title: Comparison of two platelet transfusion strategies to minimize ABO-nonidentical transfusion, outdating, and shortages using a computer-simulated "virtual blood bank".
abstract: BACKGROUND
  Transfusion of ABO-incompatible platelets (PLTs) is associated with reduced PLT recovery and a risk of transfusion reactions. However, a policy of transfusing only ABO-identical PLTs may increase wastage due to product outdating. A prospective study attempting to compare the effects of different ABO compatibility strategies could be costly and disruptive to a blood bank's operations.
  
  
  METHODS
  We designed a "virtual blood bank," a stochastic computer program that models the stocking and release of products to meet demand for PLT transfusion in a simulated hospital population. ABO-nonidentical transfusions (ABOni), outdates, and inventory shortages were recorded and compared under two different transfusion strategies: ABO-First, a strategy that prioritizes transfusion of ABO-identical PLTs, and Age-First, a strategy that minimizes outdating by transfusing products closest to expiration.
  
  
  RESULTS
  The ABO-First strategy resulted in fewer ABOni but more outdates than the Age-First strategy. Under conditions that mimic a large hospital blood bank, the ABO-First strategy was more cost-effective overall than the Age-First strategy if avoiding an ABOni is valued at more than $19 to $26. For a small blood bank, the ABO-First strategy was more cost-effective if avoiding an ABOni is valued at more than $104 to $123.
  
  
  CONCLUSIONS
  Based on a virtual blood bank computer simulation, the cost of avoiding an ABOni using the ABO-First strategy varies greatly by size of institution. Individual blood banks must carefully consider these management strategies to determine the most cost-effective solution.
authors.affiliation: Department of Pathology & Immunology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Ronald
authors.initials: R
authors.lastname: Jackups
authors.forename: Steven
authors.initials: S
authors.lastname: Kymes
mesh_terms: D000017:ABO Blood-Group System; D000094902:Blood Banking / Q000379:methods*; D001787:Blood Group Incompatibility / Q000517:prevention & control; D001788:Blood Grouping and Crossmatching; D003198:Computer Simulation; D006801:Humans; D008962:Models, Theoretical; D017713:Platelet Transfusion / Q000379:methods*
chemical_list: D000017:ABO Blood-Group System