(P-TS-89) Releasing Our Grip on O-negative PRBCs for Better Utilization

From the onset of the COVID19 pandemic, Geisinger Health significantly restricted indications for O-NEG PRBC transfusion. Local and national blood suppliers continue in 2024 to report critical inventory levels for O-NEG PRBC. We consider true clinical indications for O-NEG PRBC as patients who are at risk of developing HDFN, those who have anti-D alloantibody, and specific at-risk populations in whom anti-D would complicate their transfusion management, such as HSCT and Sickle Cell Disease patients. This allowed our far-flung rural-to-urban health system to provide O-NEG PRBC to our patients who truly need O-NEG PRBCs and to reduce the utilization of O-NEG for those who did not require O-NEG PRBC.

Study

Design/Methods: Guideline: Regardless of RhD type, all females > 50 years of age and all males >18 yo who are not RhD-NEG HSCT or Sickle Cell patients, or previously RhD-alloimmunized, are issued RhD-POS ABO-compatible PRBC units unless there are RhD-NEG units within 5 days of expiration available. We reviewed utilization of O-NEG PRBC in 2023 to determine adherence to our RhD guidelines and the effect on our O-NEG inventory.

Results/Findings: O-NEG comprised 8% (1580 of 19840) of PRBC units transfused at the 9 Geisinger hospitals in 2023. We found 21% noncompliance with guidelines, affecting 327 O-NEG units. We also identified 343 O-NEG PRBC given to RhD-POS patients within 5 days of expiry, or 21% of total transfusions of O-NEG PRBC. Among the 327 units given against guidelines, 99 O-NEG PRBC units went to RhD-POS individuals in Trauma or Emergency Release where historical types were known or eligible for O-POS PRBC from the start. RhD-NEG individuals who were eligible for RhD-POS transfusions received 227 O-NEG PRBC units. Among the O negative units given against policy, 124 of 327 were within 7 days of expiration, another 89 units were within 10 days of expiration, and yet another 56 units were within 14 days of expiration. Blood Bank staff at certain sites adjusted their adherence to the guideline to prevent having O-NEGs that would have to go to RhD-POS patients in order not to waste the unit.

Conclusions:

First, the 21% of our 8% overall O-NEG utilization that went to RhD-POS patients within 5 days of product expiry is a target for further reduction. We suggest changing our recommendation from within 5 days to within 14 days of expiration for any RhD-NEG patient and within 5 days for any RhD-POS. This change could improve our adherence to internal guidelines and further reduce by 82% the number of O-NEG PRBCs going to RhD-POS individuals without increasing overall O-NEG utilization. Second, despite our internal guidelines existing since May 2020, staff remain uncomfortable with the recommendation of giving RhD-POS blood to eligible RhD-NEG individuals. Further educational efforts are warranted.