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Background: Oxidative stress is a major driving force in the development of storage lesions in red cell concentrates (RCCs). Unlike manufactured pharmaceuticals, differences in component preparation methods and genetic/physiological status of donors result in nonuniform biochemical characteristics of RCCs. Various characteristics of donated blood on oxygen saturation (SO2) distribution were investigated, and a model to estimate potential oxidative stress burden of stored RCC at transfusion is proposed. Study design and methods: The oxygen content of freshly prepared RCCs (770) was quantified noninvasively as fractional hemoglobin saturation (SO2) with visible reflectance spectrometry. Using separate RCCs and mimicking typical handling of RCCs during routine storage, evolution of SO2 was followed for construction of an empirical model. Based on this model, the oxygen exposure index (OEI) was formulated to estimate the accumulated oxygen exposure burden of RCC at the time of transfusion. Results: The SO2 of RCCs varied widely at donation (mean 43% ± 1.3%; range 20%–93%). Multivariate regression model showed that sex and processing method had small effects on SO2 (R2 = 0.12), indicating that variability was mainly attributed to other individual donor characteristics. Storage simulation model indicated that median SO2 increased gradually over 6 weeks (approx. 1.3 fold), while OEI increased at a faster rate (approx. eight‐fold). Conclusion: In addition to storage age, the OEI provides a potential new metric to assess the quality of RCCs at the time of transfusion in terms of their oxidative stress. In future studies, a single noninvasive measurement during storage could link OEI to clinical outcomes in transfusion recipients. [ABSTRACT FROM AUTHOR]

Background and objectives In 2015, the ISBT Working Party on Blood Supply Management published the results of an international survey on blood product wastage in hospitals. The responses were predominantly from Europe and North America, and it was decided to form another survey concentrating on low- and middle-income countries (LMIC). Materials and methods The survey was designed by the authors and translated into an online survey tool by the ISBT office. A pilot survey was produced and completed by 3 volunteer contributors. Where necessary, amendments were made and the survey was sent by the ISBT to 33 participants from LMIC. The survey was further distributed by participants to colleagues in their or other countries. Results In total, 31 completed surveys were received from 11 different countries. Not all respondents answered all questions meaning different questions may have been answered by a different combination of respondents. The demographics of hospital type, size and distance from the blood supplier varied considerably. Red-blood-cell (RBC) wastage was estimated to be <5% (n=9 respondents), 5-10% (n=3) or 10-25% (n=5). The most important category of wastage was outdated RBCs in the blood bank or after issue. Wastage as a result of an RBC being issued to a patient and not completely transfused because the patient did not require the entire volume was <10% (n=18), 10-20% (n=3), 20-30% (n=1), 40–50% (n=1) and >50% (n=1). Conclusion Wastage rates varied considerably between countries, and innovative solutions will be required to reduce this problem. [ABSTRACT FROM AUTHOR]

Background and Objectives It is likely that there will be an increased emphasis on production of whole blood as evidence for efficacy in massively transfused patients increases. Depending on the magnitude of the increase, this has the potential to impact many blood collectors’ practices and to influence the whole supply chain. Methods The review uses current knowledge of practices and discusses the impacts on blood collectors, suppliers and the implications for blood donation, manufacturing, inventory and distribution. Results Increased whole blood utilisation will influence the production, supply and distribution of blood donation consumables with suppliers further influenced by likely equipment redundancy in the event of a significant increase. New blood components or consumables require regulatory approval and registration, a complex and resource-consuming area. Wastage would increase directly as a result of the need to have whole blood constantly available at the right location despite stochastic demand. Efficiency and yield would be influenced due to the reduced number of separated blood components and plasma for fractionation volumes. To ameliorate this, whole blood may need to be returned later in shelf life so that plasma can be recovered. A high uptake of whole blood requires a review of the blood donation and manufacturing infrastructure with the possibility of amendments to fixed assets such as blood processing centres. Conclusion The impacts are across the whole supply chain, and whilst the topics discussed are not directly applicable to any specific blood collector, the general principles will apply to many. [ABSTRACT FROM AUTHOR]

Background: As patient blood management becomes more widespread, fewer red blood cell (RBC) units have been transfused. This multinational study evaluated changes in blood center RBC distributions.Study Design and Methods: Data on number and ABO and D groups of RBC distributions were obtained from several large American blood centers and national or provincial blood services (NPBS) from fiscal year (FY) 2010 through FY2014. Due to relatively larger numbers of distributions and differences in ABO and D groups between the Japanese Red Cross and the other NPBS, Japanese data were not included in distributions calculations.Results: Data from seven American blood centers and eight NPBS were obtained. Overall, at both the American and the seven NPBS that were analyzed, there were declines in the number of RBC distributions between FY2010 and FY2014, 16.9 and 8.0%, respectively. The number of O- RBC distributions decreased by 9.0% at American blood centers but the proportion of RBC distributions that were O- increased by 9.3% during this time. The NPBS had 1.6% increase in O- RBC distributions and 10.5% increase in the proportion of O- distributions. The proportion of O+ distributions increased slightly over time at American centers (2.9%) while decreasing slightly (1.1%) at NPBS despite reductions in the absolute numbers of O+ distributions. Overall there was 2.6% decrease in the proportion of B+ and AB+ RBCs distributed and 13.6% absolute reduction in the number of these units distributed.Conclusion: Although overall RBC distributions have decreased over time, the proportion of O units has increased substantially. [ABSTRACT FROM AUTHOR]

Background Clinical trials are investigating the potential benefit resulting from a reduced maximum storage interval for red blood cells ( RBCs). The key drivers that determine RBC age at the time of issue vary among individual hospitals. Although progressive reduction in the maximum storage period of RBCs would be expected to result in smaller hospital inventories and reduced blood availability, the magnitude of the effect is unknown. Study Design and Methods Data on current hospital blood inventories were collected from 11 hospitals and three blood centers in five nations. A general predictive model for the age of RBCs at the time of issue was developed based on considerations of demand for RBCs in the hospital. Results Age of RBCs at issue is sensitive to the following factors: ABO group, storage age at the time of receipt by the hospital, the restock interval, inventory reserve, mean demand, and variation in demand. Conclusions A simple model, based on hospital demand, may serve as the basis for examining factors affecting the storage age of RBCs in hospital inventories. The model suggests that the age of RBCs at the time of their issue to the patient depends on factors external to the hospital transfusion service. Any substantial change in the expiration date of stored RBCs will need to address the broad variation in demand for RBCs while attempting to balance considerations of availability and blood wastage. [ABSTRACT FROM AUTHOR]

BACKGROUND: Errors in the collection and labeling of blood samples for pretransfusion testing increase the risk of transfusion-associated patient morbidity and mortality. Statistical process control (SPC) is a recognized method to monitor the performance of a critical process. An easy-to-use SPC method was tested to determine its feasibility as a tool for monitoring quality in transfusion medicine. STUDY DESIGN AND METHODS: SPC control charts were adapted to a spreadsheet presentation. Data tabulating the frequency of mislabeled and miscollected blood samples from 10 hospitals in five countries from 2004 to 2006 were used to demonstrate the method. Control charts were produced to monitor process stability. RESULTS: The participating hospitals found the SPC spreadsheet very suitable to monitor the performance of the sample labeling and collection and applied SPC charts to suit their specific needs. One hospital monitored subcategories of sample error in detail. A large hospital monitored the number of wrong-blood-in-tube (WBIT) events. Four smaller-sized facilities, each following the same policy for sample collection, combined their data on WBIT samples into a single control chart. One hospital used the control chart to monitor the effect of an educational intervention. CONCLUSION: A simple SPC method is described that can monitor the process of sample collection and labeling in any hospital. SPC could be applied to other critical steps in the transfusion processes as a tool for biovigilance and could be used to develop regional or national performance standards for pretransfusion sample collection. A link is provided to download the spreadsheet for free. [ABSTRACT FROM AUTHOR]