Transfusion Medicine Consultant, Medical Director Center for Regenerative Biotherapeutics Mayo Clinic Rochester, Minnesota, United States
Background/Case Studies: Cryoprecipitate AHF (cryo) is used routinely to replenish fibrinogen for acquired coagulopathies, despite limited evidence from robust clinical trials. Most recently, the National Blood Collection and Utilization Survey (NBCUS) reported increased distribution (6.3% from 2,304,000 to 2,449,000 units) and transfusion (5.4% from 1,184,000 to 1,248,000 units) of cryo, while the collection and transfusion of other blood components stabilized. In this context, this study aims to describe blood center distribution and hospital utilization patterns of cryo in North America.
Study
Design/Methods: Cryo and whole blood (WB) distribution data were collected for five 12-month periods from July 1, 2016, to June 30, 2021, by 4 collection centers (n=2 United States [US], n=2 Canada). During the same study period, cryo utilization by hospital department and the average midnight inpatient census were collected by 8 academic hospitals (n=7 US, n=1 Canada). To explore year to year trends, the following metrics were calculated for the five 12-month interval at each site: % cryo units distributed relative to WB collections, total cryo units transfused adjusted for census, cryo recipients adjusted for census, cryo units per recipient ratio, and % cryo utilized by department. A linear mixed model was used to explore the covariance for each metric within hospitals over time. Multiple comparison of least square means was performed to compare metrics between hospitals.
Results/Findings: Both US collectors reported an increase in cryo distribution (absolute number and normalized to WB collections, data not shown). Distribution decreased at one Canadian collection center where a transition to fibrinogen concentrate was made. Among hospitals, the metrics described above to reflect cryo utilization, the number of patients treated, and dose per patient treated differed significantly within each hospital and between hospitals over time (Table 1). Likewise, departments that most frequently transfused cryo were also highly variable between sites. Conclusions: From July 1, 2016, to June 30, 2021, cryo distribution increased overall, particularly in the US. Concomitant increase in cryo utilization was not observed at the study sites sampled. Cryo utilization patterns were highly variable between hospitals and among clinical departments, possibly demonstrating practitioner preference rather than adherence to evidence-based studies and guidelines.
