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Despite the scale of blood usage worldwide, blood remains a scarce and precious resource. As with any perishable product, careful management of inventories to minimize wastage is crucial. However, due to the nature of the supply of blood, wastage is not only an economic issue as every unit wasted, squanders the time and effort of the human donor. Blood inventory management is therefore a trade-off, ensuring 100% availability of all blood products at all times whilst minimizing wastage. Hospitals are at the front line of blood use and are the location where much blood is wasted. Inventory management practices in hospital transfusion laboratories are critical. Much of the extant literature in this area posits that good management of hospital blood inventories is due to sophisticated inventory models and algorithms. However, recent research has found that good management practices are much more important. The drivers for low wastage and good inventory management practice can be described using six key themes. Blood supply chain management is much more than managing wastage in hospitals. Proper management of the supply chain as a whole can lead to significant reductions in blood wastage. Recent research has found that methods commonly used in commercial supply chain management can lead to efficiencies in the blood supply chain context. An example of this is stock sharing or lateral transhipment of blood units close to expiry between hospitals, reducing wastage across the supply chain. [ABSTRACT FROM AUTHOR]

During 2009/2010 loss of platelets within NHS Blood and Transplant (NHSBT) due to time expiry was 9·3%. Hospitals remain reluctant to hold stocks of platelets due to the poor shelf life at issue. The purpose of this study was to identify areas for time compression in the apheresis platelet supply chain to extend the shelf life available for hospitals and reduce wastage in NHSBT. This was done within the context of NHSBT reconfiguring their supply chain and moving towards a consolidated and centralised approach. Time based process mapping was applied to identify value and non-value adding time in two manufacturing models. A large amount of the non-value adding time in the apheresis platelet supply chain is due to transportation and waiting for the next process in the manufacturing process to take place. Time based process mapping provides an effective 'lens' for supply chain professionals to identify opportunities for improvement in the platelet supply chain. [ABSTRACT FROM AUTHOR]

1. Ouabain is known to have natriuretic effects only at high doses, and therefore if endogenously produced ouabain has a role in the regulation of sodium excretion, the renal response to ouabain must be increased substantially in certain physiological situations. The aim of this study is to determine whether treatment with the mineralocorticoid, aldosterone, potentiates that natriuretic response to ouabain. 2. Six conscious sheep received renal arterial infusion of either vehicle or aldosterone (3 micrograms/h). Forty hours after commencement of infusion ouabain was infused into the renal artery at 400 micrograms/h for 60 min. A second infusion of ouabain was administered on the 6th day of aldosterone treatment. 3. In the absence of aldosterone, the effects on sodium excretion produced by ouabain infusion at 400 micrograms/h into the renal artery were variable and not statistically significant. Ouabain infusion after 40 h of aldosterone treatment increased sodium excretion from 40 +/- 14 to 676 +/- 69 mumol/min in the second hour following cessation of ouabain infusion (P < 0.001). Ouabain infusion after 6 days of aldosterone treatment increased sodium excretion similarly. Ouabain-stimulated sodium excretion was significantly greater during aldosterone treatment compared to vehicle treatment (P < 0.05). In contrast, no enhancement of effect was observed after acute treatment with aldosterone. 4. These results demonstrate potentiation of the natriuretic response to ouabain infusion by chronic mineralocorticoid treatment and suggest a potential role of endogenous digitalis-like factor in the physiological control of sodium homeostasis.

1. The effect of renal arterial infusion of synthetic human atrial natriuretic factor (ANF (99-126] on renal function in the conscious euvolaemic sheep was characterized. ANF (99-126) was infused for 2 h at 5 and 50 micrograms/h into the renal artery of crossbred Merino ewes with chronically indwelling cannulae inserted in the renal artery. The effect on absolute and fractional excretion of Na, K, Ca, Cl and HCO3, glomerular filtration rate (GFR), effective renal plasma flow (ERPF) and free water clearance (CH2O) were measured. 2. Infusion at 50 micrograms/h produced a fourfold increase in Na and Cl excretion. Ca excretion increased eightfold, while K and HCO3 increased by small amounts. At the lower dose only Na, Cl and Ca excretion increased significantly. The changes in absolute excretion of each ion were closely mirrored by changes in fractional excretion. CH2O became more negative at both levels of infusion. Small changes in GFR were measured at both rates of infusion. No changes in ERPF or renin secretion were observed. 3. ANF (99-126) infusion at 50 micrograms/h for 1 h increased the excretion of Li, such that more than 70% of the change in Na excretion was associated with the changes in Li clearance. Changes in GFR accounted for less than 10% of change in Na excretion. 4. Following either long-term (50 micrograms/h for 6 h) or repeated short-term (20 micrograms/h for 30 min) infusions of ANF (99-126), the response of Na excretion was not sustained. The mechanisms of the tachyphylaxis remains undetermined. 5. ANF (99-126) is a powerful stimulus to the absolute and fractional excretion of Na, K, Ca, Cl and HCO3. The mechanism of action is not known, but appears to be related to changes in tubular function and/or a change in glomerulotubular balance.