Finding the Gift of Life when Shelves are Bare
/by Brian Witte, PhD
Source: nezartdesign.tumblr.com
Imagine if street lights shut off, taps ran dry, or the internet switched off every year during the holidays. The chaos caused by disruptions in utilities would be immense. That is just what happens, though, with the nation’s blood supply.
Blood is not a utility, of course, but as discussed in the recent RAND Corporation report[i] on the blood supply, it is an essential public good. Health and well-being depend on the availability of blood products.
This pattern of seasonal scarcity is no secret among transfusion services and blood center veterans. Like electric power, blood products must be generated at roughly the same rate at which they are consumed.
Like the summer lull in collections, this winter down-turn is due mostly to donor availability, with travel, family obligations, college winter vacation, and preparations for the holidays, although extreme weather events can play a role.[ii]
Unlike commodities, blood cannot simply be purchased in bulk and saved against future need. This is especially true of platelets, with an expiration date just 5 days after collection. Red blood cells are more durable, but their shelf life of 42 days limits the size of any strategic reserve.
It is a tribute to the resourcefulness and dedication of America’s transfusion and collection community that this slow season does not cause more hardship. This dedication to patient care can be seen in trends towards fewer adverse events and fewer reported days with insufficient blood supply[iii], although significant seasonal shortfalls remain.
Short-term donation boosts
The strategies for addressing these shortages are two-fold. On the blood center side, increased efforts surrounding donor recruitment and retention can help boost collection rates. The simplest approaches include strategic advertising campaigns and stories from sympathetic news outlets that help to remind donors of the increased need.
More targeted tactics to boost collection could be modeled on recently published trials attempting to implement on-demand collection models. Bruhin et al[iv] looked at the short and long-term efficacy of calling both highly motivated and occasional donors to boost participation in a blood drive.
Their results were startling due to the markedly different outcomes. In brief, both types of donors were more likely to donate following a phone call. Frequent donors, however, were actually less likely to respond to later calls urging them to donate, whereas the casual group were more likely to respond. In other words, donors who were already highly motivated were turned off by additional reminders, while infrequent participants became more engaged.
Although the study was small, it is certainly suggestive that direct donor outreach can be effective if done judiciously.
Another potential approach[v] lies with an effort to develop a “walking blood bank” for combat troops in Afghanistan. The inherently chaotic nature of the conflict makes predicting blood product use very difficult, and the great distance makes resupply from the U.S. problematic.
Rather than try to keep sufficient supplies on hand to meet any emergency, the initiative developed a network of donors who could be alerted to an increased need for donation. With most routine tests already on file, the turn-around-time from alert to use was quite brief.
Whether such a system would work among a less-engaged civilian population in the U.S. remains to be seen. The sense of urgency created by such an alert system could prove very motivational, however.
Finally, studies indicate that a financial reward can produce a short-term boost in the frequency of individual donors[vi]. Interestingly, the financial reward did not affect long-term donor engagement. This observation coincides with the World Health Organization’s position that an all-volunteer donor pool produces safer and high quality blood products.[vii] Nevertheless, rewards targeted to boost donations during seasonal slow-downs may be worth further investigation.
Transfusion center management
So long as seasonal availability pressures remain the norm, transfusion centers will have to manage. If the blood center has access to historic blood use patterns at the facility they may be able to forecast times of low availability and adjust their acquisition and storage accordingly.
Notably, AABB recently updated their guidelines[viii] for LRBC storage and use. In a large and well controlled study, no adverse effects were seen in patients receiving red blood cells at any point prior to the units’ expiration date. Although storage space may be a challenge, taking advantage of the full life span of blood products presents a valuable opportunity.
Another viable response to low availability of blood is to use teamwork and collaboration to reduce demand. In his 2007 article for Transfusion[ix], Leo J. McCarthy, a 30-year veteran of blood banking, shared his experience with managing shortages. In brief, he advocates increased, pro-active communication among health center stakeholders alongside innovative sourcing strategies.
Using expert knowledge and historical data, blood centers can sometimes alert other departments to coming shortages. With foreknowledge, elective procedures could be scheduled accordingly. Proactive scheduling is certainly less disruptive than having to cancel operations due to insufficient blood availability, although that is all too common.
Less drastically, greater emphasis could be given to the increasingly common Patient Blood Management programs[x] that have been so successful at reducing transfusion demand in recent years. Implementing any new program has a certain overhead cost in terms of provider time and attention. The urgency of a blood shortage, however, may provide the extra emphasis needed to implement such programs.
Mr. McCarthy also cites the importance of having multiple sources of blood products. He notes that his hospital had two, rather than one, blood products providers and that
[b]ecause blood shortages frequently occur in one provider system and not both, I found it exceedingly useful to maintain a supply of blood from both major providers. Therefore, I was never totally dependent on one supplier. Consequently, most of our shortages were greatly minimized and short.
The benefits of diversification have been demonstrated across multiple disciplines. As just one example, when adverse winter weather conditions affect blood collection in northern states, more southerly blood centers may have an abundance of units available.
Crisis/Opportunity
At the risk of flogging a cliché, the drop in blood product availability around the holidays is both a concern and an opportunity. As stewards of this lifesaving resource, both hospitals and blood centers must be vigilant in how they reinforce sustainability in the blood supply. As the RAND report makes clear, this area has considerable room for growth. With communication and ingenuity, however, this can be the impetus for improving conservation of a precious resource, for exploring new channels of donor engagement, and for exploring new relationships to ensure steady supply.
Sources & Further Reading
[i] Mulcahy, Andrew W. Toward a sustainable blood supply in the United States: an analysis of the current system and alternatives for the future. Santa Monica, CA: RAND Health, 2016.
[ii] Davis, Victoria. "Winter weather impacts blood supply, Indiana Blood Center asks for donations." The INDY Channel. RTV6, 18 Dec. 2016. Web. 20 Dec. 2016.
[iii] Whitaker, B. 2011 National Blood Collection and Utilization Survey Report, p. 44. Retrieved December 20, 2016, from http://www.aabb.org/research/hemovigilance/bloodsurvey/Documents/11-nbcus-report.pdf
[iv] Bruhin, A et al. "Call of duty: the effects of phone calls on blood donor motivation." Transfusion 55.11 (2015): 2645-652. Web. 20 Dec. 2016.
[v] Hejl, G et al. "The implementation of a multinational “walking blood bank” in a combat zone." Journal of Trauma and Acute Care Surgery 78.5 (2015): 949-54. Web. 20 Dec. 2016.
[vi] Weidmann, C et al. "Monetary Compensation and Blood Donor Return: Results of a Donor Survey in Southwest Germany." Transfusion Medicine and Hemotherapy 41.4 (2014): 257-62. Web.
[vii] “Towards 100% voluntary blood donation.” World Health Organization, 2010. Web. 20 Dec. 2016.
[viii] Tobian, A et al. "Red blood cell transfusion: 2016 clinical practice guidelines from AABB." Transfusion 56.10 (2016): 2627-630. Web.
[ix] Mccarthy, L. "How do I manage a blood shortage in a transfusion service?" Transfusion 47.5 (2007): 760-62. Web.
[x] Standards for a patient blood management program. Bethesda, MD: AABB, 2014.
