The great East Japan earthquake of March 11, 2011, from the vantage point of blood banking and transfusion medicine

A robust optimization model for multi-objective blood supply chain network considering scenario analysis under uncertainty: a multi-objective approach

Annually, different regions of the world are affected by natural disasters such as floods and earthquakes, resulting in significant loss of lives and financial resources. These events necessitate rescue operations, including the provision and distribution of relief items like food and clothing. One of the most critical challenges in such crises is meeting the blood requirement, as an efficient and reliable blood supply chain is indispensable. The perishable nature of blood precludes the establishment of a reserve stock, making it essential to minimize shortages through effective approaches and designs. In this study, we develop a mathematical programming model to optimize supply chains in post-crisis scenarios using multiple objectives. Presented model allocates blood to various demand facilities based on their quantity and location, considering potential situations. We employ real data from a case study in Iran and a robust optimization approach to address the issue. The study identifies blood donation centers and medical facilities, as well as the number and locations of new facilities needed. We also conduct scenario analysis to enhance the realism of presented approach. Presented research demonstrates that with proper management, crises of this nature can be handled with minimal expense and deficiency.

Evaluating the Effect of Inert Recruiting on Blood Donations Immediately After the Consecutive Earthquakes

OBJECTIVE

Disasters can have impact on the demand and supply of blood, with such a difficult perspective, planning of an appropriate response to counterbalance the need for blood is of paramount importance. The primary objective of this study was to evaluate how the impact of blood imbalances may be absorbed by inert recruitment of donors during 2 life-threatening earthquakes that shook Taiwan on the same date in 2016 and 2018.

METHOD

A retrospective database search from blood bank registries was developed.

RESULTS

Despite the public efforts to restrain the flow, a 3- to 4-fold increase in volunteers responded to the earthquakes. This surge alleviated after a day and did not contribute to sub-par collections. Those who donated more than usual immediately after the event were identified as first-time, younger, and female populations. The hospitals providing inpatient care to the injured transfused a slightly decreased amount of packed red cells, whereas the use of whole blood, platelets, and plasma remained stable. The inert recruiting was effective in reducing the duration of donor overabundance.

CONCLUSION

Compared with other examples, the inert recruiting approach was effective in reducing the duration of donor overabundance to 1 day and may be useful for disaster preparedness of transfusion supplies.

Blood transfusions in mass casualty events: recent trends

BACKGROUND AND OBJECTIVES

The US AABB disaster task force recommends estimating 3 RBC units per admission (UPA) for mass casualty events (MCEs). In a previous analysis, median MCE UPA were 2·7 RBCs, 1·2 plasmas and 0·27 platelet doses (Vox Sang 2017; 112:648). Additional recent data were sought from the current era of balanced massive transfusion protocols (bMTPs).

MATERIALS AND METHODS

Publications in English from 1980 to 2020 were reviewed for MCEs using ≥50 RBCs/event and with numbers of admissions available. MCE reports were stratified by era and event-wide or trauma-centre source. The bMTP era included all MCEs since 2010 plus a 2008 bMTP military report.

STATISTICS

Mann-Whitney test.

RESULTS

Thirty-two MCEs met analysis criteria. Event-wide reports used medians [interquartile ranges] of 1·8 [1·2-3·9] RBC, 0·6 [0·3-0·9] plasma and 0·14 [0·06-0·26] platelet-dose UPA. Trauma centres transfused 3·4 [2·7-6·3] RBC, 2·4 [1·3-4·1] plasma and 0·41 [0·34-0·50] platelet-dose UPA, all P < 0·05 vs event-wide. Same-event median post-day-1 transfusions were 50% of day-1 use for RBC, 28% for plasma and 16% for platelets. Compared to prior years, the median plasma/RBC transfusion ratio rose from 0·28 to 0·67 in the bMTP era (P < 0·01). In recent mass shootings, trauma centres transfused up to 42 platelets (range 0·45-0·57 UPA) on day 1.

CONCLUSION

Based on available mass casualty data, we recommend planning for 3 RBC, 1 plasma and one-fourth platelet-dose units per admission for blood centres (event-wide), and 6, 4 and one-half UPA, respectively, for trauma centres, which have seen rising plasma usage and large mass-shooting platelet needs.

Blood bank preparedness for mass casualty incidents and disasters: a pilot study in the Piedmont region, Italy

BACKGROUND AND OBJECTIVES

Blood is a critical resource for responding to mass casualty incidents (MCI). The main framework for transfusion preparedness is the American Association of Blood Bank (AABB) Disaster Operation Handbook. A disaster preparedness plan for co-ordinated blood supply was issued in Italy in 2016.

AIM

To assess the level of preparedness of the Transfusion Centers (TS) in the Piedmont region, to evaluate the applicability of AABB checklist and to evaluate the application of the Italian plan.

MATERIALS AND METHODS

We surveyed all the Regional Transfusion Centers (TS) using the AABB checklist, addressing 74 priority action items grouped according to 16 preparedness domains. The Italian 2016 plan has been considered the regulatory cut-off and hospitals were stratified based on the type and the TS workload. A principal component analysis (PCA) was conducted to summarize the variance among centres.

RESULTS

Twenty-one out of 25 TS agreed to participate. Eighty-one % were at high and 18% were at medium level of preparedness. All but two centres were above the cut-off determined by the Italian law. A significant better preparedness was found in medium size hospitals compared to bigger and smaller hospitals. Other than that, the different TS showed a quite homogeneous distribution of preparedness variance.

CONCLUSIONS

This study demonstrated a good level of preparedness in the Piemonte TS, above the Italian law requirements in the majority of TS. The AABB checklist could be used to highlight gaps and needs in the regional TS networks in case of emergency crisis.

Transfusion under triple threat: Lessons from Japan's 2011 earthquake, tsunami, and nuclear crisis

The Great East Japan Earthquake of March 11, 2011 provoked tsunami waves with inland penetration up to 5 km and run-up heights to 40 m. More than 400 km² were flooded, mainly along the northeast coast of Japan's largest island, Honshu. Nearly 20,000 human lives were abruptly taken by this natural disaster. Four coastal nuclear facilities went into automatic shutdown; at one, Fukushima Daiichi, cooling system failures resulted in the meltdown of three reactor cores, accompanied by explosive release of radioisotopes. Essentials of modern blood banking and transfusion medicine were lost: roads, vehicles, blood collection venues, and facilities for blood testing and processing. Normal channels of communication were interrupted, not only by physical damage but also due to circuit overload as mobile phone users sought information and tried to exchange messages about their own and others' health, welfare, and whereabouts. The Japanese Red Cross, as a monopoly supplier of allogeneic blood, responded with a nationally coordinated effort that met the transfusion demands of a disaster characterized by immediate mass fatality rather than mass injury. Japan's routine transfusion demands are also met by hospital-based autologous blood programs, which could be pressed into service for emergency allogeneic collections. Herein we report institutional and personal experience in anticipation of future disasters, in which transfusion needs might differ from routine demand.

Blood Donor Deferral among Students in Northern Japan: Challenges Ahead

BACKGROUND

As Japan's aging society needs more blood, young students comprise a progressively smaller portion of the donor pool. To ensure a safe and sustainable blood supply, it is crucial to select suitable donors. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese students.

METHODS

Computerized records of blood centers in northern Japan (Miyagi and Fukushima Prefectures) from March 2010 through March 2011 were retrospectively analyzed.

RESULTS

Among 231,361 individuals visiting during the 12-month period, 24,778 were students. Of these, 19,193 (77%) attempted donation, and 5,585 (23%) were deferred. Low hemoglobin, questionnaire-based interview decisions, and medication were the main reasons for temporary deferral. Age, sex, and blood center location were associated with low hemoglobin; donation history and blood center location were associated with medication-based deferral. The odds ratio among female students deferred for low hemoglobin was 35.48 with a 95% CI of 27.74-45.38.

CONCLUSIONS

These results suggest that continued efforts are needed to motivate deferred potential donors to return, to prevent low hemoglobin especially among females, and to review medical interview decisions, while paying close attention to regional differences.

Analysis of blood donor deferral in Japan: characteristics and reasons

BACKGROUND AND OBJECTIVES

To ensure an adequate and safe blood supply, it is crucial to select suitable donors according to stringent eligibility criteria. This study aims to evaluate donor deferral rates, causes of deferral, and characteristics of deferred Japanese donors.

MATERIALS AND METHODS

Computerized records of blood centers in Miyagi and Fukushima Prefectures from March 2010 through March 2011 were retrospectively analyzed.

RESULTS

Among 231,361 individuals presenting during this period, 186,513 had complete data. Of these 160,763 (86%) attempted donation and 25,750 (14%) were deferred. The overall proportion of deferrals was higher among those less than 20 years old (24% vs 13%, P<0.0001), female (26% vs 7%, P<0.0001), and first-time donors (28% vs 12%, P<0.0001). Factors that were significantly associated with deferral status were female sex [Odds ratio (OR)=4.40], first-time donation attempt (OR=2.42), and donation at Fukushima blood centers (OR=0.57). Main reasons for temporary deferral were low hemoglobin and questionnaire-based interview decisions.

CONCLUSIONS

First-time and female were more frequently deferred whereas those presented at Fukushima blood centers were less frequently deferred. Low hemoglobin was the major contributor for female donors. Strategies to minimize deferral are needed to ensure an adequate and safe blood supply.

WITHDRAWN: When all else fails: 21st Century Amateur Radio as an emergency communications medium

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.transci.2013.08.002. The duplicate article has therefore been withdrawn. The Publisher expresses their sincere apologies to the authors and the editors for this error.