Department of Pathology, Stanford University School of Medicine, Stanford, California.
Stanford Hospital Transfusion Service, Stanford, California.
Transfusion. 2020 Apr;60(4):739-746. doi: 10.1111/trf.15713. Epub 2020 Feb 20.
O-negative red blood cells (ON-RBC) are a precious resource and the international blood banking community has become increasingly concerned with its inappropriate utilization. AABB recently made several recommendations to address the issue. Solutions must be multifaceted and involve donor centers, blood banks, and clinical departments. From the perspective of a hospital blood bank, it is difficult to rely solely on increased donor recruitment and ubiquitous blood typing of the entire in-patient population. We therefore focused on interventions within the blood bank to optimize inventory and policies to ensure appropriate ON-RBC utilization.
Transfusion data over one year was examined for the rate of out-of-group/inappropriate ON-RBC. Furthermore, we assessed whether that rate was related to product life on the day of transfusion. We also examined our stock inventory levels and how excess inventory can contribute to inappropriate ON-RBC usage.
The ON-RBC inventory level was decreased in order to reduce the rate of inappropriate transfusions while maintaining a safe level for optimal patient care. Compared to baseline, our intervention caused ON-RBCs to be transfused earlier in their shelf-life (9.27 vs. 11.15 days from expiration [DFE], p = 0.0012). This reduced the overall rate of inappropriate ON-RBC transfusions (67% vs. 54%, p = 0.0035), approximating 185 units of ON-RBC saved over the course of 6 months.
A data-driven approach to optimize stock inventory levels is widely applicable; it can be adopted by numerous institutions to improve utilization and establish a benchmark for the broader blood banking community.
O 型阴性红细胞（ON-RBC）是一种宝贵的资源，国际血库界越来越关注其不当使用。AABB 最近提出了几项建议来解决这个问题。解决方案必须是多方面的，涉及献血中心、血库和临床科室。从医院血库的角度来看，仅仅依靠增加献血者招募和对整个住院患者人群进行普遍血型检测是很难做到的。因此，我们专注于血库内部的干预措施，以优化库存和政策，确保适当使用 ON-RBC。
检查了一年的输血数据，以确定非同组/不适当的 ON-RBC 输血率。此外，我们评估了该比率是否与输血当天产品的寿命有关。我们还检查了我们的库存水平，以及多余的库存如何导致不适当的 ON-RBC 使用。
为了降低不适当输血的比率，同时保持最佳患者护理的安全水平，降低了 ON-RBC 的库存水平。与基线相比，我们的干预措施使 ON-RBC 在其保质期内更早地进行了输血（从失效日期（DFE）起 9.27 天与 11.15 天，p = 0.0012）。这降低了不适当的 ON-RBC 输血的总体比率（67%对 54%，p = 0.0035），在 6 个月的过程中节省了大约 185 单位的 ON-RBC。
一种优化库存水平的数据驱动方法具有广泛的适用性；许多机构都可以采用这种方法来提高利用率，并为更广泛的血库界建立基准。
