Management of blood supplies during an influenza pandemic

The influence of the COVID-19 pandemic on blood donation and supply in China

INTRODUCTION

During the COVID-19 pandemic, there was a sharp decline in blood donation which posed a serious threat to the clinical blood supply worldwide. The aim of this study was to evaluate the influence of the COVID-19 pandemic on blood donation and supply in China on a nationwide level.

METHODS

A comprehensive review of the published literature was performed using eight databases including PubMed, Web of Science, Cochrane Library, Ovid, Embase, CNKI, WANFANG, and VIP by searching relevant words combinations.

RESULTS

Twenty-seven studies were determined to be eligible and included. Among them, 21 studies reported the situation of blood donation during the COVID-19 pandemic in China. The donation of both whole blood and platelet concentrates declined (with a decline of 5%-86% for whole blood and 3%-34% for platelet concentrates), with this especially evident in February 2020. The COVID-19 pandemic changed the pattern of blood donation and the composition of blood donors accordingly. Fifteen articles reported the supply of various blood components during the COVID-19 pandemic. The supply and usage of both packed red blood cell (PRBC) and fresh-frozen plasma (FFP) decreased (with a decrease of 4%-40% for PRBC and 9%-58% for FFP). The proportion of blood transfusions in different departments changed too. Compared to 2019, there was a decrease in surgical blood transfusions, and an increase in that used in treatments performed in emergency and internal medicine departments.

CONCLUSION

The COVID-19 pandemic has led to an overall reduction of blood transfusion activities in most cities in China, in particular blood donations and blood demands.

Hate the Sin, Love the Sinner: Examining the Role of Religiosity on Generation M’s Attitude Toward Purchasing Luxury Counterfeiting Products in Social Commerce

Counterfeiting has become a prevalent business worldwide, resulting in high losses for many businesses. Considerable attention has been paid to research an individual attitude toward purchasing luxury counterfeit products in the offline context. However, there is currently lesser-known literature on the given phenomenon in the context of social commerce. Moreover, researchers observed that counterfeiting consumption is associated with consumer ethical values or beliefs. Practitioners and researchers are keen to find those factors that affect consumers’ ethical consumption behavior to reduce pirated products’ demand. However, the role of religion in shaping ethical behavior is less documented in the counterfeiting context. Therefore, this study investigated the effect of religiosity on the counterfeiting of luxury products in Pakistan. A five-dimensional Islamic religiosity model was adopted to understand the consumption phenomena. For quantitative research, cross-sectional data were collected from the generation M of Pakistan through self-administrative questionnaires. A total of 394 valid responses from active online users were collected to empirically examine the conceptual model by employing the partial least square structural equation model (PLS-SEM). The results reveal that all five dimensions of religiosity negatively affect the attitude of generation M. Moreover, it is found that knowledge has the highest negative effect on attitude, followed by orthopraxis, experience, central duties, and basic duties. The study also explains the theoretical and practical implications of the research. Finally, limitations and future research were also discussed.

Scalable production and complete biophysical characterization of poly(ethylene glycol) surface conjugated liposome encapsulated hemoglobin (PEG-LEH)

Particle encapsulated hemoglobin (Hb)-based oxygen (O2) carriers (HBOCs) have clear advantages over their acellular counterparts because of their larger molecular diameter and lack of vasoactivity upon transfusion. Poly(ethylene glycol) surface conjugated liposome encapsulated Hb (PEG-LEH) nanoparticles are considered a promising class of HBOC for use as a red blood cell (RBC) substitute. However, their widespread usage is limited by manufacturing processes which prevent material scale up. In this study, PEG-LEH nanoparticles were produced via a scalable and robust process using a high-pressure cell disruptor, and their biophysical properties were thoroughly characterized. Hb encapsulation, methemoglobin (metHb) level, O2-PEG-LEH equilibria, PEG-LEH gaseous (oxygen, carbon monoxide, nitric oxide) ligand binding/release kinetics, lipocrit, and long-term storage stability allowed us to examine their potential suitability and efficacy as an RBC replacement. Our results demonstrate that PEG-LEH nanoparticle suspensions manufactured via a high-pressure cell disruptor have Hb concentrations comparable to whole blood (~12 g/dL) and possess other desirable characteristics, which may permit their use as potential lifesaving O2 therapeutics.

Generic approach for mathematical model of multi-strain pandemics

Multi-strain pandemics have emerged as a major concern. We introduce a new model for assessing the connection between multi-strain pandemics and mortality rate, basic reproduction number, and maximum infected individuals. The proposed model provides a general mathematical approach for representing multi-strain pandemics, generalizing for an arbitrary number of strains. We show that the proposed model fits well with epidemiological historical world health data over a long time period. From a theoretical point of view, we show that the increasing number of strains increases logarithmically the maximum number of infected individuals and the mean mortality rate. Moreover, the mean basic reproduction number is statistically identical to the single, most aggressive pandemic strain for multi-strain pandemics.

Reduction in perioperative blood loss using ultrasound-activated scissors during tumour surgery

The aim of this study was to compare the effectiveness of Harmonic Focus+ scissors with the conventional surgical method regarding surgical blood loss and transfusion of blood products in the surgical treatment of head and neck tumours. In a retrospective study, the intraoperative blood loss, number of units of transfusion products given, operating time, and inpatient length of stay of 74 patients with squamous cell carcinoma were compared. Patients who underwent classic tumour surgery were compared with a group treated with Harmonic Focus+ scissors. A significantly lower intraoperative blood loss (496.15 ml vs 1096.0 ml, respectively; P = 0.002) and shorter operation time (436.89 minutes vs 493.13 minutes, respectively; P = 0.030) were achieved using the Harmonic Focus+ scissors when compared to the classic tumour surgery. Additionally, fewer units of blood products needed to be transfused (administration of red cell concentrates, P < 0.001) and the length of stay in the intensive care unit was shorter for patients treated with the Harmonic Focus+ scissors (P = 0.009). The study results indicate that the use of Harmonic Focus+ scissors during surgery for cancer of the oral cavity and pharynx is a safe and cost-effective method. This is of paramount importance during a pandemic when medical resources are scarce, including access to blood reserves.

Development of a scenario-based blood bank model to maximize reducing the blood wastage

INTRODUCTION

Blood is a valuable as well as a perishable commodity that has a limited lifespan. So, keeping it in a blood bank requires careful attention and management. In this study, a management model has been designed for the blood bank that can cover all the requests sent through the hospital subunits in such a way that it has the least waste.

MATERIALS AND METHODS

First, by examining the blood inventory system of a hospital, the number of inventories per month and the distribution of blood products in subunits of the hospital, and the amount of blood wastage every six months were estimated. Then, using ARENA simulation, all parts of the blood bank, including the request section, emergency blood section, donated blood section, and other sections were simulated. Finally, 10 scenarios were extracted by placing various parameters and the best scenarios were discussed and concluded.

RESULTS AND DISCUSSION

The scenarios for the four blood groups included A, B, AB, and O were applied for six months in one year. The results showed that if the amount of blood injected into the blood bank is appropriate and at the right time, the amount of wastage can be reduced by up to 80% for most of the blood groups.

CONCLUSION

The results of this study showed that if the system of receiving blood products built upon a precise management model is predetermined and placed with appropriate parameters, the amount of wastage will be reduced to the minimum possible number.

Motivation zur Vollblutspende während pandemischer Ereignisse

Auch während Pandemien müssen die Blutspendedienste kontinuierlich BlutspenderInnen rekrutieren, um die Versorgung mit Blutprodukten zu gewährleisten. Während im Anschluss an andere Katastrophen wie Erdbeben oder Terroranschlägen die Spendebereitschaft meist sprunghaft ansteigt, zeigte sich in der Vergangenheit bei beginnenden Pandemien zunächst ein Rückgang des Spendenaufkommens. Viele SpenderInnen fürchten eine Infektion oder eine Schwächung ihres Immunsystems und bleiben zu Hause. Auch fällt es den Blutspendediensten zunächst schwer, die gewohnte Anzahl an mobilen Spendeterminen zu organisieren, wodurch das Spendenaufkommen zurückgeht. In der aktuellen SARS-CoV-2-Pandemie betrug dieser Rückgang in vielen Ländern mehr als 10%. SpenderInnen, die auch während einer Pandemie spenden, sind in der Regel erfahrener und besitzen bereits eine ausgebildete Spenderidentiät. Viele dieser SpenderInnen berichten, dass sie gezielt einen Beitrag zur Überwindung der Krise leisten möchten. Auch während einer Pandemie ist demnach eine hohe Solidarität unter BlutspenderInnen zu finden. Potenzielle ErstspenderInnen lassen sich durch die unsicheren Rahmenbedingungen dagegen von einer Spende eher abhalten und es bedarf gezielter Rekrutierungsstrategien unter Einsatz von Social-Media-Kanälen, um neue SpenderInnen zu gewinnen. Erste Befunde unter deutschen BlutspenderInnen lassen hierbei eine hohe Rückkehrintention der ErstspenderInnen erwarten. Um die Blutversorgung auch während einer Pandemie aufrechterhalten zu können, sollten die Blutspendedienste neben der Rekrutierung von ErstspenderInnen versuchen, schnell die Anzahl ihrer Spendetermine zu erhöhen. Die Ansprache bestehender SpenderInnen sollte vor allem die Verunsicherung reduzieren und das Vertrauen in die Blutspendedienste stärken. Je größer das Vertrauen in die Spendeeinrichtung ausfällt, desto geringer ist die Risikowahrnehmung der SpenderInnen. Auch sollten alternative Kontaktwege etwa über Messengerdienste getestet werden, da diese eine schnelle Ansprache erlauben.

Assessing the impact of respiratory infections and weather conditions on donor attendance and blood inventory in Hong Kong

BACKGROUND

Maintaining a stable, safe and sufficient blood supply is crucial to the healthcare system. Every year, seasonal influenza epidemics lead to substantial hospitalizations and pose intense pressure on blood transfusion service worldwide, especially in an ageing population of Hong Kong which often see bi-annual influenza outbreaks. However, limited quantitative studies have been performed to assess the impacts of influenza and other respiratory infections on blood supply.

METHODS

We estimated the impacts of respiratory infections on donor attendance and blood inventory, considering the confounding effects of weather conditions. The method only required influenza-like illness data from the existing sentinel surveillance network, local weather data, donor attendance records from blood transfusion service and blood inventory levels from local healthcare system.

RESULTS

We estimated the number of donor attendance dropped by 6-10% when the number of consultations with influenza-like illnesses (ILIs) reported by sentinel general outpatient clinics exceeded five per 1000 consultations, which is a moderate activity level and has been observed frequently in Hong Kong. Blood inventory decreased with increased ILI consultation rates reported by sentinel general outpatient clinics. Adverse weather conditions had negative impacts on both donor attendance and blood inventory.

CONCLUSION

Epidemics of influenza and other respiratory infections coupled with adverse weather conditions affected blood supply in Hong Kong. The pressure on blood transfusion service to maintain a stable and sufficient blood supply during influenza seasons should not be overlooked, especially in an ageing population of Hong Kong.

An Inter-regional US Blood Supply Simulation Model to Evaluate Blood Availability to Support Planning for Emergency Preparedness and Medical Countermeasures

Objectives

Planning for a response to threats like pandemics or mass casualty events is a national priority. The US blood supply system can be particularly vulnerable to such events. It is important to understand the impacts of emergency situations on blood availability and the resiliency of the US blood supply system.

Methods

On the basis of the Stock-and-Flow simulation model of the US blood supply system, we developed an inter-regional blood transfer system representing the action of multiple blood collectors and distributors to enable effective planning of strategies to minimize collection and donation disruptions to the blood supply system in the event of a national emergency.

Results

We simulated a pandemic or mass casualty event on both a national and an inter-regional blood supply system. Differences in the estimated impacts demonstrated the importance of incorporating spatial and temporal variations of blood collection and utilization across US regions. The absence of blood shortage in both emergency scenarios highlighted the resilience of the inter-regional system to meet the potential associated blood demand.

Conclusions

Our inter-regional model considered complex factors and can be a valuable tool to assist regulatory decision-making and strategic planning for emergency preparedness to avoid and mitigate associated adverse health consequences. (Disaster Med Public Health Preparedness. 2018;12:201–210)

Declining blood collection and utilization in the United States

BACKGROUND

The Department of Health and Human Services National Blood Collection and Utilization Survey (NBCUS) has been conducted biennially since 1997. Data are used to estimate national blood collection and utilization.

STUDY DESIGN AND METHODS

The 2013 Department of Health and Human Services NBCUS is a cross-sectional survey of all US blood collection centers and hospitals as listed in the 2012 American Hospital Association Annual Survey database that perform at least 100 inpatient surgical procedures annually. The study objective was to estimate, with 95% confidence intervals (CIs), the number of blood and blood components collected and transfused in the United States.

RESULTS

In 2013, a total of 14,237,000 whole blood and apheresis red blood cell (RBC) units (95% CI, 13,639,000-14,835,000) were collected with 13,395,000 available for transfusion. Of these, 13,180,000 (95% CI, 12,389,000-13,972,000) whole blood and RBC units were transfused. This represented a 4.4% decline in the number of transfused units compared to 2011. Outdated (i.e., expired without being transfused) whole blood and RBC units declined by 17.3%. Apheresis (2,318,000; 95% CI, 2,154,000-2,482,000) and whole blood-derived platelet (PLT; 130,000; 95% CI, 23,000-237,000) distribution declined in 2013. Total PLT transfusions increased in 2013 (2,281,000) in comparison to 2011 (2,169,000). Total plasma units distributed (4,338,000) and transfused (3,624,000) declined.

CONCLUSION

Both blood collection and utilization have declined, but the gap between collection and utilization is narrowing. As collections decline further and hospitals decrease transfusions and manage products more efficiently, the decline in surplus inventory may be a concern for disaster preparedness or other unexpected utilization needs.

Going for gold: blood planning for the London 2012 Olympic Games

The Olympics is one of the largest sporting events in the world. Major events may be complicated by disruption of normal activity and major incidents. Health care and transfusion planners should be prepared for both. Previously, transfusion contingency planning has focused on seasonal blood shortages and pandemic influenzas. This article is the first published account of transfusion contingency planning for a major event. We describe the issues encountered and the lessons identified during transfusion planning for the London 2012 Olympics. Planning was started 18 months in advance and was led by a project team reporting to the Executive. Planning was based on three periods of Gamestime. The requirements were planned with key stakeholders using normal processes enhanced by service developments. Demand planning was based on literature review together with computer modelling. The aim was blood-stock sufficiency complimented by a high readiness donor panel to minimise waste. Plans were widely communicated and table-top exercised. Full transfusion services were maintained during both Games with all demands met. The new service improvements and high readiness donors worked well. Emergency command and control have been upgraded. Red cell concentrate (RCC) stock aged but wastage was not significantly increased. The key to success was: early planning, stakeholder engagement, service developments, integration of transfusion service planning within the wider health care community and conduct within an assurance framework.

Resuscitation from hemorrhagic shock using polymerized hemoglobin compared to blood

The development of an alternative to blood transfusion to treat severe hemorrhage remains a challenge, especially in far forward scenarios when blood is not available. Hemoglobin level (Hb)-based oxygen (O2) carriers (HBOCs) were developed to address this need. Hemopure (HBOC-201, bovine Hb glutamer-250; OPK Biotech, Cambridge, MA), one such HBOC, has been approved for clinical use in South Africa and Russia. At the time of its approval, however, few studies aimed to understand Hemopure's function, administration, and adverse effects compared to blood. We used intravital microscopy to study the microcirculation hemodynamics (arteriolar and venular diameters and blood flow and functional capillary density [FCD]) and oxygenation implications of Hemopure administration at different Hb concentrations-4, 8, and 12 gHb/dL-compared to fresh blood transfusion during resuscitation from hemorrhagic shock. Experiments were performed in unanesthetized hamsters instrumented with a skinfold window chamber, subjected to hemorrhage (50% of the blood volume), followed by 1-hour hypovolemic shock and fluid resuscitation (50% of the shed volume). Our results show that fluid resuscitation with Hemopure or blood restored systemic and microvascular parameters. Microcirculation O2 delivery was directly correlated with Hemopure concentration, although increased vasoconstriction was as well. Functional capillary density reflected the balance between enhanced O2 transport and reduced blood flow: 12 gHb/dL of Hemopure and blood decreased FCD compared to the lower concentrations of Hemopure (P < .05). The balance between O2 transport and tissue perfusion can provide superior resuscitation from hemorrhagic shock compared to blood transfusion by using a low Hb concentration of HBOCs relative to blood.

Temporal distribution of blood donations in three Brazilian blood centers and its repercussion on the blood supply

Background

Seasonal distribution of blood donation hinders efforts to provide a safe and adequate blood supply leading to chronic and persistent shortages. This study examined whether holidays, geographical area and donation type (community versus replacement) has any impact on the fluctuation of donations.

Methods

The numbers of blood donations from 2007 through 2010 in three Brazilian Retrovirus Epidemiological Donor Study II (REDS-II) participating centers were analyzed according to the week of donation. The weeks were classified as holiday or non-holiday. To compare donations performed during holiday versus non-holiday weeks, tabulations and descriptive statistics for weekly donations by blood center were examined and time series analysis was conducted.

Results

The average weekly number of donations varied according to the blood center and type of week. The average number of donations decreased significantly during Carnival and Christmas and increased during the Brazilian National Donor Week. The fluctuation was more pronounced in Recife and Belo Horizonte when compared to São Paulo and higher among community donors.

Conclusion

National bank holidays affect the blood supply by reducing available blood donations. Blood banks should take into account these oscillations in order to plan local campaigns, aiming at maintaining the blood supply at acceptable levels.

A stock-and-flow simulation model of the US blood supply

BACKGROUND

Lack of reporting requirements for the amount of blood stored in blood banks and hospitals poses challenges to effectively monitor the US blood supply. Effective strategies to minimize collection and donation disruptions in the supply require an understanding of the daily amount of blood available in the system.

STUDY DESIGN AND METHODS

A stock-and-flow simulation model of the US blood supply was developed to obtain estimates of the daily on-hand availability of blood, with uncertainty and by ABO/Rh type. The model simulated potential impact on supply of using different blood management practices for transfusion: first in-first out (FIFO), using the oldest stored red blood cell units first; non-FIFO likely oldest, preferentially selecting older blood; and non-FIFO likely newest, preferentially selecting younger blood.

RESULTS

Simulation results showed higher estimates of the steady-state of the blood supply level for FIFO (1,630,000 units, 95% prediction interval [PI] 1,610,000-1,650,000) than non-FIFO scenarios (likely oldest, 1,530,000 units, 95% PI 1,500,000-1,550,000; and likely newest, 1,190,000 units, 95% PI 1,160,000-1,220,000), either for overall blood or by blood types.

CONCLUSION

To our knowledge, this model represents a first attempt to evaluate the impact of different blood management practices on daily availability and distribution of blood in the US blood supply. The average storage time before blood is being issued was influenced by blood management practices, for preferences of blood that is younger and also that use specific blood types. The model also suggests which practice could best approximate the current blood management system and may serve as useful tool for blood management.

Report on Notifications Pursuant to §21 German Transfusion Act for 2008 and 2009

SUMMARY: This report contains the data collected in 2008 and 2009, pursuant to Section 21 German Transfusion Act as well as an overview of the supply situation during the last 10 years. In 2009, blood donation services reported a total of 7.5 million donations - the largest amount since 2000. At the same time, more than 4.7 million red blood cell (RBC) concentrates and more than 500,000 platelet concentrates were available. The number of therapeutic single plasma units decreased to 1.1 million units in 2009. The loss rate for RBC concentrates is still between 3 and 4% for the users while for the manufacturers it has decreased slightly to 1.4%. The loss rate, for platelet concentrates, on the other hand, increased in 2009, especially-what is noteworthy-for manufacturers of pooled platelet concentrates. The loss rate for apheresis platelet concentrates accounted for 5.2% compared to 17.5% for pooled platelet concentrates. As far as the users were concerned, loss rates for platelet concentrates largely remained unchanged with rates between 5 and 6%. Based on the data collected, the supply with blood components for transfusion can be regarded as assured. Nearly 2.9 million 1 of plasma for fractionation were collected in Germany in 2009. According to reports from the pharmaceutical industry, out of these, 2.6 million 1 remained on the German market, out of which only 56% were fractionated in this country. Many plasma derivatives are not manufactured in Germany, despite the large amounts of plasma collected. The supply with these products, however, is assured by imports. Overall, 16,409 autologous and 9,435 allogeneic stem cell preparations were manufactured in 2009, out of which 3,382 allogeneic preparations were exported. 3,181 autologous and 2,374 allogeneic preparations were transplanted; 187 of these products from imports. The large number of exported stem cells and the small number of imported ones suggest that no serious shortages are to be expected for the supply with these products.

[Report on notifications pursuant to Section 21 of the German Transfusion Act for the years 2008 and 2009]

This report contains the data collected in 2008 and 2009, pursuant to Section 21 of the German Transfusion Act (Transfusionsgesetz), as well as an overview of the supply situation during the last 10 years. In 2009, blood donation services reported a total of 7.5 million donations--the largest amount since 2000. At the same time, more than 4.7 million red blood cell concentrates and more than 500,000 platelet concentrates were available. The number of therapeutic single plasma units decreased to 1.1 million units in 2009. The loss rate for red blood cell concentrates is still between 3% and 4% for the users, while for the manufacturers, it has decreased slightly to 1.4%. The loss rate, for platelet concentrates, on the other hand, increased in 2009, and--what is noteworthy--especially for manufacturers of pooled platelet concentrates. The loss rate for apheresis platelet concentrates accounted for 5.2% compared to 17.5% for pooled platelet concentrates. As far as the users were concerned, loss rates for platelet concentrates largely remained unchanged with rates between 5% and 6%. Based on the data collected, the supply of blood components for transfusion can be regarded as assured. Nearly 2.9 million liters of plasma for fractionation were collected in Germany in 2009. According to reports from the pharmaceutical industry, of these, 2.6 million liters remained on the German market, of which only 56% were fractionated in this country; no statement can be made on the use of the remaining amount. Many plasma derivatives are not manufactured in Germany, despite the large amount of plasma collected. The supply with these products, however, is assured by imports. Overall, 16,409 autologous and 9,435 allogeneic hematopoietic stem cell preparations were manufactured in 2009, of which 3,382 allogeneic preparations were exported. A total of 3,181 autologous and 2,374 allogeneic preparations were transplanted; 187 of these products from imports. The large number of exported stem cells and the small number of imported stem cells suggest that no serious shortages are to be expected for the supply with these products.

Payment, compensation and replacement--the ethics and motivation of blood and plasma donation

The supply of blood and plasma to produce haemotherapies varies around the world, but all environments need donors to furnish the raw material. Many countries still lack adequate supply, and the question of what amounts of blood and plasma are required for optimal treatment is still unresolved. The issue of compensating donors has been a controversial and emotive one in blood transfusion for many decades. Donors are conventionally classified as paid, voluntary or replacement, and a level of stigma, based on safety and ethical considerations, has been attached to paid donation. This review points to evidence which renders many of these concerns redundant. Purist arguments against compensated donation have little basis in evidence and would lead to many of today's voluntary donors being designated as paid, because of the large range of incentives used to recruit and retain them. Misplaced application of 'Titmussian' volunteerism has precipitated its own safety and supply problems. Current systems of compensation and replacement are needed to maintain supplies of essential products and lead to safe products in controlled environments. We propose that a plurality of routes towards donation is an appropriate paradigm in the heterogeneous landscape of blood and plasma product supply.