SI27 Substantial Reductions in Blood Product Usage Achieved Through a Multi‐Discplinary Approach

Abstract

The impact of vCJD on the UK blood supply and the recently well publicised cost pressures on hospital finances make it imperative that hospitals make efforts to reduce the use of blood products. Further drivers for appropriate use of blood and blood products have come from the Department of Health [the two HSCs entitled Better Blood Transfusion (1998 and 2002)] and the National Blood Transfusion Committee [‘National Blood Conservation Strategy for NBTC and NBS’ (2004)]. Objectives can be achieved by a multi‐disciplinary approach with education, ongoing audit and collaboration between the laboratory based staff and all clinical staff. Substantial reduction in the use of blood products can be achieved with the resultant reduction in financial costs and reduction in some of the undesirable effects of transfusion. The Royal Free NHS Trust is a teaching hospital and a tertiary referral centre for haematology, hepatology and nephrology. An extremely active transplantation programme is associated with all three specialities. A multi‐disciplinary approach to blood sparing strategies resulted in a 12.33% reduction (447 K) in blood product contract value. A 9.5% reduction (1680 units) in red cell use was in excess of national averages, greater reductions of 16.8% for FFP (1313 units) and 23.9% (960 units) for platelets were achieved against a background of increased bone marrow transplant activity and greatly expanded renal activity. The substantial reduction in platelet consumption coincided with a more dramatic 79.2% reduction (160 units) in the use of HLA selected platelets for refractory patients. The major contributions to savings involved the close monitoring of blood products, particularly in bone marrow transplant recipients and renal dialysis patients. The increasing use of mini‐allo bone marrow transplants with subsequent rapid recovery of platelet increments, also played a major role in savings. Established protocols for liver transplantation include the use of thromboelastogram (TEG) and aprotinin in selected cases. A pilot study for point of care testing delivered encouraging results. Future initiatives include the expansion of cell salvage to other surgical procedures or haemorrhage scenarios and the use of Erythropoietin (EPO) in some malignancies. Point of care testing is to be expanded to cover more surgical procedures and provide a more accurate assessment of haemostasis closer to real time.