(P-IV-2) Are Cold Stored Platelets the Answer? Analyzing Platelet Inventory and Patient Blood Management Practices- How Long Are You Willing to Wait for a Prophylactic Platelet Transfusion?

Background/Case Studies: Platelet inventory management is particularly challenging due to short shelf-life and unpredictable usage. Our system has historically discarded a high percentage of our SDP inventory. While 7-day LVDS SDPs helped, discards continue to remain high. Cold stored SDPs offer a longer shelf-life but are only intended by the FDA to be used “for the treatment of active bleeding when conventional platelets are not available or their use is not practical.” We sought to determine how platelets were being used within our hospital system and the practicality of transitioning some of our hospitals with low SDP transfusion volumes to cold stored SDPs.

Study

Design/Methods: We performed a retrospective analysis of all SDPs transfused, purchased, and discarded by hospital within our system in 2024. Sites 1-6 are trauma centers, and sites 7-11 are not. Transfusions were sorted based on the indication selected by the ordering provider and adherence to the criteria was judged based on the patient’s pre-transfusion platelet (pre-Tx Plt) count. Results were assessed using the Student’s T-test.

Results/Findings: 7084 SDPs were purchased. 5898 (75.6%) SDPs were transfused of which 1083 (13.9%) were ordered prophylactically and 4127 (52.9%) were for bleeding. 1685 (21.6%) were discarded. The mean pre-Tx Plt count for prophylactic transfusions was 14.065X10⁹/L (range 7.568-23.496X10⁹/L) and for bleeding patients was 78.339X10⁹/L (range 39.225-114.873X10⁹/L). Performing prospective utilization review of SDP orders prior to issuance, which is routine at sites 1 and 3 but not the others, resulted in statistically significantly better adherence to patients having a platelet count ≤10X10⁹/L at the time of the prophylactic transfusion (p-value < 0.000005). Discard percentages by site ranged from 0% to 39.1%. There was a statistically significantly higher mean pre-Tx Plt count of bleeding patients at the trauma sites at 85.726X10⁹/L than at the non-trauma sites at 55.093X10⁹/L (p-value < 0.000001). No difference was observed between the mean pre-Tx Plt count of the prophylactic patients at the trauma sites at 14.384X10⁹/L and at the non-trauma sites 12.975X10⁹/L (p-value=0.45).

Conclusions: 52.9% of SDPs were transfused for active bleeding, and at some sites as high as 65.6% were for a bleeding indication. Only 13.9% of SDPs were transfused prophylactically, and their need could be met by placing an emergency order for a conventional SDP for a given patient rather than pulling an SDP from hospital inventory. The low overall number of SDP transfusions and unpredictable usage make cold stored platelets an attractive option. Based on this analysis, use of cold stored platelets is justifiable at some of our sites and could be considered at more depending upon their risk tolerance - how long they are willing to wait for the delivery of a conventional SDPs from one of our blood suppliers or one of our other facility blood banks.