Cryoprecipitate utilisation, shortages and institutional policies in the United States: A survey of practices and policies.

BACKGROUND

Since the COVID-19 pandemic, demand for blood products has remained high, while donations have declined. Institutional policies guiding the use of these products may affect their availability, utilisation and waste. We surveyed blood banks (BBs) in the United States (U.S.) to assess policies and practices related to cryoprecipitate compatibility and to characterise experiences with administration, shortages and waste.

METHODS

An 11-question online survey was distributed to U.S. BBs via Qualtrics. Responses were exported to Excel and analysed using descriptive statistics. Variables are reported as frequencies and percentages.

RESULTS

Of 241 BBs, 82 responded (34%). Thirty-seven (45%) served community hospitals, 31 (38%) served academic hospitals and 55 (69%) served both adult and paediatric populations. Thirty (38%) BBs reported preferentially administering ABO type-specific cryoprecipitate when available, although none reported restricting transfusion exclusively to type-specific units under all circumstances. Eighteen (23%) limited the number of out-of-group units per patient within 24 h. Ten (13%) BBs reported shortages occurring at least 3-5 times per year. During shortages, 25 (61%) BBs proactively screened orders, and 14 (34%) used fibrinogen concentrate as an alternative. Annual wastage varied, with 12 (15%) BBs discarding more than 50 pooled units, often because unused units were thawed for massive transfusion protocols (MTPs). Strategies to reduce wastage included thawing units later in the MTP cycle, proactive order screening and supplementation with fibrinogen concentrate.

CONCLUSION

Although a subset of BBs reported substantial shortages of cryoprecipitate, some institutions reported significant waste. Targeted strategies, such as limiting units administered, proactively reviewing orders, offering alternative products and modifying thawing policies for MTPs, may improve efficiency and reduce waste.