The December 2023 issue of the journal Transfusion has a “How do I do it” article on how to manage blood product shortages.i The article was authored by the AABB Donor and Blood Component Management Subsection members with the participation of blood center and blood bank staff members performing blood donor recruitment, blood collection, patient testing, and medical functions. The members of the Subsection were motivated to address blood component shortages to better prepare members of the transfusion medicine community for shortages of some or most blood components. The manuscript is divided into two sections, with advice to blood centers and hospital transfusion services. Following are the highlights of the article.
Recommendations for Blood Centers
Newer means of communication, such as text messages and social media, can increase awareness of blood donations during shortages. Group O donors, especially O-negative donors, should be encouraged to donate red blood cells via whole blood or apheresis donations of double red blood cells. Group AB donors should be encouraged to donate plasma, especially via larger-volume collections using apheresis instruments.
Blood centers can improve the inventory of platelets by issuing low-yield platelets (with a platelet yield of 2.0 to 2.9 x 1011), platelets derived from whole blood, and cold-stored platelets (lasting up to 14 days). Blood centers can improve the number of red blood cell and platelet units available by coordinating the distribution of short-dated products from transfusion services at smaller hospitals to hospitals that transfuse more blood components.
During shortages, blood centers should communicate to hospitals which blood types are in short supply, how the blood centers plan to mitigate those shortages, how orders for blood will be modified because of the shortages, and when the shortages will end. Blood collection centers, as part of a national network, can move blood components to locations experiencing blood shortages.
Blood centers should educate physicians who order transfusions on patient blood management and the appropriate use of O-negative red blood cells and AB plasma.
Recommendations for Hospital Transfusion Services
In terms of patient blood management, the authors advocate for 1) the guidelines from AABB and the Society for the Advancement of Patient Blood Management; 2) periodic audits of transfusion practices, preferably prospective; 3) antifibrinolytic agents such as aminocaproic acid and tranexamic acid to reduce the need for transfusions during surgeries; 4) the reversal of over-coagulation with vitamin K1 and 4-factor prothrombin complex concentrate; 5) intraoperative blood salvage; and 6) computerized provider order entry (CPOE) in conjunction with clinical decision support through best practice advisories.
Hospitals can make more blood components available to patients during times of shortages by splitting units of red blood cells or platelets, using low-yield platelets, using A plasma instead of AB plasma for selected patient populations, and using O-positive red blood cells for untyped patients who are not women of childbearing age or children.
Hospital staff members can increase the efficiency of transfusions during shortages by having more than one supplier of blood components, evaluating more carefully the need for transfusions, and considering the need to transfuse blood components that do not perfectly meet acceptance criteria.
Blood shortages might occur around holidays in a somewhat predictable manner, and during disasters and mass casualty events unpredictably. Implementing the measures listed above can facilitate the management of blood component shortages during periods usually associated with predictable reductions in blood donations, such as the summer months.
Hospitals might need immediate access to additional blood components in unpredictable situations, such as mass casualties and natural disasters. Hospitals treating patients in these situations can procure extra blood components from nearby hospitals. Afterward, blood centers can send components to the hospitals treating these patients and to the hospitals that provided the blood to the hospitals treating these patients. Open communication channels between hospitals and blood centers are vital to facilitate blood delivery in these situations.
In summary, the AABB Donor and Blood Component Management Subsection members have provided blood center and hospital staff members with multiple suggestions on dealing with blood shortages that, if implemented, will improve the availability of blood components for patients needing transfusions.
