Blood Bank Inventory Research Articles

Therapeutic phlebotomy procedures and their impact on a rural hospital's red blood cell inventory and fiscal stature

Therapeutic phlebotomy (TP) programs offer an important community service and often provide financial and donor unit resources for the hospital. This study assessed the financial impact and red blood cell (RBC) inventory contribution of a small, rural hospital-based TP program. TP procedures over 13 months were evaluated at a 142-bed rural hospital. The hospital had a Food and Drug Administration variance for a hereditary hemochromatosis (HH) donor program. The revenue for the non-HH therapeutic phlebotomies and the savings attained for units added to RBC inventory from allogeneic eligible HH donors were compiled. During the study, 84 patients were involved in the TP program. Of the 62 HH patients, 43 met eligibility requirements for allogeneic donations resulting in 207 donor units collected for the blood bank inventory and a savings of $21,000 in blood costs. Additionally, 22 non-HH patients underwent 183 TP procedures earning the hospital over $15,000 in net revenue. The TP program at this small, rural 142-bed hospital provided a financial gain of $36,000 during the 13-month study period. The HH donor program contributed approximately 4% to the RBC inventory. The TP program at this small, rural 142-bed hospital proved to be financially lucrative and provided a community service to patients.

The red blood cell storage lesion: a method to the madness

The red blood cell storage lesion: a method to the madness

Prevalence of glucose-6-phosphate dehydrogenase deficiency and sickle cell trait among blood donors in Riyadh

Background and Aims:Blood donation from glucose-6-phosphate dehydrogenase (G6PD)-deficient and sickle cell trait (SCT) donors might alter the quality of the donated blood during processing, storage or in the recipient's circulatory system. The aim of this study was to determine the prevalence of G6PD deficiency and SCT among blood donors coming to King Khalid University Hospital (KKUH) in Riyadh. It was also reviewed the benefits and risks of transfusing blood from these blood donors.Materials and Methods:This cross-sectional study was conducted on 1150 blood samples obtained from blood donors that presented to KKUH blood bank during the period April 2006 to May 2006. All samples were tested for Hb-S by solubility test, alkaline gel electrophoresis; and for G6PD deficiency, by fluorescent spot test.Results:Out of the 1150 donors, 23 (2%) were diagnosed for SCT, 9 (0.78%) for G6PD deficiency and 4 (0.35%) for both conditions. Our prevalence of SCT and G6PD deficiency is higher than that of the general population of Riyadh.Conclusion:We recommend to screen all units for G6PD deficiency and sickle cell trait and to defer donations from donors with either of these conditions, unless if needed for special blood group compatibility, platelet apheresis or if these are likely to affect the blood bank inventory. If such blood is to be used, special precautions need to be undertaken to avoid complications in high-risk recipients.

New Transport System for Maintaining Temperature of Blood Products in Emergency Situations

The RMH is a large, tertiary teaching hospital that is now a designated level 1 trauma centre. Facilities include a helipad and upgraded Emergency Department and Operating Theatre areas. In many cases it is not possible to provide group specific and crossmatched Red Cell Concentrates (RCC) for individuals requiring urgent and lifesaving treatment. In this situation, scarce O Negative RCC must be used. Previously, the Blood Bank at the RMH issued blood and blood products to the Emergency Department in plastic bags or foam eskies. Once issued these RCC could not be returned to the hospital Blood Bank inventory, as the product transportation and storing conditions to and in the Emergency Department were uncontrolled. Baxter Healthcare ½ recently has made available an innovative and validated system of transport for blood and blood products. This ‘Blood-In-Motion’(BiM) system consists of moulded plastic elements that are filled with a patented Phase Change Material (PCM). Following our adoption of the BiM we found it an easy to use, validated system for the safe temperature controlled transport of RCC in an emergency situation. We have further utilised the BiM system as a ‘Massive Exsanguination Pack’(MEP) used in response to a time-critical call from Emergency. The MEP transports 4 units O Neg RCC, 4 units thawed AB FFP & 1 pool Rh Neg platelets. This BiM/MEP system allows the storage of RCC and plasma products under controlled temperature for up to 6 hours. This solution has enabled the RMH to conserve a scarce and valuable resource, and to supply emergency blood products in a timely and controlled manner.

Blood inventory management in the type and screen era

Previous models on the management of hospital blood inventories have mostly dealt with the optimization of variables related to the assigned, cross-matched inventory. Because the type and screen (T and S) procedure allows blood banks to manage surgical reserves with only unassigned inventories, it becomes necessary to gain insight into the factors that determine the efficiency of this kind of blood inventory. Stochastic model that simulates the routine operation of a hospital blood bank inventory over a finite number of days was used. Factors that were analysed for their influence on outdate and shortage rates included the mean (MEAN) and variation (CVAR) in daily transfusion, the remaining shelf life of blood units shipped from the blood supplier (RSL) and the number of days between consecutive shipments (INT). Outdate and shortage rates grew exponentially with CVAR, an effect that could be partially counterbalanced by increasing RSL. The variables, MEAN and INT, had little influence on the inventory, provided that blood stocks shipped from the supplier are targeted at the expected average demand for transfusion and RSL is greater than INT. In hospitals that do not hold cross-matched inventories, CVAR is the major parameter in determining the blood inventory performance. Hospitals with large CVAR must be supplied with young red blood cell (RBC) units, whereas hospitals with smaller CVAR perform well with older stocks. These results advocate for using each hospital's CVAR as the leader parameter in regional optimization policies based on recycling blood units among participating hospitals.

Terrorist Attacks: Transfusion Specialists' Point of View.

The issue of mass casualties in civilian population has lately become globally relevant and prevalent. Explosions of loaded busses by suicide bombers as well as explosions in crowded public places create a great number of casualties, many of them being children and several members of same families, who are evacuated by scoop and run method to nearby hospitals. We report on potential hazards of massive blood transfusions to multi-trauma patients, simultaneously admitted to hospital. Upon admission to the emergency room (ER) ID and personal details of patients are recorded and a temporary ID badge is issued for unidentified patients. Then, a blood sample for typing and screening is taken and required blood is ordered. Primary blood supply for patients with unstable condition, who need immediate blood transfusion, is O Rh positive packed cells (for fertile females O Rh negative) until the ABO and Rh blood groups are established. In order to avoid misidentification our routine includes presence of a blood bank representative in the ER for confirming identification of patients and correct labeling of blood samples. 2 individuals must identify patients from whom samples are taken. In the operating rooms (OR) another blood bank representative (either a transfusion medicine specialist or a hematologist) matches blood types and identification numbers, maintains contact with the blood bank, conveys information to anesthesiology team and advises them on replacement therapy. 7 terrorist attacks resulted in a total of 55 patients, evacuated to 2 hospitals in Israel. 285 packed cells units were typed and cross-matched for these patients. The amount of packed cells supplied during the first 2 hours was 47% of the total blood supplied during the first 24 hours. The cross-matched/transfused ratio varied from 1.3 to 2.19 reflecting overestimation of blood requirement during mass casualty episodes. One “near-miss” was prevented in OR when two members of the same family were operated on in adjacent rooms. Units for one of these patients were misplaced. ABO incompatibility is one of the major causes of morbidity and mortality resulting from blood transfusions. Signs and symptoms are masked in an anesthesized patient. The fact that units of blood accumulate at patient's bedside upon being deleted from the blood bank inventory may be misinterpreted as a shortage of blood supply in the blood bank. There is also a potential for errors in matching units of blood to patients both in ER and OR. In the setup of mass casualties influx the blood bank personnel should be on alert for the following potential Achilles' heels: misidentification of the patient when taking a blood sample for typing and screening or misidentification of the patient who needs to receive the blood product. Reasons for these may be either one digit difference in serial temporary number of unidentified patients, being operated on simultaneously in nearby rooms, or several family members undergoing simultaneous surgery in adjacent OR. Such errors can be minimized by using a 3-digit bold number in addition to the running temporary ID and thus providing 2 identification parameters. Our data suggest that the amount of blood products ordered for such patients is excessive. Surgical teams should be aware of the possibility to have blood components kept on hold in the blood bank instead of accumulating them in ER and OR and risking misidentification and suboptimal storage conditions.

Should the Cell Saver Autotransfusion System Be Routinely Used in Elective Aortic Surgery?

The objective of this study is to identify the aortic surgery procedures in which the use of the Cell Saver autotransfusion system is beneficial in terms of the amount of autologous blood recovered and the reduction in blood bank demands. An evaluation of the cost-effectiveness of the system is also presented. Four hundred and thirty-four elective aortic interventions were retrospectively reviewed to examine the use of intraoperative autotransfusion (IAT). Evaluation was made of risk factors, preoperative hematological variables, the volume of IAT-processed reinfused blood, and homologous transfusion requirements over the period of hospitalization. The routine use of the IAT system was cost-effective in the interventions for AAA and TAA. In patients subjected to aortobifemoral bypass for aortoiliac occlusive disease, IAT served to alleviate demands on blood bank inventories, although in our center its use led to a slight increase in net cost. The routine use of IAT during unilateral revascularization due to occlusive disease offered no benefits in terms of reduced homologous transfusion requirements or cost-effectiveness.

Building the Clinical Laboratory and Blood Bank in Developing Countries

Clinical laboratories in hospitals of developing countries vary in their extramural or foreign fiscal support, with mission hospitals being almost always underfunded. Often, they lack supplies, equipment, and an adequate supply of trained personnel. Many of these laboratories also lack the capability to repair and maintain complex electronic equipment. Furthermore, reconciling the expectations of the medical staff with the capability of the laboratory and its staff can prove problematic. In this article, we review a method to assess the needs of an institution and to integrate its goals with the limitations of the facility. We also review how to establish afunctional blood bank inventory and to manage and exploit the differences in segments of a blood donor population. The importance of education at all levels is emphasized.

A novel system for providing compatible blood to patients during surgery: "self-service" electronic blood banking by nursing staff.

A good blood bank must be able to provide compatible blood units promptly to operating room patients with minimal wastage. A "self-service" by nursing staff blood banking system that is safe, efficient, and well-accepted has been developed. Specific blood units are no longer assigned to surgical patients who have a negative pretransfusion antibody screen, irrespective of the type of surgery. A computer-generated list of the serial numbers of all group-identical blood units currently in the blood bank inventory is provided for each patient. The units themselves are not labeled with a patient's name. The group O list will be provided for group O patients, the group A list for group A patients, and so forth. Should the patient require transfusion during surgery, the operating room nurses go to the refrigerator, remove any group-identical unit, and check the serial number of the unit against the serial numbers on the patient's list. If the serial number is on that list, the blood bank will accept responsibility for compatibility. The system was implemented in 1995. Since implementation, a total of 2154 patients have undergone operations at this hospital. Thirty-two patients received more than 10 units of red cells each. There were no transfusion errors. The crossmatch-to-transfusion ratio was reduced from 1.67 to 1.12. Turnaround time for supplying additional or urgent units to patients in operating room was shortened from 33 to 2.5 minutes. There was no incidence of a blood unit's serial number not being on the list. Work by nurses and technical staff was reduced by nearly 50 percent. The "self-service" (by nursing staff) blood banking system described is safe and efficient. It saves staff time and can be easily set up.

Directed donations for pediatric patients.

A DIRECTED or designated blood donation is one in which an individual donates blood that is reserved at the time of donation for the transfusion of a specific patient. The donor is usually a family member or close friend that has been selected by the patient. When infants and children are patients, directed donation and subsequent transfusion may be sought by the parents on behalf of their child because of concerns about the risks of blood transfusion; particularly transfusion transmitted infections such as acquired immunodeficiency syndrome (AIDS) and hepatitis. In theory, parental knowledge of the health history and personal activities of family members and friends ensures that blood from these directed donors will be safer than that obtained from the blood bank inventory. This theory, to date, has not been demonstrated to be true, and no sound scientific or medical rationale exists to justify directed donation programs. However, they have been instituted by many blood centers, and a number of ethical, philosophical, legal, logistical and safety concerns have been raised by their presence. These general concerns have been discussed elsewhere in the lay and medical press, and they will not be reiterated

Recommendations of the task force on record-keeping and blood distribution systems.

The objectives of an automated donor record system are reviewed and recommendations as to file content and structure of a computer-based system are outlined. Four sections are suggested, data related to donor identification, demography, date of last donation and special services requirements. Alternative means of data entry and donor-donation links are discussed as well as desirable capabilities of unit record and patient record systems. Two types of blood distribution systems are outlined, namely the reactive type where hospital blood bank inventories are replenished on demand and the predictive type where inventory requirements are predicted in advance and inventories are replenished on a fixed, previously agreed on schedule.

Recommendations of the Task Force on Record-Keeping and Blood Distribution Systems

The objectives of an automated donor record system are reviewed and recommendations as to file content and structure of a computer-based system are outlined. Four sections are suggested, data related to donor identification, demography, date of last donation and special services requirements. Alternative means of data entry and donor-donation links are discussed as well as desirable capabilities of unit record and patient record systems. Two types of blood distribution systems are outlined, namely the reactive type where hospital blood bank inventories are replenished on demand and the predictive type where inventory requirements are predicted in advance and inventories are replenished on a fixed, previously agreed on schedule.

Recycling older blood by integration into the inventory of a single large hospital blood bank: a computer simulation application.

Recycling units of older blood from hospital blood banks with high outdate rates to other hospital blood banks with a high level of transfusion activity and a low outdate rate to increase the probability of utilization of the blood prior to outdating is an accepted method of inventory control. The purpose of this study was to determine with the use of a computer simulation the effects of integrating a variable number of units of ten‐day‐old blood into the inventory of a single large hospital blood bank. The analysis involved separate consideration of the recycling of 30, 60, 90, 120, 180, 240, 300, and 360 units of ten‐day‐old blood with one, three, and five deliveries per week into the modeled blood bank inventory. With one delivery per week and a 30 per cent outdate rate for blood ten days old or older at the hospital or hospitals from which the blood is recycled, the net saving achieved per week by recycling these variable quantities is 5, 4, 13, 17, 7, 0, –17, and –50 units; for a 50 per cent outdate rate, the net saving achieved is 11, 16, 31, 41, 43, 48, 43, and 22 units. Possible net saving of blood based on three and five deliveries per week and other outdate rates is also given. The frequency of blood delivery has no significant effect on the net saving of blood in the blood recycling plans evaluated. The implementation of an automatic blood recycling program, a practical and effective method for reducing blood outdating in a multi‐hospital regional blood system, is discussed in detail.

Setting inventory levels for hospital blood banks.

A method is devised to predict the hospital blood bank inventory of each of the eight blood types that will be adequate on all but a given fraction of days (shortage rate). Analysis of the model confirms and extends prior statistical models and provides a rationale for a number of observations made on some common blood inventory practices. Comparison of the relationship between inventory levels and shortage rates predicted by the model and that calculated from data from 21 hospital blood banks of varying sizes, located in four separate parts of the country, reveals agreement within approximately 10 per cent. A procedure is presented and allows blood banks to select inventory levels and shortage rates based on their mean demand for blood.

Letter to the Editor—Comments on a Blood-Bank Inventory Model of Pegels and Jelmert

A paper by C. Carl Pegels and Andrew E. Jelmert [Opns. Res. 18: 1087–1098 (1970)], entitled “An Evaluation of Blood-Inventory Policies: A Markov Chain Approach,” has drown two comments by John B. Jennings and by Peter Kolesar.

Computer approach to hospital blood bank inventory control.

Since February of 1967, the Yale‐New Haven Hospital's laboratory computer (IBM 1130) has been used for data acquisition and inventory control in the blood bank. The program has been designed to replace existing systems without adding personnel so that all procedures, including key punching and computer operation, are carried out by the blood bank technologists. Data are entered by a specially designed Hollerith card. Half of it, containing information that identifies each unit of blood by group and Rh, number, source, and expiration date, is key punched by a technologist at the time blood or blood products are received. The right half of the card is designed to accept data by a manual technic called Port‐A‐Punch. The daily report contains usage data by blood types and by clinical service. It also lists units transferred, outdated, or unaccounted for. This computer system has provided: (1) more accurate inventory data; (2) detailed usage statistics; (3) an increased awareness of outdating; (4) better blood utilization; and (5) time‐saving in record keeping. Far more important, each technologist has learned to use a new and important laboratory tool.

The indications for transfusion of freshly drawn blood

The use of freshly drawn blood for transfusion should be justified by the clinical and laboratory findings manifested by the patient in relation to the known effects of storage on blood. Empirical administration of this product is wasteful, for it depletes the available donor pool and interferes with blood-bank inventory. A review of a variety of clinical situations that frequently occasion requests for freshly drawn blood indicates that most can be treated optimally with specific blood components, relatively fresh blood, or, in some instances, blood of any storage age.

The Indications for Transfusion of Freshly Drawn Blood

The use of freshly drawn blood for transfusion should be justified by the clinical and laboratory findings manifested by the patient in relation to the known effects of storage on blood. Empirical administration of this product is wasteful, for it depletes the available donor pool and interferes with blood-bank inventory. A review of a variety of clinical situations that frequently occasion requests for freshly drawn blood indicates that most can be treated optimally with specific blood components, relatively fresh blood, or, in some instances, blood of any storage age.

BLOOD BANK INVENTORY CONTROL.

A method of statistical analysis of blood bank inventories, intake and blood usage is presented, Future inventories, intake and usage may be predicted on the basis of this analysis. The relationship of demand and usage and the effect of this relationship on outdating is analyzed. This statistical analysis can then be used as a basis for rational decisions as to the size and maintenance of the blood bank inventory to meet demand and to obtain a reasonable outdating percentage. The importance of the National Clearinghouse Program of the American Association of Blood Banks is discussed, in relation to blood inventory control.