Association of a Platelet Shortage with process and clinical outcomes

Little is known about how platelet shortages impact patient care and outcomes. In the summer of 2024, a ransomware event substantially impacted blood product processing capacity in South Florida, creating a natural experiment to evaluate such a shortage.

We conducted a retrospective study of platelet test results-categorized as <10,000/μL (universal transfusion recommendation), 10,000-49,000/μL (equivocal transfusion indication), and ≥50,000/μL (transfusion rarely indicated)-from adults hospitalized at the University of Miami Hospital and Clinics during (July 29-August 4) versus pre- (July 1-July 28) or post- (August 5-September 1) shortage.

We included 26,457 platelet results-46.3% pre-, 11.3% during, 42.3% post-shortage-from 3605 hospitalizations. Platelet counts of 10,000-49,000/μL in the pre- (odds ratio [95% confidence interval]: 3.05 [1.43, 6.51]) and post- (2.89 [1.27, 6.60]) periods were more often followed by transfusions within 6 h than during the shortage. No difference was observed following platelet counts <10,000/μL or ≥50,000/μL. We found no statistically significant difference in hospital mortality or hemorrhage across periods. However, during the shortage mortality was numerically higher (20.0% vs. pre: 15.2%, post: 18.3%) and hemorrhage was lower (0.0% vs. pre: 19.0%, post: 18.3%) for hospitalizations with nadir platelet counts of 10,000-49,000/μL.

Shortage conditions were associated with fewer platelet transfusions following counts of 10,000-49,000/μL without significant patient harm. These findings suggest that, with sufficient resources, it is possible to change practice quickly and that guideline-concordant care for platelet transfusions may reduce waste while maintaining quality.