet (PLT) products with no understanding if the patient truly requires HLA matched PLTs or if there was another reason for the PLT refractoriness.

Study

Design/Methods: PLT product ordering was reviewed to determine the number of HLA matched PLT products that have been ordered over time. The HLA PLT orders were matched with the number of patients receiving a transplant. The site also looked at the changes that were occurring in the Transfusion Service (TS) Supervisor position. There had been a change in the Supervisor position 3 times in the past 3 years.

Results/Findings: The HLA PLT ordering jumped up and down during previous Supervisor tenure but dropped dramatically when the most recent Supervisor took the position. This individual saw that there was high usage with no testing to show that the patients had HLA antibodies present. The TS team was instructed to request a Panel Reactive Antibody (PRA) test to verify if HLA antibodies were present rather than just honor all HLA PLT requests. Additionally, as of March 2025 a new PLT Refractory order set was created that helped physicians automatically order the PRA testing. If the PRA testing is less than 10%, the recommendation is to not give HLA matched products. If the PRA testing is greater than 10% then HLA PLT products can be ordered. Reviewing the HLA PLT requests has had a huge impact on decreasing the HLA matching fees from the blood supplier from a high of $13,000/ month down to less than $1000/ month.

Conclusions: Taking the time to review the HLA PLT requests has led to good practice. Just because a patient has an HLA type, does not mean that the patient requires HLA matched PLTs. The questioning attitude also forces the clinical team to look at what might be going on with the patient that is contributing to the poor response to platelets rather than assume HLA matching is required.