Blood Conservation Systems: BBCIM

It's obvious that the need for more blood is there, both from looking at our interhospital ledgers and the ads on television. The drive is already at maximum to inspire more blood donation (see PSA's here, here, and here), so how do we make what we have last longer, especially in this wavering economy? Each hospital is working on reducing the need for blood by being more stringent with requirements for transfusion already; "top-up" transfusions are nigh a thing of the past, and Which leaves end stage management, an area untouched before 2003: we can do our best to ensure the units we have aren't wasted.

Yes, outdating blood is a problem. Some of the precious blood supply does end up expiring before we use it, even with the high turnover of product and sometimes inappropriate indications given for transfusion. In fact, in 2001/2002, over 4500 units of blood expired without being used in British Columbia(over 98 hospitals); 30% of these were type O (the universal donor).

The main reasons given were as follows:

• wrong blood type for population (only 3% people have type AB blood),
• rural locale (no need for the unit, but it had to be on hand Just-In-Case),
• phenotyped units saved for special patients and then never used, and
• trauma's not needing the massive amounts of blood ordered (Some surgeries/traumas can take anywhere from 4 to over 30 units of red cells to patch back together, so ordering can be overestimated to ensure supply in emergency).

Base line alleviation of this loss is simply shipping the close-to-outdate units to the nearest larger hospital, in hopes they will use it. In the case of phenotyped units, rare blood, or even universal donor units, this method just doesn't fufill potential as is; so enters the British Columbia Blood Inventory Management Pilot.

BCBIM's goals are as follows: (from website)

1. Build a web-based provincial blood inventory communication system.
2. Monitor provincial RBC inventory status and provide early warnings on RBC shortages.
3. Guide Canadian Blood Service’ and hospitals’ ordering policies to correspond with provincial RBC inventory.
4. Establish appropriate medical rules and guidelines for hospitals in response to provincial RBC shortages or other contingencies.

Started in 1997, this program has grown to include over 60 hospitals, leaving only 26 of British Columbia's hospitals uninvolved. After one year of more stringent application of the program, the number of unused blood units in BC had been reduced to 3187. That's over 1000 units of blood saved for use, or at least $500,000 in health care budget, (base cost of replacing all those units). Even better, it brings the outdate percentage down by half for our province.

In plainer English, by documenting exactly how many units of blood (including specialized blood) each hospital has, and when they expire, this overseeing program can plot the logistics of getting blood to the place most needed. For instance, CMV neg and irradiated units, which have a shorter shelf life, to pediatric hospitals, or matched phenotyped units to appropriate donors. woot.

I would highly recommend hospitals to get on board with BCBIM, or their Canadian regional equivilent. At grass roots, it is simple: Just take your daily inventory down on a standardized form,(noting which of your units outdate within seven days), and send it off. The staff at BCBIM then work with the central blood provider to coordinate best allocation of blood to ensure use. Ship your units when requested to the central blood provider(or where they ask you to ship it), and its done.

Although I searched the internet high and low, I cannot seem to find an equivilent system in Washington, or California, the two more active online med lab states. Is this type of system only practical with socialized medicine, where the province is responsible for all blood distribution rather that individual hospitals? Closest I could get to the concepts were:

http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Blood+Management.htm