Low titer group O whole blood inventory conservation: The effect of implementing group A whole blood at a simulated civilian trauma center

BACKGROUND: Substituting group A whole blood (GAWB) might relieve some of the burden on the low titer group O whole blood (LTOWB) inventory. This simulation examined the effect of implementing GAWB at a large trauma hospital. STUDY DESIGN AND METHODS: A civilian trauma center with LTOWB and GAWB par levels set to 22 and 10 units, respectively, was modeled as the baseline. The average daily number of WB recipients was 0.5 who received an average of four WB units per patient. LTOWB was issued in packages of five and all had to be consumed before a group A patient could be switched to GAWB. Several variations on the baseline simulation were also modeled. RESULTS: In the baseline simulation, there was a median (interquartile range, IQR) of 1 (0-2) GAWB and 16 (13-19) LTOWB recipients per month. The median (IQR) GAWB and LTOWB units transfused per month was 2 (0-9) and 56 (42-72), respectively. Fourteen percent of group A patients received any quantity of GAWB. The variations that had the most impact on GAWB usage included increasing the number of WB recipients to 2.5 per day where the median (IQR) monthly number of GAWB recipients and units transfused increased to 4 (3-5) recipients and 21 (12-29) units, respectively, and when the average WB requirements increased to eight units per patient resulting in transfusing a median (IQR) of 10 (5-15) GAWB units per month to 3 (1-4) recipients. DISCUSSION: Under routine civilian hospital circumstances, implementing GAWB will have a modest impact on LTOWB inventory.