Ann Lab Med.  2023 Mar;43(2):187-195. 10.3343/alm.2023.43.2.187.

Common Data Model-based Analysis of Selective Leukoreduction Protocol Compliance at Three Hospitals

• Choi S
• Choi SJ
• Shin JW
• Yoon YA

• KMID: 2551696
• DOI: http://doi.org/10.3343/alm.2023.43.2.187

Abstract

Background
The selective leukoreduction protocol (SLP) is limited in that patients who require it can be overlooked. We estimated SLP compliance (SLPC) using the Observational Medical Outcomes Partnership common data model (CDM).
Methods
Patients were classified into eight groups: pre- and post-hematology disease (A and B), pre- and post-solid organ transplantation (C and D), solid cancer (E), immunodeficiency (F), anticancer therapy (G), and cardiovascular surgery (H). We examined the red blood cell (RBC) transfusion history from three hospital datasets comprising approximately three million patients over 20 years using CDM-based analysis. SLPC was calculated as the percentage of patients who received only leukoreduced RBCs in total patients transfused RBCs.
Results
In total, 166,641 patients from three hospitals were enrolled in this study. From 2001 to 2021, SLPC in all groups, except H, tended to increase, although there were differences among the hospitals. Based on the most recent values (2017–2021), the SLPC in groups A, B, D, and G was maintained at ≥75% until 1,095 days before or after diagnosis or treatment. Groups E, F, and H had < 50% SLPC one day after diagnosis and treatment.
Conclusions
CDM analysis supports the review of large datasets for SLPC evaluation. Although SLPC tended to improve in most patient groups, additional education and monitoring are needed for groups that continue to show low SLPC.

Keyword

Red blood cell transfusion; Leukocyte reduction; Hematologic disease; Transplantation; Immunodeficiency disease; Dataset

Figure

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  Fig. 1 Overview of the data from the three hospitals uploaded to the CDM database and examples of the data conversion process. Abbreviations: CDM, common data model; RBC, red blood cell; SNOMED, systematized nomenclature of medicine; ICDO3, International Classification of Diseases for Oncology, 3rd edition; CPT4, current procedural terminology fourth edition; LOINC, logical observation identifier names and codes.

• 

  Fig. 2 Calculation process of SLPC using the CDM analysis program. (A) Setting the concept for patients group and RBC transfusion, (B) setting cohort entry event definition and inclusion criteria, (C) NRRBC and/or NLRRBC transfusion data generation using CDM, (D) NLRRBC transfusion data generation using CDM, and (E) SLPC calculation in preSOT group for a year. Abbreviations: SLPC, selective LR protocol compliance; LR, leukoreduced; RBC, red blood cell; CDM, common data model; LRRBC, LR RBC; NLRRBC, non-LR RBC; SOT, solid organ transplantation.

• 

  Fig. 3 Cumulative SLPC change before hematology disease diagnosis (A), after hematology disease diagnosis (B), before SOT (C), after SOT (D), after solid cancer diagnosis (E), after immunodeficiency diagnosis (F), after anticancer therapy (G), and after cardiovascular surgery (H) in patient groups exposed to NLRRBCs in SCHBC, SCHCA, and SCHSU from 2001 to 2021. SLPC was calculated as the percentage of patients who received only leukoreduced RBCs in total patients transfused RBCs. Abbreviations: SLPC, selective LR protocol compliance; LR, leukoreduced; SOT, solid organ transplantation; NLRRBCs, non-LR red blood cells; SCHBC, Soonchunhyang University Bucheon Hospital; SCHCA, Soonchunhyang University Cheonan Hospital; SCHSU, Soonchunhyang University Seoul Hospital.

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  Fig. 4 Subgroup analysis of SLPC in (A) pre-liver, (B) pre-kidney, (C) post-liver, and (D) post-kidney transplantation subgroups of SOT and (E) neonate and (F) non-neonate subgroups of cardiovascular surgery. *Cardiovascular surgery for neonates is not performed at SCHSU. Abbreviations: SLPC, selective LR protocol compliance; SOT, solid organ transplantation; SCHBC, Soonchunhyang University Bucheon Hospital; SCHCA, Soonchunhyang University Cheonan Hospital; SCHSU, Soonchunhyang University Seoul Hospital.

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