(P-QU-2) Analyzing Platelet Transfusion Refractoriness within a 6 month period: Highlighting the need for an algorithmic approach for optimal platelet utilization
Background/Case Studies: Platelet transfusions support is required in several patient populations. However, some patients become refractory to stock platelets and experience Platelet Transfusion Refractoriness (PTR), necessitating cross-matched (XM) or HLA matched platelets. This study analyzed the patients who received XM or HLA platelets within a 6-month period in 2023. We seek to optimize the use of XM or HLA platelets.
Study
Design/Methods: A single-center, retrospective review of HLA or XM platelets dispensed ordered for a patient within a 6-month period use was conducted from July 2023 to December 2023. Several data points including biometric data, pre and post transfusion values, XM results, and CPRA were evaluated.
Results/Findings: During the study period, 6158 units of platelets were transfused at the hospital. Of the 6158, 19 (0.3%) were XM platelets and 79 (1.3%) were HLA platelets. The XM and/or HLA platelets were dispensed to a total of 21 unique patients, of whom only 10 had documented orders for XM and/ or HLA platelets. Of the 10, only 7 had a one-hour post stock platelet count; 4 were refractory to XM platelets and were escalated to HLA platelets, 4 only received HLA platelets, and 2 only received XM platelets. Of the 8 patients who had a documented XM result, 6 had a result of less than 5 out of 14. Of the 8 patients who were escalated to HLA platelets, 7 had a CPRA >90% . Only 3 had a one-hour post XM or HLA platelet count to calculate the CCI. Conclusions: PTR is a complex issue, requiring the coordination of blood bank technicians, hospital staff, and providers to recognize when a patient is becoming refractory to stock platelets, to order a XM and/ or HLA consultation, to follow-up on the responsiveness to XM or HLA, and re-evaluate the necessity of these special-order platelets in a cost-effective manner. As demonstrated, only 48% of HLA or XM platelets were indicated, highlighting the need for an algorithmic approach to PTR, as proposed in Figure 1in our institution. Future directions include evaluating the efficacy of this approach after implementation to minimize wastage.
