Keeping The Stock Alive, A Dilemma of Hemovigilance

Abstract Introduction/Objective Being well-prepared for emergent blood transfusions is crucial in level 1 trauma centers. As advocates of hemovigilance, we follow protocols that encourage the appropriate use of group O, D- (O-) pRBCs. Moreover, by prioritizing using red blood cells with shorter shelf lives, we can better ensure that these valuable resources are not wasted. Methods/Case Report The number of O short-dated RBC units transfused in a level 1 trauma hospital in December 2023 was evaluated for type-specific distribution and utilization in bleeding patients and massive transfusion protocol. This study defines short-dated units as units expiring ≤7 days during transfusion. Results (if a Case Study enter NA) Of the 320 pRBCs evaluated, 59 were identified as short-dated units and 46(78%) were of the O- blood type. Interestingly, most O- units used for transfusion during this month (69%, 46/66) were short- dated; in comparison, only 5% (13/254) of group O, D+ (O+) units were transfused with a shorter shelf life. O- units were administered to 10 O- patients (17%), 27 O+ patients (46%), and 9 non-O blood type patients (15%). All short- dated O+ units were given to O+ patients, with 31% (4/13) used in massive transfusion protocols (MTP). None of the short-dated O- units were used in MTP, but over half (52%, 24/46) were utilized in patients experiencing bleeding. Conclusion Approximately 95% of individuals of African American descent have a blood type of D+. Given that this is the primary demographic we serve, it is unsurprising that our institution sees a relatively higher usage of O+ blood units, resulting in fewer short-dated O+ units being transfused. The cause of increased usage of short-dated O- is likely multifactorial, one of which is maintaining an adequate O- in our inventory for trauma patients. Balancing our preparedness for massive hemorrhage situations and hemovigilance for this blood type can be challenging for institutions like ours.