By establishing standard operating procedures and incorporating regular quality control measures, healthcare organizations work to ensure that whole blood platelets used in transfusions are safe, effective and of high quality. The collection of whole-blood derived (WBD) random-donor platelets poses both benefits and challenges for healthcare organizations.
There are essentially no challenges, problems or issues of WBD random-donor platelet donations for the blood donors themselves. “Because WBDs are manufactured after the donation process, there’s no extra effort or time required of the donor,” explained Phillip J. DeChristopher, MD, PhD, Professor of Pathology and Medicine, Medical Director, Transfusion Medicine / Blood Bank / Apheresis at Loyola University Health System in Maywood, Ill.
Blood centers, however, must have standard operating procedures (SOP) in place to properly manufacture WBD platelets. SOPs are used to train and ensure competency among the organization’s technical staff.
Alternately, apheresis platelet donors spend a considerable amount of time-two or more hours-filling out the donor qualification questionnaire and donating via the apheresis device, observed DeChristopher. SOPs need to be established for apheresis platelet collection as well, but the automated device does most of the work of manufacturing. Both methods require quality assurance audits.
“Blood centers have to manufacture WBD platelets (by physical separation using routine centrifugation techniques) individually from each whole blood donation, and then employ control measures for content and quality,” DeChristopher explained.
Manufacturing WBD platelets is an expensive process-requiring both time and money. WBD platelets have to be pooled at hospital blood banks/transfusion services, a step that requires technologists’ time, in order to make large enough doses for adults, DeChristopher told ADVANCE.
“Currently, the platelets have to be tested for bacterial contamination prior to issue, a separate step which adds some cost,” he said. “In contradistinction, apheresis platelets are usually tested by direct bacteriological testing at the blood center, prior to being sold to hospitals.”
Managing Platelet Usage and Wastage
Predicting the required quantities of any component usage, including platelets, is more of an art than a science for hospital blood banks, according to DeChristopher. “The key is to balance supply and demand,” he said. “Taken from an annualized perspective, one can budget for the same number of components by using historical activity, usage and financial records.”
This approach presumes, however, that the blood usage remains stable from one fiscal year to the next, DeChristopher observed. “Usage is subject to change, mostly depending upon the nature of the clinical programs that the hospital blood bank supports,” he said.
According to DeChristopher, hospitals supporting hematology / oncology, cardiothoracic surgery, solid organ transplantation programs and Level 1 Trauma services are “platelet thirsty.” What’s less certain, he said, is the level of activity that each existing program will experience over any period of time.
“This year’s activity may or may not be as busy as last year’s activity,” he explained. “Historical controls are only approximately predictive. In my experience, annualized figures may help a blood center predict an expense budget within 10% of actual spending.”
DeChristopher has found auditing supply and demands in narrower increments, such as quarterly or monthly, is a more effective approach. “Smaller increments of time may better gauge how demands are fluctuating, more in real time,” he said.
Unexpected emergencies or unpredicted rises or declines in surgical programs, however, are episodic enough to incorporate an almost permanent uncertainty in inventory control, DeChristopher shared.
The steps taken to manage platelet usage are no different than those used to manage all blood usage, DeChristopher said. “For effective blood management, institutions have to build patient blood management programs,” he explained.
Role of Patient Blood Management Programs
Patient blood management programs — comprehensive, institutional, multidisciplinary efforts led by thought leaders — produce tools for effective blood use, aimed at providing patients all the blood they need, but not more than what they need. A few of the features of an effective blood management program are development of and promulgation of institutional, evidence-based indications for transfusion; consistent and repeated educational efforts at every level; and prospective and retrospective reviews of blood ordering practices.
“Wastage with any kind of platelet component is a serious and ongoing concern for blood suppliers across the country,” DeChristopher stated. Platelet preparation and provision requires time, effort and testing. Platelets are the shortest dated blood components (with a 5-day shelf life) and the most expensive, according to DeChristopher.
University HealthSystem Consortium and the AABB have publicized benchmarks for component wastage. According to DeChristopher, institutional programs should target wastage proportions at or less than the benchmarks. He suggests keeping wastage to approximately 1% for apheresis platelets and up to 5% for WBD platelets.
“WBD platelets tend to be wasted more frequently because once they are pooled, they have a four-hour expiration date,” DeChristopher said. “To perform pooling, the system has been ‘opened’ and therefore the pools are more susceptible to bacterial contamination.”
Loyola University Health System has successfully streamlined its efforts to teach and communicate with doctors requesting platelets by developing a patient blood management program.
Rebecca Mayer Knutsen is on staff at ADVANCE. Contact: email@example.com
Limitations and benefits of whole-blood derived (WBD) random-donor platelets:
- Increased donor exposures per transfusion episode
o Potential increased risk of infectious diseases from new or emerging organisms
WBD must be separately manufactured from each whole blood donation
Leukocyte reduction requires separate filtration
WBD platelets have to be individually pooled by the blood center or the hospital
Donors are limited to donations every 8 weeks
Pooled WBD platelets have same content as apheresis platelets (clinical response same as apheresis)
Use can be individualized to dose appropriate patient size/weight
Plasma antibodies, which might cause adverse effects, are diluted by a factor of 4 to 6 (depending on pool size)
Can be provided as “leukocyte-reduced”
Represent the only backup for short supply issues
Can be quickly ready for trauma, other massive transfusion or other immediate-need settings
Lower cost per transfusion episode
— Phillip J. DeChristopher, MD, PhD, Professor of Pathology and Medicine, Medical Director, Transfusion Medicine / Blood Bank / Apheresis at Loyola University Health System in Maywood, Ill