(P-IV-8) Using Every Last Drop! Optimizing the Preparation of Packed RBCs from Low Titer Group O Whole Blood to Prevent Waste

Background/Case Studies: Group O Low titer Whole Blood (LTOWB, WB) has become an important tool supporting massive hemorrhage in prehospital transport, trauma resuscitation, and intraoperative hemorrhage management. Our health system maintains a robust inventory of 55 - 80 WB (leukocyte-reduced) on helicopters and critical care ambulances, in trauma bays and in the blood bank for first round massive transfusion protocol (MTP) across our 9 sites daily.
Looking at 2024 System LTOWB utilization, 1954 units (76%) were transfused as WB, leaving 600 units (24%) available to be processed into PRBC for transfusion before expiry. Our re-processing program allowed 534 units (94%) of our LTOWB that are not used as WB to be repurposed as PRBCs (leukocyte- reduced) units for transfusion. The standard operating procedure (SOP) for spinning of the LTOWB into a PRBC includes a hematocrit (HCT%) quality control check to ensure 65-80% HCT of PRBC units. We encountered variable HCT% results, with 14.5% of the PRBC units failing QC, resulting in discarded units. To further reduce the waste of this group O resource, we evaluated a visual mark for plasma removal versus our current procedure for a volume-based plasma removal.

Study

Design/Methods: We followed our general procedure for preparation of PRBC units (centrifugation at 4100 rpm at 4^oC for 10 minutes at a force of 2433G). We then collected plasma extraction weight and volume based on visual marks of 0.5, 1.0, 1.5 and 2.0-inches from the junction of the tubing and the unit bag. Finally, we measured the HCT(%) of units prepared at those visual marks and compared the results to historical volume based HCT(%) QC (2024QC Data).

Results/Findings: Of the 41 units of LTOWB tested at 1.0-inch visual mark line, more than 90% of the units had an acceptable HCT between 65% to 80% PRBC (average HCT 74.6%) as opposed to 85% of units that passed using the old approach of plasma volume (256 mL or 280mL) removal with most failures being below the 65% HCT (not enough plasma removed). The upper and lower limits of the 1-inch mark if calculated out would all still be within the range.

Conclusions: Re-purposing LTOWB as a PRBC is essential to maximize your O inventory, prevent unnecessary waste while supporting a LTOWB program and allow for every drop of the universal "O" RBC resource to be utilized. Utilizing the visual 1-inch mark for expressing plasma from LTOWB is a universal approach, easy to follow and has repeatability to recreate ideal PRBC HCT available for transfusion.