Use of Half RBC Units in Oncology Patients during Severe RBC Shortage to Extend Hospital Supply

ABSTRACT

Background/Case Studies Blood supply during the COVID-19 pandemic was at record lows due to blood drive cancellations, fear of contracting COVID-19, and COVID-19 donor deferrals. Splitting platelet units is a well-known method of extending platelet supply. Due to the blood type O RBC shortage during the pandemic, we split one RBC unit into two half-units to extend the RBC supply. RBC splitting has been utilized in pediatric and fluid overloaded patients, however there is no research demonstrating the effectiveness of RBC splitting to extend RBC supply. Study Design/Methods: We examined transfusion data on half and whole RBC units transfused from May 21, 2021 to November 1, 2021. The criteria for half-unit transfusion were dependent on the blood supply. In general, if there was less than one day supply of RBC units on hand, half-units were issued for stable, non-bleeding patients with hemoglobin above 7.0 g/dL in outpatients and 6.5 g/dL in inpatients. During the study period if a patient received any half RBC units, the time between the first half-unit transfused to the next RBC transfusion within the next 90 days was noted. If a patient received only whole units during this time, we observed the time from the first RBC transfusion to the next RBC transfusion in the subsequent 90 days. Pre-transfusion hemoglobin was obtained the day of the transfusion and posttransfusion hemoglobin was obtained either the day of or day after the RBC transfusion. Results/Findings: Over 6 months, 276 patients received only whole units and 229 patients received at least one halfunit. The median number of days to next transfusion in patients who received a transfusion within 90 days after a half-unit was 3 (mean 6.7 +/- 11.4) and whole unit was 5 (mean 11.8 +/- 16.7) (p <0.001). There were 38 (16.6%) patients who did not receive a transfusion within 90 days of first transfusion after a half-unit and 62 (22.5%) patients after a whole unit. The median pre-transfusion hemoglobin in those transfused half-units was 6.9 (mean 6.9 +/- 0.5) g/dL and whole units 7.0 (mean 7.2 +/- 1.3) g/dL (p <0.001). The median hemoglobin prior to the second transfusion was 6.8 (mean 6.8 +/- 0.6) g/dL in those previously transfused halfunits and 7.0 (mean 7.2 +/- 1.1) g/dL after a previous whole unit (p <0.0001). Of those transfused half-units, 46.7% received a second unit within 3 days, 56.8% within 5 days and 65.9% within 7 days. After a whole unit, 30.4% received a second unit within 3 days, 37.3% within 5 days and 44.9% within 7 days. Conclusion(s) Our study demonstrates the use of half RBC units can extend RBC inventory in the short term. Patients transfused half-units received a second transfusion earlier than those who received a whole unit, median 3 days versus 5 days after whole unit (p <0.001).