(P-TS-112) Trial of Pathogen Reduced Cryoprecipitated Fibrinogen Complex at a Tertiary Care Non-Trauma Pediatric Hospital Increases Cost Without Decreasing Waste

Background/Case Studies: Managing blood products efficiently and minimizing wastage is crucial, especially during bleeding emergencies. Our non-trauma pediatric hospital standardly issues a conventional cryoprecipitate pool (CRYP) with its massive transfusion protocol (MTP). In events where patients are under two years of age, on ABO-incompatible transplant protocol, or without ABO blood type on record, our standard protocol is to provide a type AB CRYP. CRYP requires thawing from frozen storage, impacting time to administration, and its 6-hour shelf-life at room temperature leads to wastage. The FDA-approved Pathogen Reduced Cryoprecipitated Fibrinogen Complex (PR Cryo, Cerus Corporation) has a post-thaw shelf life of 5 days at room temperature. This hospital's Transfusion Service (TS) trialed PR Cryo for more efficient product dispensing and decreased CRYP wastage.

Study

Design/Methods: During a four-month trial, this 400-bed free-standing pediatric hospital's TS purchased 40 PR Cryo units. TS maintained one PR Cryo unit at room temperature for immediate release during the trial. If not utilized or returned, the PR Cryo was available to issue for non-emergent orders. TS tracked each unit's use, waste, and reason for waste.

Results/Findings: During the trial, there were 14 emergency bleeding events, with ten units of PR Cryo issued. Post-MTP, two returned units were suitable and issued to other patients. Of the remaining units, 55% (n=22) of PR Cryo replaced CRYP orders. PR Cryo transfusion was 70% (n=28) units, with 30% (n=12) units discarded. Waste reasons included 22.5% (n=9) of units expired without any order or emergent need, 5% (n=2) failed visual inspection upon thawing/storage, and 2.5% (n=1) failed temperature check post-MTP. Of note, this hospital's cardiac surgery program recently decreased overall blood usage, removing a population historically using cryo products and making it challenging to utilize pre-thawed PR Cryo at our hospital.

Conclusions: The clear benefit of PR Cryo is immediate readiness, eliminating the need to thaw and improving the product's availability for patients. However, the limitations outweighed the benefits, specifically the high cost without decreased wastage. The quantity of PR Cryo units wasted remained within the same range compared to CRYP waste over one year (see Figure A), with the cost per PR Cryo unit double that of the conventional product. The trial showed promise in optimizing efficiency. However, limited MTP activations and decreased blood utilization by cardiac surgery impacted our CRYP waste. Due to these limitations, our hospital opted not to adopt or utilize PR Cryo beyond the trial period.