(P-TS-68) Massive Transfusions in an Oncology Setting  

Background/Case Studies: Activation of the Massive Transfusion Protocol in an Oncology setting occurs in the Operating Suites, ICU, Interventional Radiology and Emergency Center. Predictive tools based on historic Surgical blood loss data are not always accurate.
The aim of the Transfusion Service is to provide blood and blood products in an efficient manner without delay by maintaining a sufficient quantity of universal blood donor products at all times for rapid transportation.

Study

Design/Methods: A Transfusion Medicine Physician is on call 24-7 for consultation with Anesthesia/Surgery/Interventional Radiology and ER.  
A Surgery Satellite (mini) Blood bank is located adjacent to the Operating Suites and is operational M-F 7 am -11 pm to facilitate the timely release of blood/blood products for Surgical and IR patients. There are 130 pRBCs (45 O Pos/45 A Pos.20 A Neg/ 10 B Pos/5 B Neg/ 10 O Neg) and 14 Thawed Plasma (8 A Pos/4 O Pos/ 2 B Pos) stored in inventory Mondy thru Friday in addition to crossmatched pRBCs units requested preop for surgical patients. When MTP is activated, the goal is to keep one cooler ahead for the duration of the MTP.  Blood Products are automatically set up and sent in established ratios (1st cooler - 4 RBC+4 FFP + 1 Platelet, 2nd cooler - 4 RBC +4 FFP + 1 Cryo). Emergency release of uncrossmatched blood is also available as 4 RBC + 4 FFP in the first crate. A valid 30-day Type & Screen is allowed for patients with a new sample with no history of transfusion or surgical intervention within the post 3 months. Electronic crossmatches are performed at the Surgery Satellite for release of pRBCs for surgical patients with valid Type and Screens and negative Antibody Screens.
Upon termination of MTPs, various parameters and outcomes are assessed.

Results/Findings: From 01/2022 to 03/2024, 140 MTPs were activated: 75 (55%) occurred in ICU, 32 (23%) in OR, 11 (8%) in ER, (8%) in IR and 8 (6%) other locations. 
53 (38%) patients received 8 or >pRBC units (median 10 [range 8-72]), 30 (44%) patients received median of 4 (range 4-7).and the remainder 25 (18%) patients received < 3 units. Only 47 (34%) patients received transfusions in a 1:1:1 ratio. 
We found that MTPs should not have been activated in 7 (12%) of the patients.
The non-surgical bleeds consisted of GI /Tracheostomy/Tumor/Vaginal/ Mouth/Skin ulcer bleeds.

Conclusions: Key issues identified: The need for precise communication between OR/IR/ER and Transfusion Service, Blood /blood products to be transfused in a 1:1;1 ratio (not compliant in 66% of the cases), conduct regular MTP simulations in key areas with key personnel, discuss possible termination when further resuscitation is futile, conversion to a product-based transfusion and lab-testing when possible. A performance improvement effort is underway led by the Safety Officers from Transfusion, Surgery, Anesthesia and ICU in collaboration with the Transfusion Medicine Physicians.