Divisional Chief Medical Director American Red Cross Sharpsburg, Georgia, United States
Background/Case Studies: Maintaining an adequate supply of O-negative RBCs and AB plasma is challenging due to low prevalence (~7 and 4%, respectively) in the population but high demand from hospitals (both at ~14%).Distributions of both products, but particularly O-negative RBCs, have demonstrated a steady increase from ~11-14% between 2014-2023. Despite an increased relative proportion of O-negative and AB collections since 2014, hospital demands have been unmet.
Study
Design/Methods: American Red Cross (ARC) O-negative RBC and AB plasma utilization were evaluated with respect to size and attribute of hospitals during the implementation of various mitigation strategies to stabilize supply.
Results/Findings: O-negative RBC use by hospitals did not differ significantly based on hospital type and/or acuity (level I/II trauma centers, pediatric, tertiary care, transplant, etc.)O-negative utilization ranges of high volume ( >20k units RBCs/yr) hospitals compared to medium volume (8-20k RBCs/yr) hospitals were similar (between 8-28%).By contrast, hospital with low volume use (2-8k RBCs/yr) had a wider utilization range of 4-40% with the widest use range (1.4-100%) observed in hospitals using fewer than 2k RBCs/yr, suggesting significant variability in clinical practice.While implementation of an O-negative surcharge did not significantly change behavior, dialog to encourage right-type ordering, reduce discards in neonatal practice, active tracking of how O-negative RBCs were used, and implementation of blood center-guided, attribute-specific utilization limits resulted in reduced O-negative use and sustainable inventory.By contrast, overuse of AB plasma was limited to a smaller cohort of hospitals due to maintaining thawed units to support MTPs for trauma. These hospitals converted to use of A plasma following consultation with ARC medical team. Implementation of clinical attribute-driven utilization caps resulted in AB plasma distributions to sustainably decline from 13-15% to below 10%. Conclusions: Overall, maintaining an adequate supply of O-negative RBCs and AB plasma required maintaining aggressive collections (~60% over population prevalence) and a multi-faceted approach and partnership between hospital and blood collectors that included targeted education of evidence-based stewardship approaches, partnership to help understand the drivers of utilization, implementation of surcharge to offset increased cost of collection, and implementation of distribution limits based on hospital attribute.
