(P-MG-3) Improving Blood Bank Test Ordering Practices by Evaluating Transfusion Support in the First Two Weeks of Autologous Stem Cell Transplant for Multiple Myeloma

Sunday, October 20, 2024

12:00 PM - 1:00 PM

Presenting Author(s)

AG

Alexander Garcia, MLS

City of Hope Orange County, Lennar Foundation Cancer Center, California, United States

Background/Case Studies: Hold specimens in the blood bank represent patient specimens that are collected in anticipation of possible RBC transfusion, however, are not directly tied to a type/screen order. At our multisite cancer center, hold specimens in blood bank account for 36,000 specimens yearly, with approximately 20% of these utilized for pre-RBC transfusion type/screen, resulting in 80% unnecessary patient specimen collections. We became aware of an electronic health record (EHR) order set utilized by our providers for multiple myeloma (MM) patients during the first 14 days of outpatient autologous hematopoietic stem cell transplant (aHSCT) that includes 5 hold specimen orders. Within this order set, hold specimens are collected on transplant days -1, +2, +5, +8, and +11, and the day -1 hold specimen is pre-selected. We evaluated the RBC requirements of MM patients undergoing aHSCT to determine if there is utility for hold specimens to remain in the order set. We also evaluated the platelet transfusion requirements of MM patients as we are aware that some of our providers have the misconception that type/screen is required for platelet transfusion.

Study

Design/Methods:

RBC and platelet transfusion data in the first 14 days of transplant (days 0-14) were obtained for all patients undergoing aHSCT in 2023 by querying the blood bank laboratory information system. Inclusion criteria included patients with the diagnosis of MM. Both outpatient and inpatient aHSCT patients were included.

Results/Findings: There were 257 patients with a diagnosis of MM who underwent aHSCT in 2023. Overall, 60 of 257 patients (23%) received at least 1 RBC transfusion, and 202 of 257 patients (79%) received at least 1 platelet transfusion during the first 14 days after transplant. RBC transfusion requirements peaked from days +9 to day +10, corresponding to an RBC transfusion incidence of 6.6 and 7.4% respectively. Platelet transfusion requirements peaked from days +8 to +13, corresponding to a platelet transfusion incidence ranging from 9.3-38.9% (Figure 1).

Conclusions:

Platelet transfusions were frequent among MM patients during the first 14 days following aHSCT; however, RBC transfusions were required in only a minority of patients on any given post-transplant day. The day +8 hold specimen had the greatest likelihood of utilization for pretransfusion testing, however each hold BB specimen in the order set had a low likelihood for utilization overall. Based on the demonstrated transfusion requirements, removal of the hold specimens from the order set for aHSCT MM patients was approved by the clinical team. Providers were educated to order type/screen when clinically necessary instead of upfront and were also educated that type/screen tests are not required for platelet transfusion.