Blood Shortages Research Articles

Study of development prospects of blood service enterprises depending on the type of donation

The blood service is a strategically important branch of the state. The basis of safe blood supply is the popularization of regular (repeated) voluntary free blood donors, because they support the lowest risk of infection. In Ukraine, between 2012 and 2020, the number of donors decreased almost halved, during a war blood needs increased by 30–60%, and blood shortages increased even more. The purpose of the article is to determine and study the prospects for the development of blood service enterprises depending on the type of donation. In countries with a high level of collected blood, the share of regular donors is more than 80%, and paid and family donations are mostly absent. In Ukraine, on average, the share of repeat (regular) donors increased from 7% to 15% during 2012–2020 and remains very low comparing with almost European countries. It was established that there are close inverse relationships between the share of regular donors and the share of erythrocyte mass write-offs (-0.98), between the share of regular donors and the share of donor deferrals (-0.96), and between the share of regular donors and the share of shortages of preserved donor blood (–0.70). There is also a close direct relationship between the share of donor deferrals and the share of erythrocyte mass write-offs (0.94), as well as an average direct relationship between the share of donor deferrals and the share of shortages of preserved donor blood. In the Sumy region, the number of donors increased by 2.5 times, the share of regular donors tripled and reached 74% in 2020, and the number of donations per 1,000 population increased by 6.5 times and reached 61.7. In the Kharkiv region, the number of donors and the number of donations remained at approximately the same level, but the share of regular donors increased by 1.7 times and reached 33.3%. In both regions, during 2012–2020, the share of erythrocyte mass write-offs and shortages of preserved donor blood decreased to the level of less than 1%. The share of donor deferrals also tends to decrease. All this indicates an increase in blood safety. It is estimated that increasing the share of regular donors to 80% at the national level can lead to savings in the amount of UAH 86 million 76.4 thousand during the year. The authors justified the need to develop strategies for converting primary donors into permanent ones.

THE LEVEL OF SUPPLYING UKRAINE WITH DONOR BLOOD AND BLOOD COMPONENTS: STATISTICAL ANALYSIS

The work aims to analyze the level of providing Ukraine with blood and blood components under stable conditions. During 2012–2020, the number of donors decreased twice; the plasma collection decreased by 30%, whole blood - by 56.8%; the number of blood transfusion centers decreased by 42.6%, transfusion departments of medical facilities - by 43.7%, hospitals collecting blood - by 15.1%. According to national reports, in 2020, the needs of Ukraine's healthcare institutions were met by 91.1% of donor blood, 94.6% of plasma, 88.9% of erythrocyte mass, and 124.1% of platelets. According to indicators recommended by WHO, the number of donations per 1,000 population in 2020 in Ukraine is three times less than necessary. Only the Sumy region has provided more than 33 donations per 1.000 population since 2015 (40.46–61.68), Crimea and Luhansk region in 2012–2013. In all other regions, the indicator is below the norm. According to this indicator, blood shortage was 952,546 donations or 66.2% of the recommended by WHO. Another recommended WHO indicator, the amount of collected blood per inhabitant during 2012–2020, was almost twice less as needed - 5.3 ml (WHO recommends 12-15 ml). The blood shortage in 2020 amounted to 276,990.5 liters or 55.7% of the WHO recommended amount. There are significant differences in approaches to the formation of needs for blood and blood components at the state level and the world. The study results show a need to create and implement a system of indicators that would reflect the country's and region's objective needs. In order to improve the provision of Ukraine with blood and blood components during stable conditions, it is necessary to implement marketing programs at the national level. For a significant increase in blood collection volume and its components, it is advisable to analyze the existing experience of leading blood centers in Ukraine and the experience of countries that fully satisfy their country's needs and implement them in their work. The organization of marketing activities and the marketing management system in blood centers should also be analyzed. It can be the subject of further research in this direction. The results of this study can be helpful to marketing specialists involved in blood service promotion.

Horizontal collaboration in a decentralised system: Indonesian blood supply chain

ABSTRACT This paper examines the impacts of horizontal collaboration among blood transfusion units (BTUs) in the Indonesian blood supply chain to anticipate problems such as uncertainty of supply and demand. The conceptual model developed in this study, as well as its implementation, considers the uncertainty. A discrete event simulation is used to evaluate the horizontal collaboration with three main performance indicators: the rate of blood shortages, the rate of outdated blood bags, and the total profits. Two blood transfusion units (BTUs) in Indonesia are examined as case studies in this research. Based on data from the two case studies in one year, a set of experiments, results, and sensitivity analyses were conducted to test the benefits of horizontal collaboration. The results show that the horizontal collaboration decreases blood shortages, outdated blood bags, and inventory costs and increases the total profits. The total revenues increased, and there was additional income from selling blood bags to partner collaboration.

Balanced blood component resuscitation in trauma: Does it matter equally at different transfusion volumes?

BackgroundIt remains unclear whether the association between balanced blood component transfusion and lower mortality is generalizable to trauma patients receiving varying transfusion volumes. We sought to study the role red blood cell transfusion volume plays in the relationships between red blood cell:platelet and red blood cell:fresh frozen plasma ratios and 4-hour mortality. MethodsAdult patients in the 2013 to 2018 American College of Surgeons Trauma Quality Improvement Program database receiving ≥6 red blood cell, ≥1 platelet, and ≥1 fresh frozen plasma within 4 hours were included. The following 4 cohorts were defined based on 4-hour red blood cell transfusion volume: (1) 6 to 10 units, (2) 11 to 15 units, (3) 16 to 20 units, and (4) >20 units. The association between red blood cell:fresh frozen plasma, red blood cell:platelet, and 4-hour mortality was evaluated discretely for each red blood cell transfusion volume category, statistically adjusting for confounders. ResultsA total of 14,549 patients were included. In patients receiving 6 to 10 units of red blood cells, red blood cell:platelet ratios were not associated with 4-hour mortality, and only red blood cell:fresh frozen plasma ≥4:1 were associated with significantly higher odds of 4-hour mortality compared to 1:1. For patients receiving >10 red blood cell units, increasing red blood cell:platelet and red blood cell:fresh frozen plasma ratios were consistently associated with increased odds of 4-hour mortality. For example, in red blood cell volumes of 11 to 15, 16 to 20, and >20 units, risk-adjusted 4-hour mortality odds ratios for red blood cell:platelet ≥4:1 were 2.27 (1.47–3.51), 3.32 (2.26–4.90), and 3.01 (2.33–3.88), respectively. ConclusionThe association between balanced blood component transfusion and 4-hour mortality is not homogenous in trauma patients requiring different transfusion volumes and is specifically less evident in patients receiving lower volumes. Such findings should be considered in the current and future blood shortage crises across the nation.

1139: FOUR-FACTOR PROTHROMBIN COMPLEX CONCENTRATE FOR REFRACTORY BLEEDING IN TRAUMA AND CARDIAC SURGERY

Introduction: Four-Factor Prothrombin Complex Concentrate (4F-PCC) is a concentrated product containing factors II, VII, IX, X, proteins C and S, that is FDA approved for reversal of vitamin K antagonists in adults with acute major bleeding or need for urgent surgery. The utilization of factor products for off-label indications has been increasing secondary to continued national blood shortages and ease of administration, with the hope of reducing blood product utilization. Methods: This single-center retrospective study at an academic level I trauma center analyzed the use of 4F-PCC for refractory bleeding between June 2018 and March 2022 in adult trauma and cardiovascular surgery patients. The primary objective was to determine blood product utilization in patients during a time period of six hours pre and post 4F-PCC administration. Secondary outcomes included thrombotic events, mortality, and use of supportive hemostatic medications. Results: Thirty-five patients received 4F-PCC for significant exsanguination refractory to massive transfusion: cardiac (n=32, 91%) and trauma surgery (n=3, 9%). The median age was 62 years (IQR 50-69) and the majority were male (n=21, 60%). The median dose administered was 2128 units (IQR 1668-2750) or 25 units/kg of factor IX (IQR 20.7-29). Units of blood products given pre and post 4F-PCC administration were: packed red blood cells (PRBC) [5.4 (IQR 3.2-8.9), 2.1 (IQR 1.8-4.1) p< 0.01], fresh frozen plasma (FFP) [4.4 (IQR 2.5-8.0), 3.4 (IQR 1.3-4.7) p=0.03], platelets [1.9 (IQR 1.1-2.2), 1.2 (IQR 1.0-2.2) p=0.20] and cryoprecipitate [1.3 (IQR 0.8-2.4), 0.9 (IQR 0.8-1.8) p=0.83]. Five patients experienced thrombotic events and the mortality was 29%. Three patients received concomitant phytonadione and seven received desmopressin. Conclusions: There was a significant reduction in PRBC and FFP units transfused after 4F-PCC administration in patients for refractory bleeding for trauma and cardiac surgery patients. Further investigation is warranted to determine if the reduction in product administration results in differences in clinical outcomes and if this finding is replicated in other surgical populations.

The impact of COVID-19 on blood safety and availability in the Islamic Republic of Iran.

The COVID-19 pandemic has affected blood inventory and donation worldwide. The Islamic Republic of Iran was among the first countries to report the COVID-19 pandemic and it faced a significant blood shortage during the first weeks of the pandemic. We aimed to evaluate the impact of COVID-19 pandemic on the number, type, and safety of blood donations, comparing the periods before and during the pandemic. This retrospective study evaluated data from all volunteers who attended the blood transfusion centres in the Islamic Republic of Iran from March to December 2020 (during the COVID-19 pandemic) and during the same period in 2019, i.e. pre-pandemic. Data on the number of blood collections, confirmed transfusion transmissible infection marker test results, and donor demographic information were collected from the Iranian Blood Transfusion Organization integrated donor database. Total blood donations decreased by 8.38%. The number of first-time, lapsed, and female blood donors increased by 4.41%, 0.17%, and 0.90% respectively. Regular blood donation decreased by 4.58%. The distribution of the 3 main blood products, red cell concentrate, frozen fresh plasma and platelets, decreased by 7.86%. All changes were statistically significant. The prevalence rates of hepatitis C virus and hepatitis B surface antigen increased significantly during the pandemic. COVID-19 had a negative effect on blood safety and availability in the Islamic Republic of Iran. To improve blood supply and enhance regular blood donation, the Iranian Blood Transfusion Organization needs to reassure blood donors of the safety and hygiene measures being observed at blood collection sites.

Re-Entry Evaluation of Chinese Blood Donors with Unconfirmed Hepatitis B Screening Results.

The hepatitis B virus (HBV) remains a high priority for Chinese blood banks due to the high prevalence of infection. HBV blood safety has been significantly improved by the implementation of highly sensitive and specific serological and molecular HBV screening assays. The multiplication of viral markers tested and the ever-increasing analytical sensitivity of the tests can make the interpretation of the results difficult. False-positive or indeterminate results may lead to permanent donor deferrals and conflicts between donors and blood banks. To avoid blood shortages, blood services aim to limit unnecessary donor losses by developing procedures for the re-entry of donors temporarily deferred due to an unconfirmed HBV reactivity. The development of such procedures based on donor follow-up and HBV confirmation remains limited. A review of the scarce data available revealed considerable heterogeneity in testing methods and re-entry algorithms, limited validation studies, and a lack of accurate assessment of the residual infectious risk potentially associated with donor re-entry. In conclusion, systematic and widely validated confirmatory testing and prolonged follow-up are essential for safe re-entry of temporary deferred donors. Standardization of HBV testing methods and the establishment of dedicated expert laboratories are needed because of the complexity of HBV infection in blood donors.

Acute Myeloid Leukemia in Western Kenya: Exploring Outcome Disparities through Cases

Introduction: For young adults with acute myeloid leukemia (AML) in the United States, 60-80% can achieve complete remission and 33% can be cured with intensive treatment; in India that figure drops to overall 1-year survival of 55.6%; in Western Kenya overall 1-year survival is less than 10%. In the United States, achievement of complete remission is an appropriate goal. As described in Wanjiku 2021, in western Kenya, patients are typically not treated with standard induction therapy due to lack of supportive care. Three cases of children and young adults in Eldoret, Kenya with AML in the month of April 2022 are discussed to elucidate barriers to successful treatment in resource-limited settings. Cases: Case 1 (WK) is a 19 year old man with symptoms of dizziness, fatigue, abdominal pain, and wasting for one year, referred from Kericho District Hospital with bone marrow aspirate suspicious for acute myeloid leukemia, referred for flow cytometry, cytogenic/molecular studies, chemotherapy and management of acute myeloid leukemia. Family paid in advance for flow cytometry. Prior to referral he received hydroxyurea, allopurinol, and 6 units of blood. Hemoglobin on arrival was 4.0 g/dL, white blood cells 64.5, platelets 16. Four units of blood were ordered, only one was available. His condition deteriorated and he died of respiratory failure. Case 2 (WC) is a 16 year old man with puffy face, severe pallor, nosebleeds, and exercise intolerance, referred from Kericho District Hospital with bone marrow aspirate suspicious for acute myeloid leukemia. Hemoglobin was 5.5 g/dL, white blood cells 15, platelets 52. Five units of blood were ordered, no blood was available. Family paid in advance for chemotherapy, and he was started on "prephase 1" etoposide 50mg/m2 IV infusion over 1 hour for 6 days, then discharged to follow up in oncology clinic in two weeks. Case 3 (MK) is a 25 year old woman local to Eldoret, with one week of generalized body pain, abdominal pain, and weakness. Peripheral blood smear demonstrated 90% blasts and reduced platelets, and she presented to the hospital for bone marrow aspiration and blood transfusion. Initial hemoglobin 2as 5.2 g/dL, WBC 28.9, platelets 71. Five units of blood were ordered, and she received four. Bone marrow aspirate reported nonspecific features of acute leukemia, flow cytometry reported 93% blasts, AML-M0. Discussion: Significant disparities and barriers exist in the treatment of acute myeloid leukemia in resource-limited settings. The first step is diagnosis, including awareness and access to early treatment and diagnostic capabilities. Anecdotally, the rate of AML in the Kericho region is attributed to environmental exposures related to tea farming. In the setting of Western Kenya, some patients especially in Eldoret and Kericho had access to bone marrow aspirate and referral capability to flow cytometry. The next major barrier identified was supportive care, including scarcity of blood products. In April, the blood shortage was reported to be related to federal holiday, meaning that classes of school students and military recruits were not coming to donate blood on a regular basis. The next major barrier was induction of chemotherapy, including the practice of low-dose chemotherapy (low-dose cytarabine or etoposide alone) without intent to cure, due to concerns of managing the complications of induction chemotherapy. On the far end of the treatment spectrum, bone marrow transplant was not an option in the country of Kenya, and patients seeking this treatment option were obligated to travel abroad. Conclusion: Key barriers exist to treatment of AML in western Kenya, which contribute to disparities in outcomes of young adults with AML in western Kenya compared to the United States. Barriers identified from examining cases included access to bone marrow aspiration and flow cytometry, availability of blood products, choice of chemotherapy approach (low-dose versus standard induction), supportive care environment, and availability of treatment options including bone marrow transplant. More research is needed to identify the causes of death for patients in this local population, and create a system that can reduce the international disparities and move towards equitable goals of remission and cure.

A Successful Patient Blood Management System Implemented during the COVID Pandemic Based on Daily Blood Inventory Levels in a Single Large Oncology Institution

Introduction: The recent pandemic brought to light the fragility of the US Blood Collection system and supply chain disruption. As blood donations declined, blood donor centers (BDC) and blood banks (BB) worldwide reported a significant blood shortage. Our blood donor center had challenges from imposed COVID precautions (social distancing, contact restrictions, donations by appointments only, wearing of PPEs, etc.) to increase blood collections to replace the units transfused daily. The study was to review our Institutional process for development of Covid-19 risk levels-based dashboards which tracked the pandemic and provided risk levels in real time to faulty/staff employees. Methods: As the Blood Inventory decreased daily during the start of the pandemic and ultimately became critical, the Transfusion Service/Blood Bank (TS/BB) would reset and lower the triage Hgb level from 7.0 gm/dl to 8.0 gm/dL based on O pRBC units in inventory. The challenge was to disseminate the blood inventory to all stakeholders, decrease the number of calls/pages to TS/BB/Transfusion Medicine Physician (TMP) on call and be consistent in setting Hgb triage levels. Surgery/Anesthesia required daily inventory to predict cases that would have to be cancelled and rescheduled for possible increased estimated blood loss. As the national/local blood supply shortage became critical especially for O RBC Units, a Blood Shortage Decision Matrix was created in collaboration with our Chief Patient Safety Officer, Chief Administrative Quality Officer and Chief Information Technology Officer teams with a color-coded legend (RED - Hgb <=7.0 gm/dL [Emergencies only], ORANGE- Hgb <=7.0 gm/dL, YELLOW -Hgb <=7.5 gm/dL and GREEN <=Hgb 8.0 gm/dL) illustrating how blood would be triaged based on the O red cells units available in Inventory for transfusion each day (See Table ). Minimal/critical numbers for each blood product/blood group were derived based on logistic regression/machine learning/manual counts from historic usage within the past 2 years. A similar color-coded diagram was used for Platelet Inventory. The blood inventory continues to be reported at the daily morning Department/Divisional (Operations) Tier Readiness Briefings (Institution's Pathway leading to a High reliability Organization) for institution wide dissemination. The TS/BB Information System is linked to real time blood inventory of all blood products entered into the system and provided us with real time inventory except for units that required a second ABO Rh and irradiation. Computer queries were performed for the latest inventory by blood product available and received, total number of Inpatient and Emergency Medicine patients by blood types and their latest hemoglobin values with transfusion orders and transfused currently, patients who were not transfused currently with no active orders and patients who were transfused since last day of transfusion by blood types. Supply Estimates were made for blood products from donors collected at our BDC and blood products that would have to be purchased from outside suppliers. This was to guide decision making for both the BDC to provide blood products to the TS/BB and for the TS/BB to assess how many products needed to be ordered from outside suppliers. Demand estimates were made from historical data, current inpatient census from the EMR inpatient dashboard, number of current inpatients (ICU, Hematologic Oncology, Acute Cancer Care Center etc.) who were O pos (Per Webi query with a real time report run each morning), by location, blood type, hemoglobin level and days since latest hemoglobin level. Data was used to assess how many of the patient groups already met hemoglobin levels designed by the color code chart described above between 7.0 and 8.0 gm/dL which assisted the TS/BB to triage pRBC orders based on Hgb levels set for the colors. Results: The Blood Shortage Decision Matrix since its implementation in October 2021 has allowed clear organizational-wide ownership across all levels of the organization, use of a standardized Blood Inventory management by the TS/BB, improved communications with primary care teams, better understanding of the challenges maintaining an adequate blood supply by the Executive/Administrative Leadership leading to allocation of additional needed resources to the Blood Donor Center/TS/BB and also helps the Institution on its path toward a High reliability Organization. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Predicting willingness to donate blood based on machine learning: two blood donor recruitments during COVID-19 outbreaks

Machine learning methods are a novel way to predict and rank donors' willingness to donate blood and to achieve precision recruitment, which can improve the recruitment efficiency and meet the challenge of blood shortage. We collected information about experienced blood donors via short message service (SMS) recruitment and developed 7 machine learning-based recruitment models using PyCharm-Python Environment and 13 features which were described as a method for ranking and predicting donors’ intentions to donate blood with a floating number between 0 and 1. Performance of the prediction models was assessed by the Area under the receiver operating characteristic curve (AUC), accuracy, precision, recall, and F1 score in the full dataset, and by the accuracy in the four sub-datasets. The developed models were applied to prospective validations of recruiting experienced blood donors during two COVID-19 pandemics, while the routine method was used as a control. Overall, a total of 95,476 recruitments via SMS and their donation results were enrolled in our modelling study. The strongest predictor features for the donation of experienced donors were blood donation interval, age, and donation frequency. Among the seven baseline models, the eXtreme Gradient Boosting (XGBoost) and Support vector machine models (SVM) achieved the best performance: mean (95%CI) with the highest AUC: 0.809 (0.806–0.811), accuracy: 0.815 (0.812–0.818), precision: 0.840 (0.835–0.845), and F1 score of XGBoost: 0.843 (0.840–0.845) and recall of SVM: 0.991 (0.988–0.994). The hit rate of the XGBoost model alone and the combined XGBoost and SVM models were 1.25 and 1.80 times higher than that of the conventional method as a control in 2 recruitments respectively, and the hit rate of the high willingness to donate group was 1.96 times higher than that of the low willingness to donate group. Our results suggested that the machine learning models could predict and determine the experienced donors with a strong willingness to donate blood by a ranking score based on personalized donation data and demographical details, significantly improve the recruitment rate of blood donors and help blood agencies to maintain the blood supply in emergencies.

Successful Collaboration of a Hospital Based Blood Center and Blood Bank during the Pandemic and Blood Shortage

Abstract Introduction/Objective At the beginning of the SARS-Co-V2 pandemic, many hospitals implemented mitigating strategies to preserve their blood supply in anticipation of a blood shortage. Our health system, Inova (IHS), which includes 5 hospitals supported by our hospital based blood services, was no different. During the pandemic we experienced a decline in donations and available blood products. In anticipation of this shortage, our institution mobilized the Patient Blood Management (PBM) initiative. A multidisciplinary review of transfusion criteria was performed across the system. This included enforcing single unit red blood cell (RBC) transfusions, partial RBC exchanges for sickle-cell disease, and reduction in plasma replacement volume during plasma exchanges for patients with thrombotic thrombocytopenic purpura (TTP). By implementing these strategies, patient outcomes were not impacted despite the constraints to our blood supply. Methods/Case Report IHS Executive leaders were identified to participate along with key stakeholders in the PBM committee meetings to ensure proper blood utilization for our patients. Clinical guidelines were updated within the physician order sets. Data was compiled with a focus on hemoglobin metrics along with the percentage of single unit transfusions. Collaborating with IHS Apheresis Services and our providers, we developed a strategy to reduce the number of blood products transfused. Results (if a Case Study enter NA) Although there was decline in donor blood collections during the pandemic due to significant concerns of SARS-CO-V2 exposure, the implementation of Patient Blood Management strategies at our institution proved to be beneficial for product management and resource allocation. Although there was a decline in the number of donations (6.5%) we were able to transfuse more patients. Conclusion The SARS-Co-V2 pandemic significantly reduced the blood inventory nationwide. By implementing a robust Patient Blood Management program, we were able to successfully utilize our blood inventory while maintaining transfusion practices that aligned with standards of care. The collaborative efforts between our hospital based blood center and the blood bank led to the optimal use of a reduced blood supply during the pandemic. Incorporating Patient Blood Management principles and safe implementation of novel treatment plans for certain apheresis patient population during the pandemic enabled our system to have more available blood products and care for more patients with improved patient outcomes.

Effect of Autotransfusion in HCC Surgery on Survival and Recurrence: A Systematic Review and Meta-Analysis.

Simple SummaryAdministering patients their own blood during liver surgery would reduce the burden on blood banks and immunologic reactions to foreign blood products. Two methods of autotransfusion are available: scheduled donation before surgery and salvage during surgery (intraoperative blood salvage, IBS). However, concerns over circulating tumor cells dissuade against autotransfusion in patients undergoing liver surgery for hepatocellular carcinoma (HCC). This meta-analysis evaluated available reports on autotransfusion, including the reintroduction of blood collected from the surgical area during a tumor operation. Patients who received blood collected from the surgical site during liver transplantation did not develop more recurrences of HCC and their overall survival was similar to patients who received donor blood products. Patients undergoing liver resection mostly received blood they donated prior to surgery. They showed a better overall survival as well as cancer-free survival after surgery. Randomized controlled trials are needed to better estimate the effects of autotransfusion on patients and studies incorporating autotransfusion of blood collected during liver resection are needed.Background: The chronic blood shortage has forced clinicians to seek alternatives to allogeneic blood transfusions during surgery. Due to anatomic uniqueness resulting in a vast vasculature, liver surgery can lead to significant blood loss, and an estimated 30% of patients require blood transfusions in major hepatectomy. Allogeneic transfusion harbors the risk of an immunologic reaction. However, the hesitation to reinfuse a patient’s own blood during cancer surgery is reinforced by the potentiality of reintroducing and disseminating tumor cells into an individual undergoing curative treatment. Two methods of autotransfusions are common: autotransfusion after preoperative blood donation and intraoperative blood salvage (IBS). We aim to investigate the effect of autotransfusion on recurrence and survival rates of patients undergoing surgery for HCC. Methods: The protocol for this meta-analysis was registered at PROSPERO prior to data extraction. MEDLINE, Web of Science and Cochrane Library were searched for publications on liver surgery and blood salvage (autologous transfusion or intraoperative blood salvage). Comparative studies were included. Outcomes focused on long-term oncologic status and mortality. Hazard ratios (HR) estimated outcomes with a fixed-effects model. Risk of bias was assessed using ROBINS-I, and certainty of evidence was evaluated with GRADE. Separate analyses were performed for liver transplantation and hepatectomies. Results: Fifteen studies were included in the analysis (nine on transplantation and six on hepatectomies), and they comprised 2052 patients. Overall survival was comparable between patients who received intraoperative blood salvage (IBS) or not for liver transplantation (HR 1.13, 95% CI [0.89, 1.42] p = 0.31). Disease-free survival also was comparable (HR 0.97, 95% CI [0.76, 1.24], p = 0.83). Autotransfusion after prior donation was predominantly used in hepatectomy. Patients who received autotransfusion had a significantly better overall survival than the control (HR 0.71, 95% CI [0.58, 0.88], p = 0.002). Disease-free survival was also significantly higher in patients with autotransfusion (HR 0.88, 95% CI [0.80, 0.96], p = 0.005). Although overall, the certainty of evidence is low and included studies exhibited methodological heterogeneity, the heterogeneity of outcomes was low to moderate. Conclusion: Autotransfusion, including intraoperative blood salvage, does not adversely affect the overall or disease-free survival of patients with HCC undergoing resection or transplantation. The results of this meta-analysis justify a randomized-controlled trial regarding the feasibility and potential benefits of autotransfusion in HCC surgery.

Wider perspectives: It's a changing world-The use of ABO-incompatible plasma for resuscitating massively bleeding patients.

Wider perspectives: It's a changing world-The use of ABO-incompatible plasma for resuscitating massively bleeding patients.

Perceptions and practices of the Brazilian LGBT+ population toward blood donation

In May 2020, after years of demands by activists and in light of COVID-19-related blood shortages, the Brazilian Federal Supreme Court abolished the rules that demanded a 12-month celibacy period for men who have sex with men (MSM) to donate blood. The objective of this open web survey was to assess the perceptions and practices regarding blood donation and blood donation rules among members of the Brazilian LGBT+ community. The data collection was conducted between October 2019 and March 2020, before the changes in the rules for blood donation and before the onset of the COVID-19 pandemic in Brazil. A total of 1639 adult individuals, self-declared as LGBT+ , participated (54.3 % MSM, 2.2 non-MSM, 43.5 % women). As expected, most of the study participants did not agree with the 12-month deferral period for MSM donate blood. Blood donation was already practiced by MSM, even before the abolition of the restrictions on donation. Among MSM and women, 38.7 % and 41.0 % have already donated blood, respectively. A significant number of participants reported lying in screening interviews at blood banks in order to be able to donate, and many said they knew people who were MSM and disobeyed the rules for donation, even though they knew them. Therefore, the practice of blood donation was already present among these people, even before the restriction policy change, confirming the need for revised rules for blood donation.

Optimal policy of ordering blood units in the hospital according to compatibility and priority transfers between blood groups under uncertainty conditions: A case study

In spite of significant advancements in medicine, there is still a shortage of human blood in the world. At present, there is no alternative chemical process or product that can produce blood, and only humans are capable of doing so. It is for this reason that blood is such an important component of our healthcare system. Due to the perishability of blood, managing blood inventories can be challenging. The challenge is to maintain a high level of supply while minimizing loss due to expiration. The purpose of this study is to present a mathematical model that reduces inventory costs, determines the optimal ordering policy in hospitals, and prevents the loss of blood units. To determine the optimal inventory level and order volume, a mixed integer programming model is presented in both deterministic and non-deterministic conditions. In order to address the uncertainty in the problem, a robust optimization approach is used. This model minimizes the transfer of blood groups and transmission between hospitals by considering compatibility and priority. A sensitivity analysis has also been conducted on the model. Based on a case study, it is demonstrated that the costs of buying, storing, ordering, and wasting two important RBCs and platelets can be reduced.

Multivariate time-series blood donation/demand forecasting for resilient supply chain management during COVID-19 pandemic

COVID-19 has caused negative impacts on blood supply chain management, due to uncertain supply/demand and logistical disruptions. In the early weeks following the COVID-19 pandemic, 20–30% reduction in blood donation had observed, which adversely affected the whole blood supply chain. Although this shortage was partially compensated through rescheduling of elective surgeries and shifting some inpatient surgeries to outpatient surgeries, resumption of the normal surgeries by hospitals had increased the demands for the blood products. At the same time, the total blood supply was increased by some measures taken to overcome the blood shortage. In this paper, a multivariate time-series deep learning model based on long short-term memory is proposed to forecast the blood donation/demand. It takes daily time-series of blood donation/demand (internal features) as well as daily time-series of new confirmed COVID-19 cases/deaths (external features) as its inputs, and predicts blood donation/demand for the next week. The proposed model is used to achieve a resilient blood inventory management, capable of handling the uncertainties occurring during the COVID-19 pandemic. The proposed blood donation/demand forecasting model has been successfully simulated on the collected data of Tehran Blood Center in Tehran, Iran, for a time period from February 24, 2020, to October 14, 2021. Obtained results show the efficiency of the proposed model by obtaining 6.1% and 6.5% error between the actual and forecasted values of the number of donations and demands, respectively. The results of applying the proposed model for inventory management of blood platelets demonstrate the resiliency of our model to reduce shortage and wastage rates against the existing uncertainty handling models by 32.1% and 26.6%, respectively. The proposed method can be used to assist the decision makers in managing the blood supply chains through prioritizing the blood transfusions during COVID-19 and similar pandemics in the future.

GAMBARAN PENGETAHUAN IBU HAMIL TENTANG ANEMIA DEFISIENSI ZAT BESI BERDASARKAN KARAKTERISTIK DI PUSKESMAS LOSARI KABUPATEN BREBES

Anemia of pregnant women is a condition in which there is a shortage of red blood and a decrease in hemoglobin of less than 9.5 g/dl in the body of pregnant women (normal Hb 11 g/dl). Data from the Losari Health Center, which examined pregnancy found 423 people, and those who did HB (Haemoglobin) checks were 132 people. From the examination, the following data were obtained who had anemia there were 30 people (22.72%). This type of research is descriptive with an observational research design. The form of non-probability sampling, sampling method with total sampling is usually done in specific case studies and is very homogeneous in the characteristics of the population. The tstudy used total sampling where the total sample of the population was 30 first trimester pregnant women, who have anemia because of deficiency of iron. The results showed that the knowledge of pregnant women about iron deficiency anemia was mostly sufficient (60%). Based on the parity of the results obtained (73%), most of them were primiparous. Based on the diet, the results (63%) showed that most of the diets did not vary. Based on the socio-economic results obtained (83%) most of the results are less ( 1 million/month). Suggestion of this study is that pregnant women pay more attention to eating patterns with good nutrition, for health workers to increase counseling, especially pregnant women, for Puskesmas to improve quality services for pregnant women.

Implementation of national blood conservation recommendations at an adult sickle cell center

Due to the national blood supply crisis caused by the COVID-19 pandemic, the American Society of Hematology proposed guidance to decrease blood utilization for sickle cell patients on chronic transfusion therapy (CTT). Little evidence exists to support the efficacy and safety of these blood conservation strategies. Through retrospective analysis, we sought to describe outcomes following implementation of these recommendations in 58 adult sickle cell patients on chronic exchange transfusions. The strategies employed included: relaxing the goal fraction of cells remaining (FCR) to 30%-50%, utilizing depletion exchanges in select patients, and transitioning select patients to monthly simple transfusions. We compared hemoglobin S%, hemoglobin values, and other laboratory parameters, acute care visits, and red blood cell usage during the first year of the COVID-19 pandemic to the year prior using Wilcoxon signed rank test. Of 53 patients who remained on chronic exchanges during the pandemic, use of depletion exchange increased (15%-23%) and FCR increased (34.9 [SD 4.7] vs. 37.6 [SD 4.5], p< .05). These changes resulted in 854 units conserved without clinically significant changes to pre-exchange laboratory parameters, including hemoglobin S%, or number of acute care presentations. In contrast, five patients who transitioned to predominantly simple transfusions, experienced difficulty maintaining hemoglobin S% less than 30 and worsening anemia. Our data suggest that in a blood shortage crisis, optimizing the exchange procedure itself may be the safest means of conserving blood in a population of adult patients with sickle cell disease.

Hospital red blood cell and platelet supply and utilization from March to December of the first year of the COVID-19 pandemic: The BEST collaborative study.

BackgroundAt the start of the coronavirus disease 2019 (COVID‐19) pandemic, widespread blood shortages were anticipated. We sought to determine how hospital blood supply and blood utilization were affected by the first wave of COVID‐19.Study Design and MethodsWeekly red blood cell (RBC) and platelet (PLT) inventory, transfusion, and outdate data were collected from 13 institutions in the United States, Brazil, Canada, and Denmark from March 1st to December 31st of 2020 and 2019. Data from the sites were aligned based on each site's local first peak of COVID‐19 cases, and data from 2020 (pandemic year) were compared with data from the corresponding period in 2019 (pre‐pandemic baseline).ResultsRBC inventories were 3% lower in 2020 than in 2019 (680 vs. 704, p < .001) and 5% fewer RBCs were transfused per week compared to 2019 (477 vs. 501, p < .001). However, during the first COVID‐19 peak, RBC and PLT inventories were higher than normal, as reflected by deviation from par, days on hand, and percent outdated. At this time, 16% fewer inpatient beds were occupied, and 43% fewer surgeries were performed compared to 2019 (p < .001). In contrast to 2019 when there was no correlation, there was, in 2020, significant negative correlations between RBC and PLT days on hand and both percentage occupancy of inpatient beds and percentage of surgeries performed.ConclusionDuring the COVID‐19 pandemic in 2020, RBC and PLT inventories remained adequate. During the first wave of cases, significant decreases in patient care activities were associated with excess RBC and PLT supplies and increased product outdating.

Passive order auditing associated with reductions in red blood cell utilization: National blood shortage experience.

Decreased blood collection during the Coronavirus Disease 2019 (COVID-19) pandemic resulted in long-term red blood cell (RBC) shortages in the United States. In an effort to conserve RBCs, the existing passive alert system for auditing inpatient transfusions was modified to activate at a lower hemoglobin threshold (6.5g/dL instead of 7.0g/dL for stable, nonbleeding inpatients) during a 9-month shortage at an academic medical center. Hemoglobin levels prior to RBC transfusions were compared for inpatients receiving RBC transfusions to determine whether RBC utilization changed during the intervention. This retrospective study compared the number of single-unit RBC transfusions and hemoglobin levels prior to RBC transfusion among inpatients during the 9months of the intervention (Period 2, 06/01/2021-2/28/2022) to the same period of the previous year (Period 1, 06/01/2020-2/28/2021). Overall full unit RBC transfusions to inpatients decreased by 15% from 5182 to 4421. Of all transfusions, 50.3% and 49.8% were single-unit RBC transfusions in Period 1 and Period 2, respectively. The incidence rate difference and incidence rate ratio of single RBC units transfused per 1000 patient days were significantly decreased (p=0.0007). The average pre-transfusion hemoglobin level significantly decreased from 7.18 g/dL to 7.05 g/dL (p=0.0002), largely due to significant decreases in hemoglobin transfusion triggers for adult inpatient ward transfusions. Modification of the passive alert system was associated with significantly decreased RBC utilization during a long-term RBC shortage. Modification of transfusion criteria recommended by passive alerts may be a feasible option to decrease RBC utilization at centers during long-term RBC shortages.