Outpatient Transplant Management Affects ANC Recovery Data Endpoin

Outpatient Transplant Management Affects ANC Recovery Data Endpoints

Rebecca Evans, Jessica Matthias and Barbara Kutchmarek, Blood and Bone Marrow Transplant Program, University of Wisconsin Hospital and Clinics, Madison, WI

We noted an increase in number of days to ANC recovery in the autologous transplant patient population. In order to determine the cause, we developed an audit plan comparing time to ANC recovery in autologous transplants performed in CY 2003 (n=33) and CY 2013 (n=72). A change in clinical practice was discovered. In 2003, the majority of patients were inpatient at the time of the first lab value demonstrating ANC ≥0.5 x 10⁹/L. If they were discharged prior to ANC ≥ 0.5 x10⁹/L, patients returned for daily lab draws until the first of the three consecutive lab value of ANC ≥ 0.5 x10⁹/L was reached. In 2013, many patients were discharged prior to ANC recovery. None of these patients discharged prior to ANC ≥ 0.5 x10⁹/L returned for daily lab draws. For patients in this subset, we discovered a gap in the number of days between their last lab showing ANC < 0.5 x10⁹/L and their first lab showing ANC ≥ 0.5 x10⁹/L. The upward trend in days to ANC recovery was not because of delayed ANC recovery, but due to increasing days between lab draws.

Table 1: ANC Recovery Comparison

	2003 (n = 33)	2013 (n = 72)
ANC Recovery Inpatient	26 (79%)	45 (63%)
ANC Recovery Post-Discharge	7 (21%)	27 (38%)
Daily Labs Drawn Until ANC ≥ 0.5 x109/L Post-Discharge	5 (15%)	0
ANC ≥ 0.5 x109/L With Non-Daily Lab Draws	2 (6%)	27 (38%)
ANC ≥ 0.5 x109/L With Daily Lab Draws	31 (94%)	45 (63%)
Days between last lab ANC < 0.5 x109/L <500 and first lab ANC ≥ 0.5 x109/L	1-2	1-19

Table 2: Days to ANC Recovery

	2003 (n=33)	2013 (n=72)	2013 Daily Labs (n=45)	2013 Non-Daily Labs (n=27)
Average	11	15	12	21
Median	11	13	11	20
Range	9-15	10-42	10-16	15-42

We propose adding a reporting field to capture date of last lab showing ANC < 0.5 x10⁹/L. This would help identify when a delay in lab draw occurred leading to the realization that ANC recovery may have been earlier than indicated.