Best Practice for Special Product Inventory Management
facilitated by Audrey Savage, Terry Haines and Heather Aplin

The workshop was run twice during the day.  Audrey gave a short presentation before participants split into groups to discuss the topics for discussion.

Topics for discussion
1 Should we be holding stocks of CMV neg and/or irradiated units?
2 Should we hold a stock of phenotyped units?
3 Holding increased stocks vs the cost of adhoc deliveries vs wastage.
4 How do we handle requests related to neonates, children/young people?

Outcome of the discussion

1. Should we be holding stocks of CMV neg and/or irradiated units?
Important issues
• Source CMV neg from stock
• Irradiated units are ordered on a named patient basis.
• Currently do not give CMV neg to pregnant ladies.
• Speak to nurses from Haematology clinic to prepare a list of products required a week in advance.
• The distance from the Regional Transfusion Centre (RTC) will affect the levels of stock held
• The number of routine deliveries will have a bearing on the level of stock held
• Keeping more stock may skew levels of group O.
• NBS should facilitate the acceptance that Leucocyte depleted = CMV negative
• Some of the larger hospitals try to establish the CMV status of transfusion dependent patients,
• Depends on patient group
• Impact of the threat of terrorism
• Low % of CMV neg available for group B, non existent for group AB.
• Should all platelets be irradiated?

Summary of main points:
The distance from the RTC has a big impact on the level of stock held, this may change with the re-configuration of the RTC’s with most hospitals increasing the amount of stock they hold.
All hospitals hold a % of CMV neg units but order Irradiated units on a named patient basis.
Good communication with clinicians treating patients who are regularly receiving blood products is extremely useful both for the laboratory and the RTC to plan ahead.
Do the guidelines need to review the benefits and risks of transfusing CMV neg products or not to certain patient groups? It is beneficial to determine the CMV status of transfusion dependent patients.
 
2. Should we hold a stock of phenotyped units?
Important issues
• Some hospitals hold stocks for patients with known antibodies that are transfused regularly, others do not.
• For patients with Sickle cell or Thal
• R1RI  Kell neg for females
• Distance of the hospital from the RTC
• Availability of the units from the RTC
• Clinical significance
• Not all units issued from the blood service are labeled with confirmed phenotype
• Historical information via Electronic Delivery Note would be useful
• Conflicting feedback on group substitution the morning workshop identified that it should not be necessary for planned transfusions and is only acceptable if unavoidable and the afternoon workshop identified that it was acceptable
• Depends on size of hospital
• Segregate R1R1 O’s and A’s
• Pre ordering for named patients
• More phenotyping information is required i.e. EDN

Summary of main points:
Once again the size of the hospital and the distance from the RTC had a big influence on the volume and type of phenotyped units held.
Most hospitals regardless of size try to segregate R1R1 Kell negative units for females <50 years of age.
Larger hospitals treating multi transfused patients such as Sickle or Haematology patients should try to maintain stocks for these patients, communication with clinicians is vital to achieve this.
Most people felt that a degree of group substitution was acceptable but this practice could be avoided with better planning.
Smaller hospitals and those remote from the RTC were more in favor of group substitution.
More phenotype information on units would be a great benefit (EDN)

3. Holding increased stocks vs the cost of ad-hoc deliveries vs wastage.
 Important issues
• Distance from RTC.
• Size of hospital
• Communication with users
• Problems when large volumes are ordered for a named patient and cannot be returned
• Short dated irradiated units are put into stock.
• Sharing stock between hospitals causes problems with ‘cold chain’
• Depends on patient group
• Good communication / advance notice
• Timing of deliveries
• Use short dated irradiated units rather than waste them

Summary of main points:
Size of hospital and distance from RTC had a big influence on the level of stock held. Most hospitals felt that sharing stock with a neighbouring hospital was a good idea but most expressed concerns around maintaining the ‘cold chain’.
Also if hospitals were in not in the same Trust finance could be a problem. Perhaps within regions there needs to be clearer policies and procedures covering transportation of blood between hospitals?
Are SLA’s required between Trusts for such transfers? Everyone agreed that using short dated irradiated units as stock was acceptable.

4. How do we handle requests related to neonates, children/young people?
 Important issues
• Type of Trust
• Proximity to the RTC
• NBS Centre needs to reflect the stock requirement of their hospitals.
• Communication: patient electronic records should be transferable between Trusts.
• Keep different groups of MB FFP not just AB
• Request split packs of other blood groups not just O’s
• Those with neonates and children stock MB FFP, some stock only AB, others stock all groups.
• BCSH guidelines recommend that non group O children should not receive group O platelets; however there are no group B or AB neonatal platelets available.
• Paedipacks: all hospitals represented were relatively close to RTC’s so didn’t have any problems. All hospitals with neonatal workload held a stock.
• If a paedipack is transfused to a patient the remaining 3 or 7 (depending on predicted usage) are held for that patient.
• No one holds a stock of neonatal platelets.
• Stock sharing should be encouraged
• Good planning / communication
• Order on a named patient basis

Summary of main points:
Hospitals with a neonatal or childrens unit hold a stock of MB treated products, some only stock AB.
There is a lack of group B and AB neonatal platelets although presumably if there was a specific need for a named patient and enough warning given they could be prepared?
All centers reserve paedipacks from a specific donor for a neonate receiving multiple transfusions.
This does lead to increased wastage but is considered acceptable to reduce donor exposure.
It was suggested that it would be beneficial to have paedipacks available in blood groups other than O. In N Ireland O and A and RhD pos and neg paedipacks are available)