P213 Creation of a platelet transfusion refractoriness web app for use at the point-of-care

Abstract

Aim Platelet transfusions are a cornerstone of therapy for patients who develop thrombocytopenia while undergoing hematopoietic stem cell transplantation (HSCT). Many of these patients demonstrate anti-HLA alloantibody mediated platelet transfusion refractoriness (PTR) and require HLA-matched platelets. The calculated panel reactive antibody (cPRA) is a useful tool for identifying patients at risk for PTR, but it requires manual intervention to calculate and so it is only calculated when requested. However, routine use of cPRA before every HSCT, using the existing pre-HSCT alloantibody results, could identify PTR earlier and more efficiently manage its complex transfusion needs for improved patient care. To accomplish this goal, we created an electronic medical record (EMR) web app for use by clinicians, blood bank/donor center, and tissue typing lab to better identify and manage PTR patients. Methods An online cPRA web-service was created to electronically receive alloantibody data and return cPRA values for several different ethnicities. Additionally, to increase flexibility, the cPRA web-service calculation can be customized with user defined antigen frequencies and epitopes. To utilize the cPRA web-service, a PTR web app was created with connections to several clinical data sources including: Tissue Typing Lab, Blood Bank, Donor Center, and EMR. The PTR web app was embedded into the EMR so that it could be easily viewed while caring for patients undergoing HSCT. Platelet utilization and transfusion effectiveness were compared before and after implementation. Results The cPRA web-service allows for automated computer generated cPRAs, making it feasible to calculate up-to-date cPRAs for every HSCT patient. The web app displays platelet counts along with platelet transfusion events, platelet units in inventory, and has a section for the clinical care teams and lab staff to communicate. We plan on making the cPRA web-service publicly available for others to use and customize. Conclusions We built a customizable cPRA web-service and platelet transfusion visualization web app to provide better point-of-care access to real time cPRA values to enable PTR risk stratification of HSCT patients. The web app also summarizes all of the key clinical data to efficiently manage PRT and improve platelet usage.