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Comparison of two platelet transfusion strategies to minimize ABO-nonidentical transfusion, outdating, and shortages using a computer-simulated “virtual blood bank”




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.

Study Design and 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.


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.


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.