Modeling rare blood in Canada.

Abstract

Many countries maintain rare blood programs to provide access to blood for patients with complex serologies. These include a process to screen donors and a registry to record information about rare donors; blood agencies may also freeze some units. However, frozen blood is much more expensive than liquid blood. A two-phase approach to analysis was used to evaluate how rare a blood type must be before a frozen inventory is necessary and what screening rates are required to support a rare blood program. A simulation model was employed to evaluate the impact of inventory on patient access. Results suggested that, for 27 of 29 phenotypes managed by Canadian Blood Services, insufficient donors had been identified to ensure a stable inventory. Analytic results showed the screening rate necessary to ensure a stable inventory and the time frame to build a rare donor base. Twenty-nine simulation scenarios were executed to evaluate patient access to rare blood against inventory levels. Results show that some amount of frozen inventory is necessary for phenotypes rarer than 1 in 3000. However, holding more than two units apiece of O-, O+, A-, and A+ did not improve patient access. While some level of frozen blood is needed for rare blood, large inventories do not improve access. Modest amounts of frozen inventory, combined with increased door screening, provides the greatest chance of maximizing patient access.