Maintaining adequate donations and a sustainable blood supply: Lessons learned

Novel high molecular weight polymerized hemoglobin in a non-obese model of cardiovascular and metabolic dysfunction

The widespread adoption of high-calorie, high-fat, high-sucrose diets (HFHSD) has become a global health concern, particularly due to their association with cardiovascular diseases and metabolic disorders. These comorbidities increase susceptibility to severe outcomes from viral infections and trauma, with trauma-related incidents significantly contributing to global mortality rates. This context underscores the critical need for a reliable blood supply. Recent research has focused on high molecular weight (MW) polymerized human hemoglobin (PolyhHb) as a promising alternative to red blood cells (RBCs), showing encouraging outcomes in previous studies. Given the overlap of metabolic disorders and trauma-related health issues, it is crucial to assess the potential toxicity of PolyhHb transfusions, particularly in models that represent these vulnerable populations. This study evaluated the effects of PolyhHb exchange transfusion in guinea pigs that had developed metabolic disorders due to a 12-week HFHSD regimen. The guinea pigs, underwent a 20 % blood volume exchange transfusion with either PolyhHb or the lower molecular weight polymerized bovine hemoglobin, Oxyglobin. Results revealed that both PolyhHb and Oxyglobin transfusions led to liver damage, with a more pronounced effect observed in HFHSD-fed animals. Additionally, markers of cardiac dysfunction indicated signs of cardiac injury in both the HFHSD and normal diet groups following the Oxyglobin transfusion. This study highlights how pre-existing metabolic disorders can exacerbate the potential side effects of hemoglobin-based oxygen carriers (HBOCs). Importantly, the newer generation of high MW PolyhHb showed lower cardiac toxicity compared to the earlier generation low MW PolyhHb, known as Oxyglobin, even in models with pre-existing endothelial and metabolic challenges.

Mitigating the impact of blood shortages in England

The supply of blood components and products in sufficient quantities is key to any effective health care system. This report describes the challenges faced by the English blood service, NHS Blood and Transplant (NHSBT), towards the end of the COVID-19 pandemic, which in October 2022 led to an Amber Alert being declared to hospitals indicating an impending blood shortage. The impact on the hospital transfusion services and clinical users is explained. The actions taken by NHSBT to mitigate the blood supply challenges and ensure equity of transfusion support for hospitals in England including revisions to the national blood shortage plans are described. This report focuses on the collaboration and communication between NHSBT, NHS England (NHSE), Department of Health and Social Care (DHSC), National Blood Transfusion Committee (NBTC), National Transfusion Laboratory Managers Advisory Group for NBTC (NTLM), National Transfusion Practitioners Network, the medical Royal Colleges and clinical colleagues across the NHS.

Patient Blood Management as an Emerging Concept in Quality: The Role of Nurses

BACKGROUND

Transfusion of blood components has long been considered lifesaving therapy. While blood transfusion may be clinically indicated as a treatment option for some patients, the benefits of transfusion in asymptomatic, hemodynamically stable patients are questionable.

PROBLEM

Blood component transfusion is routinely used as a default therapy when not clinically indicated, increasing the risk of poor patient outcomes, adverse events, pressures on blood supply and availability, and increased health care costs.

APPROACH

Nurses have the responsibility to advocate for patients and reduce/avoid unnecessary blood transfusion through the implementation of patient blood management (PBM). The PBM paradigm includes treatment of anemia, minimizing blood loss and bleeding, optimization of coagulation, and employing true patient-centered decision making.

CONCLUSIONS

PBM should become the standard of care with the goal of improving health care quality and patient outcomes while using the multidisciplinary team for its implementation. As advocates for their patients, nurses can play a major role in the development, implementation, and promotion of PBM.

Prediction of Mid-term Platelet Transfusion in Stable Trauma Patients Using Rotational Thromboelastometry

Background

Rotational thromboelastometry (ROTEM; TEM International GmbH, Munich, Germany) is a global coagulation test that guides evidence-based platelet transfusion in trauma patients. We evaluated ROTEM parameters for predicting mid-term (five days) platelet transfusion in trauma patients.

Methods

Maximum clot firmness and clot amplitudes after 5, 10, and 15 mins (A5, A10, and A15, respectively) of fibrin-specific ROTEM (FIBTEM) and extrinsically activated ROTEM (EXTEM) were retrospectively collected from 82 hospitalized, stable, non-bleeding trauma patients after successful initial resuscitation. Platelet-specific ROTEM (PLTEM) was calculated by subtracting FIBTEM from EXTEM. Platelet transfusions were reviewed for five days after ROTEM.

Results

The areas under the curve for FIBTEM, EXTEM, and PLTEM predicting platelet concentrate transfusion of >12 U at mid-term were 0.915-0.923, 0.878-0.896, and 0.551-0.735, respectively. FIBTEM and EXTEM parameters were comparable to those of fibrinogen, fibrin/fibrinogen degradation products, D-dimer, and antithrombin III. Strong correlations (r>0.7) were noted between platelet count and EXTEM (A5, A10, and A15) or PLTEM (A5), platelet function (per platelet count) and EXTEM (A10 and A15), and fibrinogen levels and all FIBTEM parameters.

Conclusions

FIBTEM and EXTEM can reliably predict mid-term platelet transfusion in trauma patients. FIBTEM, EXTEM, and PLTEM parameters correlate with conventional coagulation tests (platelets and fibrinogen).

How do I manage a blood product shortage?

BACKGROUND

The demand for blood products sometimes exceeds the available inventory. Blood product inventories are dependent upon the availability of donors, supplies and reagents, and collection staff. During prolonged extreme shortages, blood centers and transfusion services must alter practices to meet the needs of patients.

STUDY DESIGN AND METHODS

The Association for the Advancement of Blood and Biotherapies Donor and Blood Component Management Subsection compiled some strategies from its blood center and hospital transfusion service members that could be implemented during blood product shortages.

RESULTS

Some strategies that blood centers could use to increase their available inventories include increasing donor recruitment efforts, using alternate types of collection kits, manufacturing low-yield apheresis-derived platelets and/or whole blood-derived platelets, using cold-stored platelets, transferring inventory internally among centers of the same enterprise, using frozen inventory, decreasing standing order quantities, prioritizing allocation to certain patient populations, filling partial orders, and educating customers and blood center staff. Transfusion service strategies that could be implemented to maximize the use of the limited available inventory include increasing patient blood management efforts, using split units, finding alternate blood suppliers, trading blood products with other hospital transfusion services, developing a patient priority list, assembling a hospital committee to decide on triaging priorities, using expired products in extreme situations, and accepting nonconforming products after performing safety checks.

DISCUSSION

Blood centers and transfusion services must choose the appropriate strategies to implement based on their needs.

Indexing blood banking performance in India: A retrospective cross-sectional analysis of states and districts

Background

Multiple international assessments have highlighted gaps in blood banking globally. However, there is a dearth of subnational assessments. We applied a thematic framework with multiple composite indices to assess blood bank performance across Indian states and districts.

Methods

In this retrospective cross-sectional analysis, data for 2493 blood banks in 35 states/union territories (UTs) and 616 districts was extracted from the National Blood Transfusion Council for 2016. The framework involved seven themes (accreditation, ownership, safety, volume, infrastructure, regulation, and workforce) with several indicators nested under them. Composite thematic indices and an overall index (0-100, with 100 being the best performance) were constructed using the adjusted Mazziotta-Pareto index method that can provide composite indices that are partially non-compensatory and easily interpretable.

Results

The state-level median [interquartile range] value of the overall index was 59.61 [46.35, 71.67]. Chandigarh had the highest values for safety, regulation, workforce, and ownership indices, Maharashtra for volume and infrastructure indices, and Manipur for accreditation index. Districts in southern and western states performed well on the overall index with inter- and intra-state variations for themes. District-level correlations depicted positive associations among indices with the strongest correlation between ownership and accreditation indices (n=616, R=0.92, p<0.001).

Conclusion

Blood banking in India is fragmented, with variations in themes across geographies. The northern and northeastern states require more attention for volume, accreditation, infrastructure, and ownership. While the southern and western-central regions need to prioritize safety. The framework with thematic indices, when applied to routine data, can be useful for monitoring and evaluation to decide local policies and resource allocations.

A Review of Amelioration of Awareness About Blood Donation Through Various Effective and Practical Strategies

Blood donations play a crucial role in medical care; however, the global shortage of donors remains and has a serious impact on medical interventions. The challenges involved include the lack of public awareness of the importance of blood donation, the lack of understanding of the process and eligibility criteria for blood donation, and the lack of comprehensive strategies aimed at raising awareness and participation among potential donors, with particular emphasis on the involvement of young people. It is essential to recognize that blood donation delivers significant benefits to donors and recipients, improves overall health, and ultimately saves lives. Various initiatives, such as blood donation camps, dynamic social media campaigns, and strategic networking of medical professionals, have proved effective in promoting blood donation. In particular, in the event of an emergency, the availability of sufficient blood supplies is increasingly essential, underlining the urgent need to establish and maintain a sustainable blood donor network. An in-depth understanding of the motivation and conservation of donors is crucial in this context, as it is known that demographic factors significantly impact the frequency of blood donation. In addition, ethical and legal considerations require careful attention, highlighting the essential role of obtaining informed consent and ensuring the confidentiality of donors throughout the process. As we look ahead to the evolving landscape, it presents a series of formidable challenges. These challenges encompass the critical necessity to broaden and diversify our donor base, thereby extending and varying our sources of financial support for specific initiatives, organizations, or projects. Moreover, we must proactively harness the opportunities presented by emerging technologies and commit ourselves to closing the information gaps within the existing public knowledge sphere. In summary, the review emphasizes the paramount importance of ongoing efforts to strengthen and enrich donors' engagement through customized strategies and educational outreach.

Managing blood supplies during natural disasters, humanitarian emergencies, and pandemics: lessons learned from COVID-19

INTRODUCTION

The COVID-19 pandemic has resulted in a historic public health crisis with widespread social and economic ramifications. The pandemic has also affected the blood supply, resulting in unprecedented and sustained blood shortages.

AREAS COVERED

This review describes the challenges of maintaining a safe and sufficient blood supply in the wake of natural disasters, humanitarian emergencies, and pandemics. The challenges, which are accentuated in low- and high-income countries, span the impact on human capacity (affecting blood donors and blood collections personnel alike), disruption to supply chains, and economic sustainability. COVID-19 imparted lessons on how to offset these challenges, which may be applied to future pandemics and public health crises.

EXPERT OPINION

Pandemic emergency preparedness plans should be implemented or revised by blood centers and hospitals to lessen the impact to the blood supply. Comprehensive planning should address the timely assessment of risk to the blood supply, rapid donor recruitment, and communication of need, measures to preserve safety for donors and operational staff, careful blood management, and resource sharing.

Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis

BACKGROUND

Surgical transfusion has an outsized impact on hospital-based transfusion services, leading to blood product waste and unnecessary costs. The objective of this study was to design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery to reduce waste.

STUDY DESIGN AND METHODS

To address the high rates of surgical blood issue requests and red blood cell (RBC) unit waste at a large academic medical center, a failure modes and effects analysis was used to systematically examine perioperative blood management practices. Based on identified failure modes (e.g., miscommunication, knowledge gaps), a multi-component action plan was devised involving process changes, education, electronic clinical decision support, audit, and feedback. Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre- and post-intervention.

RESULTS

The number of perioperative RBC unit issue requests decreased from 358 per month (SD 24) pre-intervention to 282 per month (SD 16) post-intervention (p < .001), resulting in an estimated savings of 8.9 h per month in blood bank staff labor. The issue-to-transfusion ratio decreased from 2.7 to 2.1 (p < .001). Perioperative RBC unit waste decreased from 4.5% of units issued pre-intervention to 0.8% of units issued post-intervention (p < .001), saving an estimated $148,543 in RBC unit acquisition costs and $546,093 in overhead costs per year.

DISCUSSION

Our intervention, designed based on a structured failure modes analysis, achieved sustained reductions in perioperative RBC unit issue orders, returns, and waste, with associated benefits for blood conservation and transfusion program costs.

Comparison of RhD Typing Results by Serology and Molecular Methods

OBJECTIVE

Molecular testing determines D antigen status when abnormal serologic results are observed. Molecular testing is routinely batched, resulting in longer turnaround time for abnormal D status resolution. During the interim, obstetric patients with questionable/uninterpretable and weak D typing results by serology, per the immunohematology reference laboratory (IRL) policy, will receive RhD negative blood. This study aimed to determine whether serology results achieved a concordance.

METHODS

Six hospitals provided samples to the IRL (first IRL) for RhD status by DNA. De-identified samples were sent for serology RhD (second IRL). A concordance of ≥80% was acceptable.

RESULTS

Forty-nine samples were evaluated. Results were concordant (65.3% [32/49]) and discordant (34.7% [17/49]). This is significantly lower than clinically acceptable 80% (z = 2.57, P < .05). The turnaround-time was 3.0 hours for serology and 4.4 days for molecular evaluation.

CONCLUSION

Due to a low concordance, serology could not be used in place of molecular testing.

Factors That Influence the Sustainability of Human Milk Donation to Milk Banks: A Systematic Review

Donor human milk is the recommended alternative for feeding preterm or low birth weight infants when the mother's own milk is unavailable or not in sufficient quantity. Globally, the needs of vulnerable infants for donor human milk exceed the supply. This review aimed to identify the factors impacting the sustainability of human milk donation to milk banks. A systematic review of the literature was performed on eight databases to retrieve articles published until December 2021. The study protocol is available in PROSPERO (#CRD42021287087). Among the 6722 references identified, 10 studies (eight quantitative observational and two qualitative) met the eligibility criteria for a total of 7053 participants. Thirty factors influencing the sustainability of the donations to milk banks were identified and categorized as follows: (1) donation duration, (2) donors' infant features (e.g., gestational age, birth weight), (3) donors' features (e.g., socio-demographic characteristics, milk donation history), and (4) factors related to the milk bank and health care systems (awareness and support). The available evidence suggests that larger volumes of donated milk are associated with a longer duration of donation, as are early donation, previous milk donation, and donors with an infant of smaller weight and gestational age. Supporting and encouraging early donation and recruiting donors with infants of low birth weight and low gestational age could support longer donation times and greater volumes of milk donated. To identify efficient strategies and to draw appropriate recommendations to improve donor milk access, future studies should further explore the issues of the sustainability of human milk donation to milk banks.

Decreasing blood wastage during ex vivo lung perfusion recovery through utilization of thermal control technology

BACKGROUND

The Organ Care System (OCS) is a revolutionary ex vivo organ perfusion technology that can potentially expand the organ retrieval range. The OCS Lung device uses packed red blood cells (pRBC) with a proprietary solution. We report the ability to reduce blood waste during this procedure by using a thermal packaging solution in conjunction with the OCS platform.

METHODS

We retrospectively reviewed all OCS Lung recoveries performed by our recovery team, using pRBCfrom May 2019 to January 2021. Initially, units were stored using passive refrigeration with the Performance cooler at a temperature range of 1-6°C for 4 h. Subsequently, thermal control technology with the ProMed cooler was utilized to maintain the same temperature range for 72 h.

RESULTS

Twenty-three recoveries were initiated with 63 pRBC. The Performance cooler was used for 8, while the ProMed cooler for 13. 37.5% of pRBC transported with the Performance cooler was used within the validated time range, while 25.0% were used beyond the validated time range based on clinical judgment. In addition, 37.5% of pRBC transported with the Performance cooler were returned to the institution after canceled recoveries with an estimated loss of $1800; the ProMed cooler had no wastage.

CONCLUSIONS

This study showed that using an advanced thermal packaging solution facilitates proper storage of pRBC and represents an advancement for extended donor lung preservation. The elimination of blood wastage in this initial study portends ongoing benefits for the limited blood supply and reduced cost.

The Impact of COVID-19 Pandemic on Blood Transfusion Services: A Perspective from Health Professionals and Donors

Purpose

Since the emergence of the COVI9-19 pandemic, there has been concern about the availability and sufficiency of blood transfusions to meet patient needs. Also, the adequate and safe blood supply is a major issue to fulfill present demands. This study aims to determine the impact of the COVID-19 pandemic on the blood transfusion service and identify solutions to overcome this impact from the perspective of blood donors and healthcare professionals.

Methods

This study was conducted prospectively among Saudi Arabian blood donors and healthcare professionals between May 2020 and May 2021. A group of professional health care professionals and blood donors participated in this study to determine the impact of the COVID-19 pandemic on blood transfusion services and identify possible solutions to overcome the adverse effects on blood system activities.

Results

To understand the impact of pandemic COVID-19 on blood transfusion services in Saudi Arabia, we investigated population dynamics and statistical analysis from different age groups and health care professionals. A total of 424 blood donors and 372 healthcare professionals participated in this study. The suggested solution by the participants to overcome the blood shortage during pandemics was the organization of mobile blood drives at donors’ homes, work, and educational sites. Statically significant associations were found between blood donation during this pandemic and age (p=0.019) and marital status (p=0.001).

Conclusion

The findings of this study highlight the main problems of blood transfusion due to the onset of COVID-19. Hence, the data could be a source of improving blood transfusion and blood donation systems by healthcare centers and on an individual basis. Healthcare professionals use this public management system in hospitals to minimize the adverse effects of the pandemic.

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Has the trend of declining blood transfusions in the United States ended? Findings of the 2019 National Blood Collection and Utilization Survey

INTRODUCTION

Previous iterations of National Blood Collection and Utilization Survey (NBCUS) have demonstrated declines in blood collection and transfusion in the United States since 2008, including declines of 3.0% and 6.1% in red blood cell (RBC) collections and transfusions between 2015 and 2017, respectively. This study describes results of the 2019 NBCUS.

METHODS

The survey was distributed to all US blood collection centers, all hospitals performing ≥1000 surgeries annually, and a 40% random sample of hospitals performing 100-999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, distributed, transfused, and outdated.

RESULTS

In 2019, 11,590,000 RBC units were collected (95% confidence interval [CI], 11,151,000-12,029,000 units), a 5.1% decrease compared with 2017, while 10,852,000 RBC units were transfused (95% CI, 10,444-11,259 units), a 2.5% increase from 2017. Between 2017 and 2019, platelet distributions (2,508,000 units; 95% CI, 2,375,000-2,641,000 units) decreased by 2.0%, and plasma distributions (2,679,000 units; 95% CI, 2,525,000-2,833,000 units) decreased by 16.5%. During the same time period, platelet transfusions (2,243,000 units; 95% CI, 1,846,000-2,147,000 units) increased by 15.8% and plasma transfusions (2,185,000 units; 95% CI, 2,068,000-2,301,000 units) decreased by 8.0%.

CONCLUSION

Utilization of RBC in the United States might have reached a nadir. Between 2017 and 2019, RBC collections declined while RBC transfusions did not significantly change, suggesting a narrowing between blood supply and demand. Monitoring national blood collection and utilization data is integral to understanding trends in blood supply safety and availability.

The effect of COVID-19 on blood donation habits

BACKGROUND

Blood centers (BCs) rely on schools and businesses. Shelter-in-place orders closed them. This study determined how COVID-19 affected donation habits.

STUDY DESIGN AND METHODS

Two periods were reviewed (May 1 through June 30, 2018 vs 2019 [control] and 2019 vs 2020 [study-COVID period]). These donations were reviewed: first-time, repeat (donation ≤ 2 years), and lapsed (no donation > 2 years); sex; age; ethnicity; and ABO blood groups at high school and college drives. Testing all donors for SARS-CoV-2 antibodies started May 18, 2020.

RESULTS

In the study period donations significantly increased (control P = .683, study P ≤ .0001) and comparing sex (control male P = .716, female P = .657; study male P = .004, female P ≤ .0001). In the study period there was a significant decrease in Hispanic (P = .001) and African American (P < .0001) donations also seen among high school and college drives and an increase in Caucasian (P < .0001) donations. There was a significant increase in first-time (P < .0001) and lapsed donors (P < .0001) in the study period vs control (first-time P = .087, lapsed P = .308) and a significant decrease in donors not more than 30 years (study 16-20 P < .0001, 21-30 P < .0001). There was a significant increase in all blood types in the study period (P < .0001) and in donations after implementation of SARS-CoV-2 antibody testing (P = .001).

CONCLUSIONS

Significant changes occurred in donation habits in the study vs the control periods. These included increased total donations, comparing sexes, first-time and lapsed donors, all blood types, and Caucasian donations. Significant decreases were seen in Hispanic and African American donations and those not more than 30 years old.