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Transfusion Service

(P-TS-102) The Effect of Thromboelastography on Blood Utilization and Waste

Sunday, October 20, 2024
12:00 PM - 1:00 PM  
Background/Case Studies: Viscoelastic testing (VET) is a methodology used to evaluate clot formation, strength, and dissolution. Thromboelastography (TEG) is a primary platform of VET implemented as a waived test and performed by the laboratory or non-laboratory staff in patient care areas. TEG testing may decrease morbidity and mortality by guiding transfusion orders for patients in different settings—primarily cardiac, liver and trauma patients. This study evaluates whether TEG implementation decreased overall blood product use and waste.

Study

Design/Methods: A retrospective cross-sectional analysis of red blood cells (RBC), plasma, platelet (PLT) and cryoprecipitate (CRYO) transfusion and waste at a level II trauma center was performed before (March 1, 2019-February 26, 2021) and after TEG implementation (March 4, 2022-February 29, 2024). Data was limited to Cardiac, Emergency and Trauma services. Deidentified data on blood product use and waste were obtained from the LIS. A total of 104 weeks of data before TEG and 104 weeks of data after TEG were evaluated using a paired t-test.

Results/Findings:

When the total number of transfusions was considered by product (see Table 1), there was a significant difference between pre- and post-TEG utilization of RBCs (p=0.005) and plasma (p=0.013). The mean RBC utilization increased from a mean of 16.37 units to a mean of 18.75 units per week, and the mean plasma utilization decreased from a mean of 4.27 units to a mean of 3.14 units per week. There was no significant difference in product utilization for PLT and Cryo groups.



 


Blood waste was also compared using a paired t-test (see Table 1). There was a significant decrease in the mean number of RBCs wasted (p=0.007), but the mean number of plasma wasted increased significantly between the pre- and post-TEG groups (p< 0.001). The weekly mean of PLT and Cryo waste showed no significant difference between the pre- and post-TEG groups.

Conclusions:

Both plasma utilization and waste were impacted by TEG implementation, with utilization decreasing and waste increasing. The decrease in plasma utilization is supported by other literature in this area. The increase in plasma waste may be tied to an increase in plasma transfusion during MTPs in the post-TEG period, but further data is needed to support this claim. RBC utilization and waste showed significant changes, although the impact of blood availability during the COVID pandemic should be considered a confounding variable in this study. Another possible limitation of this study is inconsistent use of TEG in all patient areas. Research on TEG impact should continue with data generated where TEG is consistently used in patient care.