Blood Utilization and Waste Following Implementation of Thromboelastography

Background: Thromboelastography (TEG) is a viscoelastic testing platform that monitors real-time coagulation. This study evaluated changes in blood use and waste following TEG implementation, as well as changes in massive transfusion protocol (MTP) blood utilization and returns following TEG implementation. Methods: The study is a retrospective analysis of blood component transfusion in 3 services (cardiothoracic surgery, emergency department, and trauma surgery) and overall blood waste at a level II trauma center for 104 weeks before and after TEG implementation. Blood utilization and waste were compared by a paired t-test. Additionally, MTP blood utilization and returns were compared for 80 cases pre-TEG and 80 cases post-TEG implementation by an independent t-test. Results: Changes in weekly mean utilization after implementation of TEG differed among component types. Red blood cell (RBC) transfusions increased by 15% (P < 0.01), while plasma transfusions decreased by 26% (P < 0.05). The mean RBC units wasted decreased (P < 0.01), but the mean plasma units wasted increased significantly between the pre- and post-TEG groups (P < 0.001). The weekly mean platelet and cryoprecipitate waste and utilization showed no significant difference between the pre- and post-TEG groups. MTP utilization and returns showed no significant difference between pre- and post-TEG implementation. Conclusions: In line with previous literature, plasma utilization decreased post-TEG implementation. Plasma waste unexpectedly increased, which may be due to an increase of orders for plasma that were not transfused. RBC utilization and waste showed significant changes, although the impact of blood availability during the COVID pandemic should be considered a confounding variable in this study.