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A Transfusion Service Supervisor wonders what is the experience with wastage of fresh frozen plasma at other institutions. He sends a report to their transfusion committee that lists the total number of FFP’s that are thawed per month along with the number of FFP’s that are thawed and discarded because they go beyond the expiration date. He then shows these data as the percentage of total units that are discarded. The Editors believe that the information presented in the publication "Errors in Laboratory Medicine, Practical Lessons to Improve Patient Safety" is germane to this discussion. ADDENDA Feb. 4, 2008 1. An Ohio blood banker comments that the data below are from a community program that includes a blood center and the hospitals it serves. The hospitals range in bed size from 25 to 850 beds and include general, specialty and trauma facilities. All facilities provide thawed FFP (24 hr expiration); one facility also provides thawed plasma (5 day expiration). In 2006, over 27,000 units of FFP were transfused throughout the community. An additional 1200 units were ordered, but not transfused and were expired 24 hours after thawing. The percent FFP wasted averaged 4.15% at a basic cost of $70,000. 88% of the hospitals report blood product wastage to the transfusion committee or similar quality assurance group, but many reported frustration that their committee ‘lacks motivation’ to improve physician ordering practices. Recommendations to the transfusion services included 1) evaluate current thawing practices (for example thaw 1 or 2 at a time; check transfusion criteria), 2) provide ‘thawed plasma’ to increase the shelf life of thawed FFP from 24 hrs to 5 days from time of thaw, and 3) include financial impact when presenting data to the transfusion committee. The blood center also provides physician continuing education on FFP issues such as transfusion guidelines, TRALI, and other related topics. Active participation is necessary to reduce blood product waste. The reporting colleague found benchmarking data and references for FFP wastage to be limited. Data from the few that she did find (including the CAP Q-Probe and Q-Track studies referenced by the e-Network Forum Editors) ranged anywhere from 5 – 10% wastage at facilities that transfuse thawed FFP (24 hr outdate). There are additional references (including this website) that describe the benefit of providing ‘thawed plasma’. In CAP Today (May 2007), one facility reported decreasing blood product waste from 5% to <1%, and indicated that providing thawed plasma contributed to the significant reduction in wasted products. ADDENDA Feb. 11, 2008 2. A Medical Director of two hospital blood banks in New England comments that the information in a 2002 article in the “Archives of Pathology and Laboratory Medicine” is germane to this discussion. In that study the authors define an Expired Unit as a “unit of FFP or PLTs that was discarded because its lifespan exceeded that allowable for transfusion, that is, its maximum storage time was reached (synonym: outdated unit)”; and a Wasted Unit as “FFP or PLT unit that was discarded prior to its expiration date due to, but not limited to, handling and storage errors, such as breakage, failure to return unused units before their temperatures exceeded allowable limits, etc.” One limitation of this study is that the authors did not report the statistics for FFP and platelets separately. At the New England physician’s healthcare system they trend the expiration and wastage rates for FFP, platelets and RBC's by product category and by hospital, according to the above definitions. Their FFP data is based on a 5 day expiration policy for plasma. They have used the combined percentiles given in the above article as their benchmarks for the different components. (A separate CAP Q-PROBE provides benchmark rates for RBC's). The responding physician’s data are included in the following three PDF files (RBC data, FFP data, Platelet data). Of additional interest, the CAP has a Q-PROBE in place for this year on Utilization of Red Blood Cell Transfusions.
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Please submit comments to the e-Network Forum. Ira A. Shulman, MD W. Tait Stevens, MD |
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