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Here in Michigan, we are now instituting rationing policies due to the severe shortage of available random donor blood.  I was wondering how other North American facilities are doing.

Scott

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We are a smaller level 2 trauma center here.  For example, we normally would want to keep our O pos inventory at 20.  Today we ordered 15, they sent 2.  This is the worst I've seen it in working 30 years here.

Scott

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don't you hate that.  I remember transfusing about 400 O+ one night; had none left.  Called for 30, they sent 3.  Day shift was bonkers at blood center when they came in. 

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Ask your blood supplier if they can import.  Our local supplier has been struggling to meet our needs (very busy transfusion service), so they worked with us to get our standing order from another part of the country.  It has its own challenges, but we have what we need.

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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.

Edited by Neil Blumberg

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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.

 

 

 

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Appreciate Kip's observations. above.  Here our rationing policies involve cooperation between the four regional hospital systems along with the supplier that serves  us.   We have decreased  transfusion thresholds for many types of patients--if a physician wants to override we are passing the request down the administrative line for approval when expedient.  All hospitals are keeping inventories low voluntarily.  If there is a real emergency at one of the hospitals the others will transfer stock as needed. 

Things are a bit better this week.  Hope this is blowing over.

Scott

 

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its actually getting worse here.  Cannot get any group Os except for emergent use.  No stock replacement.

I am an overstock and I am at my critical low levels and still can not get a routine delivery (even though I am transfusing 2 O pts - one w an antibody.  Was thinking about writing OpEd Editorial:  Your Blood Supplier Says You're Going To Die.   Here in Northern NH/Vt  I have polled the 7 hospitals in this region.  We have a total of 16 O Negs (and I have 6 of them).  Didn't even ask about O+.  My neighboring hosp called to ask if we had O+ to ship.   They had a bleeder and were down to 2u.   Blood supplier not sending them any.  No emergent and no stock replacement.

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39 minutes ago, David Saikin said:

its actually getting worse here.  Cannot get any group Os except for emergent use.  No stock replacement.

I am an overstock and I am at my critical low levels and still can not get a routine delivery (even though I am transfusing 2 O pts - one w an antibody.  Was thinking about writing OpEd Editorial:  Your Blood Supplier Says You're Going To Die.   Here in Northern NH/Vt  I have polled the 7 hospitals in this region.  We have a total of 16 O Negs (and I have 6 of them).  Didn't even ask about O+.  My neighboring hosp called to ask if we had O+ to ship.   They had a bleeder and were down to 2u.   Blood supplier not sending them any.  No emergent and no stock replacement.

This is not acceptable.  Can they import from other regions?  I won't tell you what we stock (it's a lot), but we have all of our inventory at optimum levels at this point.

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Also low in southern new england; we were unable to make a full Rh-neg MTP pack this week for an Oneg postpartum bleed.... fortunately they didnt use all the reds and the Rh-pos came back to us. eesh!

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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.

Edited by Kip Kuttner

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35 minutes ago, Kip Kuttner said:

Does your facility have an active part in the acquisition and stewardship of these DONATED gifts? 

Yes.  Last month we implemented a trial program where our supplier got our standing orders from another location.  We are a very large facility and our standing order is at least 100 RBCs a day.  During the beginning of the trial (no returns allowed) we quickly got oversupplied, at one point we hit twice our optimum level.  Our O Neg inventory was unethical.  The supplier agreed to take back some of the units because there was a glitch in the cancelling process.  I insisted they also take back some of the O Neg.

35 minutes ago, Kip Kuttner said:

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.

Sorry, I hope you don't feel I was blaming any suppliers.  I do not envy the job you have, it must be really hard keeping a facility like us, and the rest of the country, happy.

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On ‎01‎/‎17‎/‎2020 at 12:10 PM, Cliff said:

This is not acceptable.  Can they import from other regions?  I won't tell you what we stock (it's a lot), but we have all of our inventory at optimum levels at this point.

Thanks Cliff.  I've worked in those very large institutions.  Nice to be able to transfuse 400 O+ in night (of course I only had 3 left). 

Seems to me that ARC is biased towards the "big" users.  Anyway, we'll survive, and hopefully our patients will too.

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On ‎01‎/‎17‎/‎2020 at 1:25 PM, Kip Kuttner said:

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?

We have a successful blood drive every 8-10 weeks.  The problem, as I see it, is that the ARC does not understand the small hospital BB situation.  We are at least 2 hrs from our overstock and 3 hrs from the Red Cross distribution site.  My feelings are that the 7 small hospitals in Northern NH and Vt should be receiving units w the best outdates.  After 2 weeks we should be able to ship them all to institutions who use significantly more products per week than the 7 of us combined do.  Anyway, I don't want to go on a diatribe, suffice it to say that I think the rural hospital blood banks are not understood by the major suppliers.  I can go 2-3 weeks without a transfusion and months without thawing plasma.  Unfortunately, when my need is critical, usually my inventory levels are too (at least O+ and O=). 

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I understand David's point and agree 100000%.  Having worked in 50 bed, 500 bed and 1200 bed hospitals and hospitals in small towns, suburbia, and big university medical centers, blood suppliers DO NOT understand the smaller places that can go days without transfusing.  

It is everyone's responsibility to be good stewards of this very precious resource.  Inventory management from the supplier level down to the techs in the blood banks is critical to making sure every patient everywhere can get what they need as quickly as possible.  

 

 

 

 

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We are a System in the Northwest and since going to a standing order at our largest facility, it has helped. However, we also have three small, rural CAH facilities, and the smaller facilities are waiting sometimes 4-5 days to restock O's. We have level 2, 3 and 4 trauma centers in the System and Oncology infusion at three sites. Platelets seem to be the biggest shortage lately. Our oncology population uses most of those. We have not implemented formal rationing but after a couple of very high use days recently, we are going to discuss it late this week. Right now the Providers are asked if the transfusion need is immediate or if it can wait for more product to come and hope for a "gentlemen's agreement" between the providera. If anyone has a formal process to ration that they can share I would appreciate it. 

We know we use more blood than anyone else in our region, but we also now have blood drives at every hospital site in our System and in the communities we serve.  It is very frustrating to know the day could come soon when we don't have the products we need. Platelets are only collected in one site for our region. We have asked the ARC regional board to try to address that.

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