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Pérez-Aliaga AI, Ayerra I, Sánchez-Guillén J, López FJ, Puente F, Aranda A, Domingo JM, Garcés C. Routine results of an algorithm for managing the production of blood components. Vox Sang 2024; 119:541-547. [PMID: 38410835 DOI: 10.1111/vox.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND OBJECTIVES The variability in the number of donations together with a growing demand for platelet concentrates and plasma-derived medicines make us seek solutions aimed at optimizing the processing of blood. Some mathematical models to improve efficiencies in blood banking have been published. The goal of this work is to validate and evaluate an algorithm's impact in the production of blood components in the Blood and Tissues Bank of Aragon (BTBA). MATERIALS AND METHODS A mathematical algorithm was designed, implemented and validated through simulations with real data. It was incorporated into the fractionation area, which uses the Reveos® fractionation system (Terumo BCT) to split blood into its components. After 9 months of daily routine validation, retrospective activity data from the Blood Bank and Transfusion Services before and during the use of the algorithm were compared. RESULTS Using the algorithm, the outdating rate of platelet concentrates (PC) decreased by 87.8% in the blood bank. The average shelf life remaining of PC supplied to Transfusion Services increased by almost 1 day. As a consequence, the outdating rate in the Aragon Transfusion Network decreased by 33%. In addition, extra 100 litres of plasma were obtained in 9 months. CONCLUSIONS The algorithm improves the blood establishment's workflow and facilitates the decision-making process in whole blood processing. It resulted in a decrease in PC outdating rate, increase in PC shelf life and finally an increase in the volume of recovered plasma, leading to significant cost savings.
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Affiliation(s)
| | | | | | - F Javier López
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Aragón, Spain
| | - Fernando Puente
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
| | - Alfonso Aranda
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
| | | | - Carmen Garcés
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
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2
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McCullagh J, Basham P, Davies J, Hicks V, Hunter A, Lancut J, Green L. The feasibility of introducing a whole blood component for traumatic haemorrhage in the UK. Transfus Med 2024; 34:175-181. [PMID: 38576265 DOI: 10.1111/tme.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/24/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The interest in re-introducing whole blood (WB) transfusion for the management of traumatic major haemorrhage is increasing. However, due to the current leucodepletion filters used in the UK a WB component was not readily available. Instead, an alternative but similar component, leucocyte depleted red cell and plasma (LD-RCP), which provided a unique experience in assessing the feasibility of a WB component was used whilst a WB component was being manufactured. STUDY DESIGN AND METHODS Between November 2018 and October 2020, LD-RCP replaced RBC as standard of care for all trauma patients with major haemorrhage in London. The aims of the study were to assess (a) deliverability, (b) component wastage and (c) safety. RESULTS Over the study period a total of 1208 LD-RCP units were delivered, of which 96.5% were delivered 'On Time In Full' (OTIF). Of the 1208 units, 733 (60.68%) were transfused and 475 (39.3%) units were wasted. Component wastage reduced significantly throughout the study (p = 0.001). A total of 177 patients had a blood group recorded, 86 were group O and 91 were non-group O. There was no statistically significantly difference between haemoglobin (p = 0.422), or bilirubin levels (p = 0.084) between group O and non-group O patients. DISCUSSION It was feasible for NHS Blood and Transplant to deliver LD-RCP on time in full, however component wastage was high due to short shelf life and limited use of the component. Low titre group O LD-RCP units were not associated with clinical evidence of haemolysis.
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Affiliation(s)
- Josephine McCullagh
- Clinical Haematology, Barts Health NHS Trust, London, UK
- Red Cell Immunoheamatology, NHS Blood and Transplant (NHSBT), London, UK
| | - Peter Basham
- Manufacturing, NHS Blood and Transplant, London, UK
| | - Jane Davies
- Manufacturing, NHS Blood and Transplant, London, UK
| | - Vicky Hicks
- Manufacturing, NHS Blood and Transplant, London, UK
| | | | - Julia Lancut
- Blood Transfusion, East and Southeast London Pathology Partnership, London, UK
| | - Laura Green
- Clinical Haematology, Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Blood Transfusion and Components, NHS Blood and Transplant, London, UK
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3
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Javadzadeh Shahshahani H, Sharifi S, Nasizadeh S. Impact of Implementing a Standard Operating Procedure to Reduce Blood Wastage in Blood Centers of Iran. ARCHIVES OF IRANIAN MEDICINE 2024; 27:89-95. [PMID: 38619032 PMCID: PMC11017257 DOI: 10.34172/aim.2024.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 01/07/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Blood wastage leads to additional costs and reduced blood availability to patients. Above all is the moral issue of wasting donor gifts. This study aimed to determine the rate of blood wastage before and after implementing a new standard operating procedure (SOP) in Iran. METHODS In this interventional study, a SOP for wastage management was prepared and implemented in all blood centers throughout the country. Data were extracted from the integrated software of the Iranian Blood Transfusion Organization (IBTO). The wastage rate of blood components in the post-intervention years (2016-2017) was then compared with that in the pre-intervention years (2013-2015) using the Z test. RESULTS The overall wastage rate decreased by 36.86% (P<0.001, 95% CI [36.84-36.88]) after the intervention. Red blood cell (RBC) wastage decreased from 2.6% to 2.5%, platelet wastage from 19.5% to 10.6% and plasma wastage from 15.5% to 7.3% (P<0.001). The highest percentage of waste reduction pertained to plasma components, which decreased by 52.90% (P<0.001, 95% CI [52.86-52.94]). Expiration was the most common cause of RBC and platelet wastage. The most common causes of plasma wastage were RBC contamination and rupture or leakage of the bags. The intervention resulted in a drop of over 250000 discarded components each year, equal to approximately thirty-six million dollars in savings. CONCLUSION This intervention effectively reduced waste and increased efficiency. Ongoing blood wastage reviews, auditing, and receiving feedback from the central headquarters were powerful tools in following the compliance of blood centers. Further studies are recommended, especially concerning blood wastage in hospital blood banks and various wards.
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Affiliation(s)
| | - Shahin Sharifi
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Soheila Nasizadeh
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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4
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Engelke M, Schmidt CS, Baldini G, Parmar V, Hosch R, Borys K, Koitka S, Turki AT, Haubold J, Horn PA, Nensa F. Optimizing platelet transfusion through a personalized deep learning risk assessment system for demand management. Blood 2023; 142:2315-2326. [PMID: 37890142 DOI: 10.1182/blood.2023021172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
ABSTRACT Platelet demand management (PDM) is a resource-consuming task for physicians and transfusion managers of large hospitals. Inpatient numbers and institutional standards play significant roles in PDM. However, reliance on these factors alone commonly results in platelet shortages. Using data from multiple sources, we developed, validated, tested, and implemented a patient-specific approach to support PDM that uses a deep learning-based risk score to forecast platelet transfusions for each hospitalized patient in the next 24 hours. The models were developed using retrospective electronic health record data of 34 809 patients treated between 2017 and 2022. Static and time-dependent features included demographics, diagnoses, procedures, blood counts, past transfusions, hematotoxic medications, and hospitalization duration. Using an expanding window approach, we created a training and live-prediction pipeline with a 30-day input and 24-hour forecast. Hyperparameter tuning determined the best validation area under the precision-recall curve (AUC-PR) score for long short-term memory deep learning models, which were then tested on independent data sets from the same hospital. The model tailored for hematology and oncology patients exhibited the best performance (AUC-PR, 0.84; area under the receiver operating characteristic curve [ROC-AUC], 0.98), followed by a multispecialty model covering all other patients (AUC-PR, 0.73). The model specific to cardiothoracic surgery had the lowest performance (AUC-PR, 0.42), likely because of unexpected intrasurgery bleedings. To our knowledge, this is the first deep learning-based platelet transfusion predictor enabling individualized 24-hour risk assessments at high AUC-PR. Implemented as a decision-support system, deep-learning forecasts might improve patient care by detecting platelet demand earlier and preventing critical transfusion shortages.
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Affiliation(s)
- Merlin Engelke
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - Cynthia Sabrina Schmidt
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute for Transfusion Medicine, University Medicine Essen, Essen, Germany
| | - Giulia Baldini
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - Vicky Parmar
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - René Hosch
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - Katarzyna Borys
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - Sven Koitka
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - Amin T Turki
- Computational Hematology Laboratory, Department of Hematology and Stem Cell Transplantation, West-German Cancer Center, University Medicine Essen, Essen, Germany
- Department of Hematology and Oncology, Marienhospital University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Johannes Haubold
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - Peter A Horn
- Institute for Transfusion Medicine, University Medicine Essen, Essen, Germany
| | - Felix Nensa
- Institute for Artificial Intelligence in Medicine, University Medicine Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
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5
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Bravo-Iñiguez CE, Fritz JR, Shukla S, Sarangi S, Thompson DA, Amin SG, Tsaava T, Chaudhry S, Valentino SP, Hoffman HB, Imossi CW, Addorisio ME, Valdes-Ferrer SI, Chavan SS, Blanc L, Czura CJ, Tracey KJ, Huston JM. Vagus nerve stimulation primes platelets and reduces bleeding in hemophilia A male mice. Nat Commun 2023; 14:3122. [PMID: 37264009 PMCID: PMC10235098 DOI: 10.1038/s41467-023-38505-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/05/2023] [Indexed: 06/03/2023] Open
Abstract
Deficiency of coagulation factor VIII in hemophilia A disrupts clotting and prolongs bleeding. While the current mainstay of therapy is infusion of factor VIII concentrates, inhibitor antibodies often render these ineffective. Because preclinical evidence shows electrical vagus nerve stimulation accelerates clotting to reduce hemorrhage without precipitating systemic thrombosis, we reasoned it might reduce bleeding in hemophilia A. Using two different male murine hemorrhage and thrombosis models, we show vagus nerve stimulation bypasses the factor VIII deficiency of hemophilia A to decrease bleeding and accelerate clotting. Vagus nerve stimulation targets acetylcholine-producing T lymphocytes in spleen and α7 nicotinic acetylcholine receptors (α7nAChR) on platelets to increase calcium uptake and enhance alpha granule release. Splenectomy or genetic deletion of T cells or α7nAChR abolishes vagal control of platelet activation, thrombus formation, and bleeding in male mice. Vagus nerve stimulation warrants clinical study as a therapy for coagulation disorders and surgical or traumatic bleeding.
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Affiliation(s)
- Carlos E Bravo-Iñiguez
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Jason R Fritz
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Shilpa Shukla
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Department of Pediatric Hematology and Oncology, Cohen Children's Medical Center, Northwell Health, Lake Success, NY, 11040, USA
| | - Susmita Sarangi
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Department of Pediatric Hematology and Oncology, Cohen Children's Medical Center, Northwell Health, Lake Success, NY, 11040, USA
| | - Dane A Thompson
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Department of Surgery, Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Seema G Amin
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Department of Pediatric Hematology and Oncology, Cohen Children's Medical Center, Northwell Health, Lake Success, NY, 11040, USA
| | - Tea Tsaava
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Saher Chaudhry
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Sara P Valentino
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Hannah B Hoffman
- Department of Surgery, Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Catherine W Imossi
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Meghan E Addorisio
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Sergio I Valdes-Ferrer
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Sangeeta S Chavan
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Lionel Blanc
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Departments of Molecular Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA
| | - Christopher J Czura
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Kevin J Tracey
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
- Elmezzi Graduate School of Molecular Medicine at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Jared M Huston
- Institute of Bioelectronic Medicine, The Feinstein Institutes for Medical Research at Northwell Health, 350 Community Drive, Manhasset, NY, 11030, USA.
- Department of Surgery, Northwell Health, 300 Community Drive, Manhasset, NY, 11030, USA.
- Department of Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY, 11549, USA.
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6
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Delabie W, De Bleser D, Vandewalle V, Vandekerckhove P, Compernolle V, Feys HB. Single step method for high yield human platelet lysate production. Transfusion 2023; 63:373-383. [PMID: 36426732 PMCID: PMC10099704 DOI: 10.1111/trf.17188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to develop a single step method for the production of human platelet lysate (hPL). The method must result in high hPL yields, be closed system and avoid heparin use. STUDY DESIGN AND METHODS The method aimed at using glass beads and calcium. An optimal concentration of calcium and glass beads was determined by serial dilution. This was translated to a novel method and compared to known methods: freeze-thawing and high calcium. Quality outcome measures were transmittance, fibrinogen and growth factor content, and cell doubling time. RESULTS An optimal concentration of 5 mM Ca2+ and 0.2 g/ml glass beads resulted in hPL with yields of 92% ± 1% (n = 50) independent of source material (apheresis or buffy coat-derived). The transmittance was highest (56% ± 9%) compared to known methods (<39%). The fibrinogen concentration (7.0 ± 1.1 μg/ml) was well below the threshold, avoiding the need for heparin. Growth factor content was similar across hPL production methods. The cell doubling time of adipose derived stem cells was 25 ± 1 h and not different across methods. Batch consistency was determined across six batches of hPL (each n = 25 constituting concentrates) and was <11% for all parameters including cell doubling time. Calcium precipitation formed after 4 days of culturing stem cells in media with hPL prepared by the high (15 mM) Ca2+ method, but not with hPL prepared by glass bead method. DISCUSSION The novel method transforms platelet concentrates to hPL with little hands-on time. The method results in high yield, is closed system, without heparin and non-inferior to published methods.
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Affiliation(s)
- Willem Delabie
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
| | - Dominique De Bleser
- Transfusion Innovation Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Blood Services, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Vicky Vandewalle
- Transfusion Innovation Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Blood Services, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Blood Services, Belgian Red Cross-Flanders, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Veerle Compernolle
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Transfusion Innovation Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Blood Services, Belgian Red Cross-Flanders, Mechelen, Belgium.,Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium.,Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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7
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Schilling M, Rickmann L, Hutschenreuter G, Spreckelsen C. Reduction of Platelet Outdating and Shortage by Forecasting Demand With Statistical Learning and Deep Neural Networks: Modeling Study. JMIR Med Inform 2022; 10:e29978. [PMID: 35103612 PMCID: PMC8848235 DOI: 10.2196/29978] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/12/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Platelets are a valuable and perishable blood product. Managing platelet inventory is a demanding task because of short shelf lives and high variation in daily platelet use patterns. Predicting platelet demand is a promising step toward avoiding obsolescence and shortages and ensuring optimal care. OBJECTIVE The aim of this study is to forecast platelet demand for a given hospital using both a statistical model and a deep neural network. In addition, we aim to calculate the possible reduction in waste and shortage of platelets using said predictions in a retrospective simulation of the platelet inventory. METHODS Predictions of daily platelet demand were made by a least absolute shrinkage and selection operator (LASSO) model and a recurrent neural network (RNN) with long short-term memory (LSTM). Both models used the same set of 81 clinical features. Predictions were passed to a simulation of the blood inventory to calculate the possible reduction in waste and shortage as compared with historical data. RESULTS From January 1, 2008, to December 31, 2018, the waste and shortage rates for platelets were 10.1% and 6.5%, respectively. In simulations of platelet inventory, waste could be lowered to 4.9% with the LASSO and 5% with the RNN, whereas shortages were 2.1% and 1.7% with the LASSO and RNN, respectively. Daily predictions of platelet demand for the next 2 days had mean absolute percent errors of 25.5% (95% CI 24.6%-26.6%) with the LASSO and 26.3% (95% CI 25.3%-27.4%) with the LSTM (P=.01). Predictions for the next 4 days had mean absolute percent errors of 18.1% (95% CI 17.6%-18.6%) with the LASSO and 19.2% (95% CI 18.6%-19.8%) with the LSTM (P<.001). CONCLUSIONS Both models allow for predictions of platelet demand with similar and sufficient accuracy to significantly reduce waste and shortage in a retrospective simulation study. The possible improvements in platelet inventory management are roughly equivalent to US $250,000 per year.
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Affiliation(s)
- Maximilian Schilling
- Institute for Medical Informatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Lennart Rickmann
- Institute for Medical Informatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Gabriele Hutschenreuter
- Institute for Transfusion Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Cord Spreckelsen
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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8
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McGuinness S, Charlewood R, Gilder E, Parke R, Hayes K, Morley S, Al-Ibousi A, Deans R, Howe B, Johnson L, Marks DC, Reade MC. A pilot randomized clinical trial of cryopreserved versus liquid-stored platelet transfusion for bleeding in cardiac surgery: The cryopreserved versus liquid platelet-New Zealand pilot trial. Vox Sang 2021; 117:337-345. [PMID: 34581452 DOI: 10.1111/vox.13203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/22/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Platelets for transfusion have a shelf-life of 7 days, limiting availability and leading to wastage. Cryopreservation at -80°C extends shelf-life to at least 1 year, but safety and effectiveness are uncertain. MATERIALS AND METHODS This single centre blinded pilot trial enrolled adult cardiac surgery patients who were at high risk of platelet transfusion. If treating clinicians determined platelet transfusion was required, up to three units of either cryopreserved or liquid-stored platelets intraoperatively or during intensive care unit admission were administered. The primary outcome was protocol safety and feasibility. RESULTS Over 13 months, 89 patients were randomized, 23 (25.8%) of whom received a platelet transfusion. There were no differences in median blood loss up to 48 h between study groups, or in the quantities of study platelets or other blood components transfused. The median platelet concentration on the day after surgery was lower in the cryopreserved platelet group (122 × 103 /μl vs. 157 × 103 /μl, median difference 39.5 ×103 /μl, p = 0.03). There were no differences in any of the recorded safety outcomes, and no adverse events were reported on any patient. Multivariable adjustment for imbalances in baseline patient characteristics did not find study group to be a predictor of 24-h blood loss, red cell transfusion or a composite bleeding outcome. CONCLUSION This pilot randomized controlled trial demonstrated the feasibility of the protocol and adds to accumulating data supporting the safety of this intervention. Given the clear advantage of prolonged shelf-life, particularly for regional hospitals in New Zealand, a definitive non-inferiority phase III trial is warranted.
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Affiliation(s)
- Shay McGuinness
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Eileen Gilder
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand.,Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Katia Hayes
- Greenlane Department of Cardiothoracic Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Sarah Morley
- New Zealand Blood Service, Auckland, New Zealand
| | | | - Renae Deans
- Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Belinda Howe
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lacey Johnson
- Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Denese C Marks
- Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Michael C Reade
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Faculty of Medicine, University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Joint Health Command, Australian Defence Force, Canberra, Australian Capital Territory, Australia
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9
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Abstract
The supply of platelets for transfusion is a logistical challenge due to the physiology of platelets and current measures of transfusion performance dictating storage at 22°C and a short product shelf-life (<7 days). Demand for platelets has increased in recent years and changes in the demographics of the population may enhance this further. Many studies have been conducted to understand what the optimal dose and trigger for transfusion should be, mainly in hematology patients who are the largest cohort that receive platelets, mostly to prevent bleeding. Emerging data suggests that for bleeding patients, where immediate hemostasis is a key consideration, the current standard product may not be optimal. Alternative platelet preparation methods/storage options that may improve the hemostatic properties of platelets are under active development. In parallel with research into alternative platelet products that might enhance hemostasis, better measures for assessing bleeding risk and platelet efficacy are needed.
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McCullagh J, Proudlove N, Tucker H, Davies J, Edmondson D, Lancut J, Maddison A, Weaver A, Davenport R, Green L. Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients. BMJ Open Qual 2021; 10:bmjoq-2021-001396. [PMID: 34244177 PMCID: PMC8268902 DOI: 10.1136/bmjoq-2021-001396] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/19/2021] [Indexed: 01/03/2023] Open
Abstract
Recent research demonstrates that transfusing whole blood (WB=red blood cells (RBC)+plasma+platelets) rather than just RBC (which is current National Health Service (NHS) practice) may improve outcomes for major trauma patients. As part of a programme to investigate provision of WB, NHS Blood and Transplant undertook a 2-year feasibility study to supply the Royal London Hospital (RLH) with (group O negative, 'O neg') leucodepleted red cell and plasma (LD-RCP) for transfusion of trauma patients with major haemorrhage in prehospital settings.Incidents requiring such prehospital transfusion occur randomly, with very high variation. Availability is critical, but O neg LD-RCP is a scarce resource and has a limited shelf life (14 days) after which it must be disposed of. The consequences of wastage are the opportunity cost of loss of overall treatment capacity across the NHS and reputational damage.The context was this feasibility study, set up to assess deliverability to RLH and subsequent wastage levels. Within this, we conducted a quality improvement project, which aimed to reduce the wastage of LD-RCP to no more than 8% (ie, 1 of the 12 units delivered per week).Over this 2-year period, we reduced wastage from a weekly average of 70%-27%. This was achieved over four improvement cycles. The largest improvement came from moving near-expiry LD-RCP to the emergency department (ED) for use with their trauma patients, with subsequent improvements from embedding use in ED as routine practice, introducing a dedicated LD-RCP delivery schedule (which increased the units ≤2 days old at delivery from 42% to 83%) and aligning this delivery schedule to cover two cycles of peak demand (Fridays and Saturdays).
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Affiliation(s)
- Josephine McCullagh
- NHS Higher Specialist Scientist Training (HSST), DClinSci Programme, The University of Manchester, Manchester, UK .,Pathology, Barts Health NHS Trust, London, UK
| | - Nathan Proudlove
- Alliance Manchester Business School, The University of Manchester, Manchester, UK
| | - Harriet Tucker
- Blizard Institute, Queen Mary, University of London, UK, London, UK
| | - Jane Davies
- Manufacturing and Development, NHS Blood and Transplant, Bristol, UK
| | - Dave Edmondson
- Manufacturing and Development, NHS Blood and Transplant, Bristol, UK
| | | | | | - Anne Weaver
- Major Trauma Centre, Barts Health NHS Trust, London, UK
| | - Ross Davenport
- Blizard Institute, Queen Mary, University of London, UK, London, UK.,Major Trauma Centre, Barts Health NHS Trust, London, UK
| | - Laura Green
- Pathology, Barts Health NHS Trust, London, UK.,Blizard Institute, Queen Mary, University of London, UK, London, UK.,Blood Component Department, NHS Blood and Transplant, London, UK
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Lee HJ, Oh SH, Jo SY, Kim IS. Platelet Inventory Management Program: Development and Practical Experience. Ann Lab Med 2021; 41:95-100. [PMID: 32829584 PMCID: PMC7443520 DOI: 10.3343/alm.2021.41.1.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/02/2020] [Accepted: 08/02/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Patients with ongoing or expected bleeding require platelet (PLT) transfusions; however, owing to the testing required after a blood donation, manufacturing PLT products may take 1.5-2.0 days after a request is made. This supply-demand mismatch leads clinicians to retain spare PLTs for transfusions, leading to increased PLT discard rates. We developed a PLT inventory management program to supply PLTs more efficiently to patients requiring PLT transfusions within the expiration date, while reducing PLT discard rates. METHODS PLT concentrates (58,863 and 58,357 units) and apheresis products (7,905 and 8,441 units) were analyzed from May 2015 to November 2017 and from December 2017 to January 2020, respectively. We developed a program to manage total PLT inventories and prospective PLT transfusion patients based on blood type, blood product, and remaining period of efficacy; the program facilitates PLT preparation transfer to non-designated patients within the remaining period of efficacy. RESULTS The overall PLT concentrate discard rate was 3,254 (2.78%): 1,811 (3.07%) units before and 1,443 units (2.41%) after program application (P<0.001). The discard rate owing to expiration was reduced from 69 units (3.81%) before to two units (0.14%) after program application (P<0.001). CONCLUSIONS This program can guide the allocation of PLT preparations based on the remaining period of efficacy, enabling PLT products to be used before their expiration date and reducing PLT product discard rate.
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Affiliation(s)
- Hyun-Ji Lee
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung-Hwan Oh
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su-Yeon Jo
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - In-Suk Kim
- Department of Laboratory Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Martínez-Botía P, Acebes-Huerta A, Seghatchian J, Gutiérrez L. On the Quest for In Vitro Platelet Production by Re-Tailoring the Concepts of Megakaryocyte Differentiation. ACTA ACUST UNITED AC 2020; 56:medicina56120671. [PMID: 33287459 PMCID: PMC7761839 DOI: 10.3390/medicina56120671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022]
Abstract
The demand of platelet transfusions is steadily growing worldwide, inter-donor variation, donor dependency, or storability/viability being the main contributing factors to the current global, donor-dependent platelet concentrate shortage concern. In vitro platelet production has been proposed as a plausible alternative to cover, at least partially, the increasing demand. However, in practice, such a logical production strategy does not lack complexity, and hence, efforts are focused internationally on developing large scale industrial methods and technologies to provide efficient, viable, and functional platelet production. This would allow obtaining not only sufficient numbers of platelets but also functional ones fit for all clinical purposes and civil scenarios. In this review, we cover the evolution around the in vitro culture and differentiation of megakaryocytes into platelets, the progress made thus far to bring the culture concept from basic research towards good manufacturing practices certified production, and subsequent clinical trial studies. However, little is known about how these in vitro products should be stored or whether any safety measure should be implemented (e.g., pathogen reduction technology), as well as their quality assessment (how to isolate platelets from the rest of the culture cells, debris, microvesicles, or what their molecular and functional profile is). Importantly, we highlight how the scientific community has overcome the old dogmas and how the new perspectives influence the future of platelet-based therapy for transfusion purposes.
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Affiliation(s)
- Patricia Martínez-Botía
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (A.A.-H.)
- Department of Medicine, University of Oviedo, 33003 Oviedo, Spain
| | - Andrea Acebes-Huerta
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (A.A.-H.)
| | - Jerard Seghatchian
- International Consultancy in Strategic Safety/Quality Improvements of Blood-Derived Bioproducts and Suppliers Quality Audit/Inspection, London NW3 3AA, UK;
| | - Laura Gutiérrez
- Platelet Research Lab, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain; (P.M.-B.); (A.A.-H.)
- Department of Medicine, University of Oviedo, 33003 Oviedo, Spain
- Correspondence:
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