Blood Shortages Research Articles

Defining blood deserts and access to blood products for 660 million people: a geospatial analysis of eight states in Northern India

IntroductionBlood transfusion is crucial, but low-income and middle-income countries like India face a severe shortage of banked blood. This study focuses on the Empowered Action Group (EAG) states in India,...

Impact of the COVID-19 Pandemic on Blood Transfusion among Hospitalized Patients with Chronic Kidney Disease.

Background and Objectives: Hematological disorders, especially chronic anemia and coagulation disorders, are common in patients with chronic kidney disease (CKD). Severe anemia is associated with increased cardiovascular morbidity and mortality in this special group of patients and is also responsible for decreased hope and quality of life. Despite the use of appropriate iron therapy and erythropoietin-stimulating agents, red blood cell transfusion is occasionally required, usually in the setting of acute bleeding or for correction of perioperative anemia. The COVID-19 pandemic has accelerated the progression of chronic diseases and worsened the outcomes for patients with nephrological conditions. As a precautionary measure against infections, patients' access to hospitalization for their procedures has been reduced and their chronic complications, including hematological abnormalities, have gotten out of control. Materials and Methods: Our retrospective observational study was designed to evaluate the impact of the COVID-19 pandemic on blood transfusion for the patients with chronic kidney disease hospitalized in our emergency county medical unit, over a period of four years (2019-2022) who were admitted or at least referred for evaluation to the Nephrology department. We also followed the measures adopted to ensure the necessary blood products during this time. Results: Between 2190-2022, a total of 24,096 hospitalized patients were transfused at the Emergency County Clinical Hospital in Constanta, Romania. Meanwhile, in the nephrology and other medical or surgical wards of our medical unit, 1590 CKD patients were transfused with different blood derivatives. During the pandemic years, as expected, the number of transfused patients and transfused blood units decreased by 4% and 7%, respectively, in comparison with the pre-pandemic year, 2019. Unlike the general trend of transfusion activity, more patients with CKD transfused in 2022 (580) than before the pandemic (414 in 2019), and the number of blood units was higher in 2022 than in 2019 for red blood products and plasma. Between 2020-2022, from the total number of transfused patients in our study, 254 with CKD patients (16%) and 798 non-CKD (4%) died in-hospital. Conclusions: The adaptive strategies implemented to ensure the necessary blood products in the hospital during the COVID-19 pandemic mainly included restrictive transfusion and limitation of elective surgical procedures. The subject matter of the article is important as blood shortages are a problem that healthcare workers may encounter in future pandemics.

An integrated blood supply chain network design during a pandemic

The emergency supply of blood in the wake of pandemic has proved challenging. We develop in this paper a bi-objective blood supply chain (BSC) model that uses two-stage stochastic optimisation to optimise the expected cost of the supply chain and the average blood delivery time when a pandemic occurs. The model considers not only vertically and horizontally integrated mechanisms of the BSC network, but also several specific assumptions about the pandemic, such as the risk of disruption in donor groups, and the restriction of ‘no cross blood donation’. To alleviate blood shortages in the context of a pandemic, we further extended our model, which allows for blood type substitution according to ABO/Rh(d)-compatibility. To efficiently solve the model and generate the Pareto front, we develop a hybrid solution algorithm to solve the proposed model, including the ε-constraint method to transform the bi-objective model into a single-objective model, the subgradient method for finding a lower bound, and two heuristic methods for finding an upper bound. Moreover, we perform extensive numerical studies to assess the performance of the proposed approach. We also discuss the impacts of the key parameters, integration mechanisms, and planning blood type substitution on the BSC. Finally, we also apply the proposed model to a real case study of the BSC in Chongqing, China.

Use of half red blood cell units in oncology patients during severe shortages to extend hospital supply.

The COVID-19 pandemic exerted an unprecedented impact on the blood supply from 2020 through 2022. As a result, throughout 2021 there were months our hospital had less than one-day supply of type O RBCs. To meet transfusion needs, whole RBC units were split into half units and issued to stable, non-bleeding patients. This single-institution, retrospective study examines time intervals to subsequent transfusion and total numbers of RBC units subsequently transfused after the first half or whole RBC unit. Patients who were transfused RBC between May 21, 2021 and November 1, 2021 were divided into in- and outpatient groups, then based on whether they received at least 1 half RBC unit or only whole RBC units during the study period. The time interval between this first half unit transfusion, or first whole unit transfusion in those who did not receive half units, and the subsequent RBC transfusion within 90 days was calculated and compared, as well as the total number of RBC units transfused 30 days after the first unit. In general, patients transfused with half units received a subsequent transfusion significantly earlier than those transfused with whole units. Additionally, receiving an index half unit was associated with more RBC transfusions in the following 30 days (p = .001). Transfusion of half RBC units during a severe RBC blood shortage can temporarily decrease RBC usage but will result in a shorter interval to the next transfusion and greater total number of RBC units transfused in subsequent days.

Prevention of Blood Incompatibility Related Hemagglutination: Blocking of Antigen A on Red Blood Cells Using In Silico Designed Recombinant Anti-A scFv.

Critical blood shortages plague healthcare systems, particularly in lower-income and middle-income countries. This affects patients requiring regular transfusions and creates challenges during emergencies where universal blood is vital. To address these shortages and support blood banks during emergencies, this study reports a method for increasing the compatibility of blood group A red blood cells (RBCs) by blocking surface antigen-A using anti-A single chain fragment variable (scFv). To enhance stability, the scFv was first modified with the addition of interdomain disulfide bonds. The most effective location for this modification was found to be H44-L232 of mutant-1a scFv. ScFv was then produced from E.coli BL21(DE3) and purified using a three-step process. Purified scFvs were then used to block maximum number of antigens-A on RBCs, and it was found that only monomers were functional, while dimers formed through incorrect domain-swapping were non-functional. These antigen-blocked RBCs displayed no clumping in hemagglutination testing with incompatible blood plasma. The dissociation constant KD was found to be 0.724 μM. Antigen-blocked RBCs have the potential to be given to other blood groups during emergencies. This innovative approach could significantly increase the pool of usable blood, potentially saving countless lives.

The Development and Impact of a Blood Unity Application

This research focuses on the development and impact of a Blood Unity Application. Blood shortage is still a major problem in the medical sector. Emergencies come as last minute requirements and are very crucial. Inadequate blood and compatability problems make it difficult to manage the blood supply effectively. Sometimes, a lack of awareness and communication causes those who might be eager to donate to be unaware of the efforts that are running. To avoid these challenges we have designed an app which acts as a bridge between the donors and the people in need. In this paper, we present an overview of a website and a mobile application designed for blood donation. It is a user- friendly application where we collaborate the donors and hospitals to the people in need. By creating this application, we can assure a safe and secure blood transfusion. Anyone in need of blood at any time can download this app right away and use it to locate nearby donors who have the necessary blood type. We make the donors contact information available through the app to all registered users, enabling them to get in touch with them directly in case of emergency. We have also made a website similar to the app to use through PCs or Laptops from anywhere and at anytime. The website was developed through HTML, CSS, Bootstrap at frontend and PHP, MYSQL at backend and Angular Java Script at control end. The app was developed using Apache Cordova.

The effects of the COVID-19 pandemic blood shortage on trauma patients.

The effects of the COVID-19 pandemic blood shortage on trauma patients.

Money matters: The association between blood donation rates and healthcare system quality across 171 countries.

Worldwide, insufficient blood donations cause blood shortages that jeopardize vital medical treatments for patients. Blood donation rates vary widely across countries, yet the determinants of this variation remain poorly understood. This study aims to illuminate the role of the institutional context in which blood donation is embedded by examining the link between country-level blood donation rates and healthcare system quality. The study employed a cross-sectional design using data on blood donation rates from 171 countries from the 2021 WHO Global Status Report on Blood Safety and Availability and three healthcare quality indicators (i.e., Healthcare Access and Quality [HAQ] Index, life expectancy, and health expenditures). The pre-registered hypotheses are tested using multiple linear regression. Robustness checks control for confounding factors. HAQ Index and health expenditures are positively associated with blood donation rates, whereas life expectancy is not related to blood donation when controlling for confounds. Health expenditures display the most robust association with blood donations, even when controlling for confounding factors, and when comparing countries within the same continent. Higher healthcare system quality in terms of HAQ Index and higher healthcare expenditures are related to higher blood donation rates. The finding that healthcare expenditures are most consistently related to blood donation rates indicates that policymakers should consider prioritizing financial support for the healthcare system, including blood-collecting institutions. More broadly, a better understanding of the role of contextual factors for blood donation may be needed to increase blood availability worldwide.

The Integrated Online Application for Blood Bank and Donor Management System

Blood shortages pose a significant global health challenge, hindering medical interventions and causing preventable deaths. Traditional blood collection methods struggle to keep pace with demand, highlighting the need for a centralized and digital solution. We propose a online Blood Bank and Donor Management System (BBDMS) – a mobile application utilizing HTML, CSS, JavaScript, PHP, and SQL – to streamline blood donation and transfusion processes.

Understanding Attitudes and Perceptions Towards Blood Donation in Greece: An Analysis Aligned with the Health Belief Model

IntroductionThis study explores attitudes toward blood donation in Greece, where maintaining an adequate supply is challenging. Using the Health Belief Model, we examine factors like perceived severity, vulnerability, and self-efficacy.ObjectivesThe main aims of this study are to assess public perceptions and barriers concerning blood shortage in Greece, and to identify motivators and self-efficacy levels for regular blood donation.MethodsA cross-sectional study was conducted using a self-administered questionnaire distributed to a sample of Greek adults. The questionnaire was designed based on the constructs of the Health Belief Model and included questions related to perceived severity, vulnerability, self-efficacy, and barriers and facilitators to blood donation. Descriptive statistics were used to analyse the responses, calculating means and standard deviations (SDs) for each variable.ResultsPerceived Severity and VulnerabilityParticipants in our study show a heightened awareness of the severity of blood shortages, especially in summer months and during increased surgical interventions. They also acknowledge Greece’s dependency on more than just voluntary donations to meet blood supply needs. These findings align with the Health Belief Model’s constructs of perceived severity and vulnerability, suggesting avenues for promoting donation.Perceived Benefits and BarriersA significant 74% of participants believe they can regularly donate blood and plan to do so in the next six months. However, fear of needles, health concerns, and fears of transmissible diseases act as barriers. According to the Health Belief Model, targeting these barriers could facilitate blood donation.Self-EfficacyA high percentage (74%, SD=5) of participants displayed strong self-efficacy, suggesting they are likely to engage in blood donation if encouraged. This aligns with the Health Belief Model’s emphasis on self-efficacy as a motivator for health actions.Cues to ActionParticipants identified informational campaigns, digital reminders, and social encouragement as cues to action, with a disfavor for financial incentives. These cues could serve as triggers for blood donation, consistent with the Health Belief Model.ConclusionsBy aligning these findings with the Health Belief Model, it becomes evident that there are strong perceptions of severity and vulnerability, but also considerable barriers to overcome. The high self-efficacy among participants and the cues to action identified could serve as bases for targeted interventions to improve blood donation rates.Disclosure of InterestNone Declared

Forecasting demands of blood components based on prediction models

BackgroundAn adequate blood supply is an important guarantee for saving lives and protecting health. In order to manage the blood supply more effectively when the condition of demand and supply are uncertainty, it is very important to forecast the demands of blood resources. Materials and methodsSARIMAX model and LSTM model were integrated into the prediction system of blood station. The collection and supply data of blood components was directly imported into the forecasting models to achieve automatic data update and model update. The forecasting daily demands of apheresis platelets, washing red blood cells (RBCs), suspended RBCs and plasma were recorded from January to June 2023 and compared with real data. ResultsThe prediction models had good forecasting performances. In the goodness of fit results of apheresis platelet model, the maximum value of coefficient of determination (R2) could reach 87.6%, and the minimum value of the mean absolute percentage error (MAPE) was only 0.0037. The predicted data of washing RBCs could be basically fitted, and the MAPE was 0.0121. For the prediction of suspended RBCs, the R2 was greater than 66%, and the MAPE could be 0.0372. The plasma model generated very high goodness of fit results, with R2 of over 90% and the lowest MAPE of 0.0394. ConclusionThe forecasting models, which predicts future demands of different blood components based on historical data, can help managers to overcome the challenges of blood stock control more effectively, thereby reducing blood waste and blood shortages.

Does Political Diversity Inhibit Blood Donations?

Does political diversity affect the prevalence of selfless behavior across a society? According to a recurrent finding from the study of social capital, ethnic diversity reduces prosocial behavior. We ask whether the same applies to partisan identity, by turning to a frequently used proxy for social capital: blood donations. The question is especially timely: the United States is currently experiencing its worst blood shortage in over a decade. Using survey results covering over 275,000 individuals in the US from 2010 to 2020, and a preregistered survey of an additional 3,500 respondents, we show that not all measures of social diversity have analogous effects on prosocial behavior. We find mixed evidence for a region’s share of immigrants being linked to lower blood donation by US citizens, and no negative effect for racial diversity. By contrast, political diversity appears to be highly significant. Specifically, individuals are less likely to donate blood when their partisan position is farther from the mean political identity in their state or commuting zone, and when they perceive themselves to be political outliers in their community. Affective polarization is known to be a tax on social interaction with out-partisans; as we show, depending on an area’s partisan makeup, it can also be a tax on prosocial behavior writ large.

Digital Transformation In Blood Banking: The Story Of E-Raktkosh

The E-raktkosh initiative, launched by the Government of India, is a pioneering effort in the field of healthcare and technology. This paper explores the inception, objectives, and recent advancements of the E-raktkosh project, shedding light on its impact on blood management in India. By harnessing the power of digitalization, E-raktkosh has revolutionized the way blood is collected, stored, and distributed across the nation, ensuring efficient and safe access to this life-saving resource. This paper delves into the significance of E-raktkosh in addressing blood shortage challenges, enhancing transparency, and saving countless lives.

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.

Voluntary blood donation preferences in China: A discrete choice experiment among experienced and inexperienced donors.

Due partly to an ageing population, China faces an increasingly dire blood shortage crisis requiring greater voluntary blood donations. A better understanding of blood donation preferences can inform blood donation policies and potentially increase donations. We used an online survey and discrete choice experiment to achieve our study objective: identify the most influential structural facilitators and barriers to voluntary blood donation in China. First, we identified six structural attributes (travel time, venue, donation volume, paid leave, scheduling and gifts) that were hypothesized to influence voluntary blood donation; attribute selection was based on a literature review and qualitative interviews. Second, a d-efficient design with 36 choice sets and 9 blocks was developed. Participants were asked to complete four choice sets, and in each choice set, they were asked to choose from three options: two voluntary blood donation scenarios and a 'Do not donate blood' option. Study participants were recruited through an online survey platform company in China. Voluntary blood donation preferences and preferences by blood donation history were estimated with random-parameter logit models and interaction terms. In 2022, 1185 individuals enrolled in the study. Most participants had college education (92%). Generally, participants preferred longer paid leave, lower blood donation volumes and gifts after donation. Based on interaction analyses, experienced and inexperienced donors exhibited similar preferences. Campaigns to increase voluntary blood donation rates in China should consider implementing paid leave after voluntary blood donation, lower blood donation volumes and small gifts conferred after donation.

Engineering Synthetic Erythrocytes as Next-Generation Blood Substitutes.

Blood scarcity is one of the main causes of healthcare disruptions worldwide, with blood shortages occurring at an alarming rate. Over the last decades, blood substitutes has aimed at reinforcing the supply of blood, with several products (e.g., hemoglobin-based oxygen carriers, perfluorocarbons) achieving a limited degree of success. Regardless, there is still no widespread solution to this problem due to persistent challenges in product safety and scalability. In this Review, we describe different advances in the field of blood substitution, particularly in the development of artificial red blood cells, otherwise known as engineered erythrocytes. We categorize the different strategies into natural, synthetic, or hybrid approaches, and discuss their potential in terms of safety and scalability. We identify synthetic engineered erythrocytes as the most powerful approach, and describe erythrocytes from a materials engineering perspective. We review their biological structure and function, as well as explore different methods of assembling a material-based cell. Specifically, we discuss how to recreate size, shape, and deformability through particle fabrication, and how to recreate the functional machinery through synthetic biology and nanotechnology. We conclude by describing the versatile nature of synthetic erythrocytes in medicine and pharmaceuticals and propose specific directions for the field of erythrocyte engineering.

A Novel Scoring System Predicting Red Blood Cell Transfusion Requirements in Patients Undergoing Invasive Spine Surgery.

Background: Access to blood products is crucial for patient safety during the perioperative course. However, reduced donations and seasonally occurring blood shortages pose a significant challenge to the healthcare system, with surgeries being postponed. The German Blood Transfusion act requires that RBC packages become assigned to an individual patient, resulting in a significant reduction in the available blood products, further aggravating shortages. We aimed to develop a scoring system predicting transfusion probability in patients undergoing spine surgery to reduce assignment and, thus, increase the availability of blood products. Methods: The medical records of 252 patients who underwent spine surgery were evaluated and 18 potential predictors for RBC transfusion were tested to construct a logistic-regression-based predictive scoring system for blood transfusion in patients undergoing spine surgery. Results: The variables found to be the most important included the type of surgery, vertebral body replacement, number of stages, and pre-operative Hb concentration, indicating that surgical specification and the extent of the surgical procedure were more influential than the pre-existing patient condition and medication. Conclusions: Our model showed a good discrimination ability with an average AUC [min, max] of 0.87 [0.6, 0.97] and internal validation with a similar AUC of 0.84 [0.66, 0.97]. In summary, we developed a scoring system to forecast patients' perioperative transfusion needs when undergoing spine surgery using pre-operative predictors, potentially reducing the need for RBC allocation and, thus, resulting in an increased availability of this valuable resource.

Incidence of formation of anti-D between patients with and without a history of solid organ transplant.

Solid organ transplant surgeries including liver transplants constitute a substantial risk of bleeding complications and given frequent national blood shortages, supporting D-negative transplant recipients with D-negative red blood cell products perioperatively can be difficult for the transfusion services. This study was designed to compare the incidence of alloimmunization after D-mismatched red cell transfusions between patients with and without a history of solid organ transplant at a single tertiary care hospital. The patients undergoing solid organ transplants are on strong immunosuppressive regimens perioperatively to help reduce the risk of rejection. We hypothesized that the use of these immunosuppressive agents makes these patients very less likely to mount an immune response and form anti-D antibodies when exposed to the D-positive red blood cell products perioperatively. At our center, D-negative patients who received ≥1 unit of D-positive red blood cell products were identified using historical transfusion records. Antibody testing results were examined to determine the incidence of the formation of anti-D and any other red cell alloantibodies after transfusion and these results were compared between patients with and without a history of solid organ transplant. We were able to identify a total of 22 patients over 10 years with D-negative phenotype who had undergone a solid organ transplant and had received D-positive red blood cell products during the transplant surgeries. We also identified a second group of 54 patients with D-negative phenotype who had received D-positive red blood cell products for other indications including medical and surgical. A comparison of the data showed no new anti-D formation among patients with a history of D mismatched transfusion during solid organ transplant surgeries. Among our limited study population, we observed a very low likelihood of D alloimmunization among solid organ transplant recipients. A larger, prospective study could help further evaluate the need for prophylactic D matching for red cell transfusions during solid organ transplant surgeries.

Biological response of nonhuman primates to controlled levels of acute blood loss.

The global shortage of human blood for medical use has prompted the development of alternative blood sources. Nonhuman primates (NHPs) are commonly used owing to their physiological similarities to humans. The objective of the current study was to establish a controlled-blood-loss model in NHPs to explore their clinical and biological responses. Blood was sequentially withdrawn from 10 cynomolgus monkeys (10, 14, 18, 22, and 25% of the total blood volume); their vital signs were monitored, and blood parameters were serially analyzed. Humoral mediators in the blood were measured using flow cytometry and enzyme-linked immunosorbent assays. In NHPs subjects to 25% blood loss and presenting with related clinical symptoms, the systolic blood pressure ratio on day 0 after bleeding was significantly lower than that of the animals from the other groups (median: 0.65 vs. 0.88, P = 0.0444). Red blood cell counts from day 0-14 and hematocrit levels from day 0-7 were markedly decreased relative to the baseline (P < 0.01). These parameters showed a direct correlation with the extent of blood loss. The levels of creatine phosphokinase, aspartate aminotransferase, and alanine aminotransferase exhibited increases in response to blood loss and had a stronger correlation with the hemoglobin ratio than the volume of blood loss. The levels of C3a and C4a, as well as interleukin (IL)-1α and IL-15, displayed a strong correlation, with no apparent association with blood loss. The findings of the present study showed that only NHPs with 25% blood loss exhibited clinical decompensation and significant systolic blood pressure reduction without fatalities, suggesting that this level of blood loss is suitable for evaluating blood transfusion efficacy or other treatments in NHP models. In addition, the ratio of hemoglobin may serve as a more dependable marker for predicting clinical status than the actual volume of blood loss. Thus, our study could serve as a basis for future xenotransfusion research and to predict biological responses to massive blood loss in humans where controlled experiments cannot be ethically performed.

Immune cells and RBCs derived from human induced pluripotent stem cells: method, progress, prospective challenges.

Blood has an important role in the healthcare system, particularly in blood transfusions and immunotherapy. However, the occurrence of outbreaks of infectious diseases worldwide and seasonal fluctuations, blood shortages are becoming a major challenge. Moreover, the narrow specificity of immune cells hinders the widespread application of immune cell therapy. To address this issue, researchers are actively developing strategies for differentiating induced pluripotent stem cells (iPSCs) into blood cells in vitro. The establishment of iPSCs from terminally differentiated cells such as fibroblasts and blood cells is a straightforward process. However, there is need for further refinement of the protocols for differentiating iPSCs into immune cells and red blood cells to ensure their clinical applicability. This review aims to provide a comprehensive overview of the strategies and challenges facing the generation of iPSC-derived immune cells and red blood cells.