How do I manage a blood shortage in a transfusion service?

A lthough there are more than 16 million blood donations per year provided to more than 4 million recipients, blood shortages have recurred for decades with amazing periodicity, approximately twice every year, in the summer months over 4th of July and Labor Day and during the Christmas and New Year’s holidays. Anyone with any experience at blood centers or transfusion services is quite accustomed to these expected shortages. The requirement for transfusions continues to increase approximately 5 to 7 percent per year without a similar increase in donations. This fact together with the “graying” of the population will require even more donations compounded by the increasing expansions of programs requiring considerable transfusion support, for example, liver transplantations. Increasing numbers of donor rejections due to stricter donor eligibility based on real or perceived infectious threats to the blood supply, for example, Chagas disease and human herpes virus 8, and units failing additional testing will only make such shortages inevitable for the foreseeable future. The terrorist attacks of September 11, 2001, stimulated many to question our blood supply’s readiness to deal with potential disasters in the future. Many organizations, including the American Red Cross, America’s Blood Centers (ABC), and government agencies, produce weekly data showing that blood centers and hospitals each maintain (on average) a 3to 5-day supply of red cells (RBCs) creating an estimated 10-day reserve of RBCs. The July 7, 2006, ABC Newsletter, however, revealed only 40 to 50 percent of their centers maintained an RBC supply of 3 days or more! No data are available for platelets (PLTs) or other components. The RBC inventories are only averages, however, and “spot” shortages of specific blood types, D–, and blood components are hidden within these averages as are the “routinely” accepted serologic substitutions of D+ products to RH– men and women unable to conceive and commonly substituting group O RBCs and PLTs for patients with A/B/AB blood types. Little can be found in the literature on how to deal with these difficult shortages from a blood center but especially from a transfusion service perspective. When any blood shortage occurs, the transfusion service’s medical director will be expected to minimize its negative impact on his or her hospital’s transfusion activities regardless of how other hospitals might respond. Many of my comments and thoughts were stimulated by facilitating the Physicians for the Advancement of Transfusion Medicine meeting in Baltimore, Maryland, in 2004.