Leaderboard

David and Cliff, I appreciate your frustration. Blood suppliers are well aware of the critical nature of their products and cringe each time they are compelled to supply less than the request number of units. Does your facility have an active part in the acquisition and stewardship of these DONATED gifts? I would think working with your supplier to find a way to increase the available inventory would be of benefit to all. For example does your facility help publicize blood drives and or encourage staff to donate. Does your facility hold successful blood drives? Do you monitor the utilization of especially precious products. I cringe when I hear an O neg about to expire went to a non-Rh neg donor in order that it not be "wasted". If an Rh positive unit would have worked, the unit WAS wasted because I bet somewhere in the system is an Rh negative recipient waiting for that unit. The literature suggests that 50% of the time this is how Rh negative units are allocated. Please try to import Rh negative units on the open market. At a meeting today one of our customers commented that to get Rh negative units they would need to purchase proportional equivalent number of non Rh negative units. So for example if you want to import 7 0 negs you would need to accept 93 Rh positive products. And this is the experience of the blood centers. I think your accountants would fuss if your attrition doubled from the extra blood you had to take. The low titer group O whole blood will take a toll on the availability of O positive blood. Because the expiration date is 21-35 days depending on the anticoagulant we will be approaching O positive donors more often to meet trauma resuscitation needs. This is the only business I can think of where the Product is voluntarily given by someone who will never know the good deed they did. Unlike product manufacturers, we cannot go to a plastics company or a drug company and ask them to just increase their production to adjust for changes in utilization. We do not PAY blood donors. We try to convince them blood donation is an honorable thing to do...and oh by the way we will give you a t-shirt. As a result we are not supplying a commodity, although blood centers are treated like vendors and are compelled to bid against each other producing ever slimmer margins. Think about whether you would want to issue blood that said PAID DONOR on the bag. Historically this has not worked too well, but it might be a way to increase donor participation. I suggest, rather than blaming the blood supplier, opening a dialog with them and being prepared to do some work on your part to help improve the blood supply would be more productive. No one wants patients to die for lack of an appropriate blood product when transfusion is indicated.

With attention to blood utilization, the overall red blood cell usage has gone down. Consequently blood suppliers have had to pair down the number of overall units they collect in order to avoid out dating products. Since we are drawing a population, the proportion of desired units in that population (All Rh negs and all group Os) has not changed, but the absolute number of the desired we can acquire units has dropped. Transfusion practices are still demanding nearly the same number of desired units as before blood utilization practices were implemented. About half of the Rh neg units distributed go to a non-Rh negative recipient, often because hospitals do not want to "waste" them. Perhaps if before making that decision to transfuse the blood bank contacted the blood center and asked if there was an immediate need to transfuse an Rh negative unit to an Rh negative recipient, we could better utilize the resources we have. Also I believe the merging of blood centers has contributed to the problem. Where the community blood center was usually able to manage the blood needs of the local hospitals, many are selling blood by contract to facilities miles away. This has decreased the amount of ad hoc blood available for export. The "low-titer group O" craze is also taking a toll because of the demand for repeat donors to fulfill the need to have Whole blood units with a 21-35 day out date, available for emergencies. Most blood centers are trying to recruit blood donors by blood group now in order to avoid out-dating Apos and Bpos units. This means that Rh negative and group O donors are approached to give 2-3 times more often than donors of other blood groups. The desired donors are complaining that they are being approached to give red blood cells too frequently and are starting to ignore our requests. All of these issues (and perhaps others) are contributing to the nation wide blood shortage of the most desired units. Importing products is also difficult. If they are available at all, did you know that in order to import four group O negative units a blood center might have to also purchase 50- 100 group A Pos units? Platelet utilization seems to be increasing. Where do platelet donors come from? Usually whole blood donors. Sometimes the blood center needs to decide whether to take a group O product or obtain a platelet product based on the needs of the day. Thank you to those who are excellent stewards of the products you receive! Blood centers are not shorting you because they are incompetent. Frequently it is extremely difficult to obtain the most desired products any where at any price. You can help your blood center serve you by being honest with your inventory.

This is where having a transfusion service director who knows something about clinical medicine and hematology comes in very handy. It shouldn't be the medical technologists' job to triage requests. Many transfusions do more harm than good, so it's not that difficult to figure out which patients urgently need transfusion and which can wait, but this requires a knowledgeable and tenacious physician to handle the individual requests and screen them. As a field, pathology has paid little attention to the need for those who can do such tasks, as compared with surgical pathology skills, cytopathology, etc. You may need to involve your institution's hematologist(s), intensivist(s), surgeons and anesthesiologists to help make these decisions if your lab physician(s) aren't up to the task.