Time-based analysis of the apheresis platelet supply chain in England

Is Platelet Expiring Out of Date? A Systematic Review

Current platelet concentrates are perishable blood products with short shelf lives. Combined with often unpredictable demand, this results in platelet inventory management problems, manifested by high rates of outdating frequently reported at 10% to 20%, and sometimes inadequate clinical supply. The objective of this study was to critically review the published methodologies on measures to reduce platelet outdating rates, in order to determine how platelet outdating and availability can be improved. We performed a systematic review of journal articles published in English to May 2019 identified from MEDLINE, with reported methods to improve platelet inventory outdating rates and availability. The complexity of each methodology was scored based on whether a typical blood bank manager could design, implement and run a platelet outdating program based on the methodology. Twenty-four relevant citations were found-these included 8 citations employing operational research (OR) methodologies, 7 evaluation/best practice, 6 simulation and 3 forecasting. Over half the included studies have been published within the last decade. The citations reporting the lowest predicted outdating were also the most complex methods. Overall predicted outdating and shortages were less than 4% based on the available data. In conclusion, we found that research interest in platelet inventory management problems has increased in line with platelet demand and methods to assist in reducing outdating rates without increased shortages have been available now for 4 decades; high rates of platelet outdating do however continue to be reported around the world. Developments in platelet preparation and storage, and other new approaches, may assist in addressing this problem.

Implications of a switch to a 100% apheresis platelet supply for patients and for blood donors: a risk benefit analysis

BACKGROUND

A 100% apheresis platelet supply is considered to increase transfusion safety by lowering donor exposures for transfusion recipients. We performed a risk benefit analysis to contrast the reduction of donor exposures and the risk of contaminated blood products in the nation-wide inventory with the donor risks associated with a switch to a 100% apheresis platelet supply in Germany.

METHODS

Donor exposures and the number of contaminated blood products resulting from HIV-like, HBV-like, HCV-like pathogens and two theoretical agents with infection rates of 10 and 1000 in 100 000, respectively, were calculated for a 100% apheresis platelet supply in Germany based on the 2006-2012 hemovigilance reports. These numbers were compared with the current mixed platelet supply of pooled and apheresis platelets. Moreover, additional donation time and apheresis donor complications resulting from a 100% apheresis platelet supply were estimated.

RESULTS

Per million total blood products (red cells, platelets, fresh frozen plasma), a 100% apheresis platelet supply would reduce donor exposures by 87 100 and the number of contaminated blood products ranging from 0·8 to 871·1. On the other hand, this requires additional 29 478 apheresis donations, 3·4 years additional donor time, and would be associated with 58 additional donor complications, respectively.

CONCLUSIONS

A 100% apheresis platelet supply would reduce donor exposures and the number of contaminated blood products in the inventory, but would increase apheresis complications in donors. Potential risks for patients must be carefully weighed against the risks for donors, dependent on the specific pathogen scenario.