Blood Transfusion Protocol Significantly Reduces Blood Product Waste

Kristen Harris,1 Afif Kraitem,1 Jonathan Tucci,2 Kaycie Atchison,3 HollyEnde,1 Laura Sorabella1

1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, 2. Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, 3. Quality, Safety, and Risk Prevention, Vanderbilt University

Medical Center, Nashville, Tennessee

Background Hypothesis

• A structured early resuscitation protocol (OB Fast Pack,

OBFP) can:

• Provide rapid access to blood products in early

hemorrhage

• Reduce unnecessary allocation and waste compared

to immediate MTP activation

• Therefore:

• Implementation of OBFP will decrease blood product

waste

• While preserving timely and effective resuscitation

•Obstetric hemorrhage is a leading cause of maternal

morbidity and mortality worldwide

• Obstetric massive transfusion protocols (MTPs) enable

rapid access to blood products

• Typically 1:1:1 (RBC:FFP:platelets) per ACOG

•Early transfusion is critical, as vital signs and labs may

lag behind clinical need

•However, up to 33% of blood products issued during

MTP activation are unused and wasted

•There is a need for strategies that maintain rapid

access to transfusion while reducing unnecessary

product utilizationStudy Design and Methods

Study Design

• Quality improvement study (pre–post intervention)

• Setting: single-center obstetric service

• Intervention: OB Fast Pack (OBFP) protocol

(implemented December 2024)

• Population:

• Obstetric patients with intrapartum or postpartum

hemorrhage

• Prior to meeting criteria for full OB MTP activation

• Comparison:

• Pre-implementation: standard OB MTP use

• Post-implementation: OBFP + selective escalation

to MTP

Methods

• OBFP protocol:

• Rapid delivery of RBCs, FFP, cryoprecipitate (2:2:1

ratio)

• Optional fibrinogen supplementation

• Patients with ongoing hemorrhage escalated to full OB

MTP

• Blood bank quality team measured:

• Utilization and waste of:

• RBCs, plasma, platelets, cryoprecipitate

• Number of OB MTP activations

• Timeframe:

• First year post-implementation compared to pre-

implementation baselineResults: OB Fast Pack Reduces Obstetric MTP ActivationConclusion and Discussion

• 52% decrease in OB MTP activations following OBFP implementation

•100% reduction in OB MTP-associated blood product waste

•Driven by elimination of platelet and cryoprecipitate waste

•79% lower blood product waste with OBFP compared to pre-implementation MTP use

•Maintained rapid access to transfusion during obstetric hemorrhage

•OBFP provides a structured alternative to immediate MTP activation in early hemorrhage

•Promotes more judicious blood product utilization without compromising safety

•Use of pathogen-reduced cryoprecipitate improves flexibility and reduces waste

•Represents a cost-conscious, scalable approach to optimizing obstetric hemorrhage management