OneBlood

The demand for blood products sometimes exceeds the available inventory. Blood product inventories are dependent upon the availability of donors, supplies and reagents, and collection staff. During prolonged extreme shortages, blood centers and transfusion services must alter practices to meet the needs of patients. The Association for the Advancement of Blood and Biotherapies Donor and Blood Component Management Subsection compiled some strategies from its blood center and hospital transfusion service members that could be implemented during blood product shortages. Some strategies that blood centers could use to increase their available inventories include increasing donor recruitment efforts, using alternate types of collection kits, manufacturing low-yield apheresis-derived platelets and/or whole blood-derived platelets, using cold-stored platelets, transferring inventory internally among centers of the same enterprise, using frozen inventory, decreasing standing order quantities, prioritizing allocation to certain patient populations, filling partial orders, and educating customers and blood center staff. Transfusion service strategies that could be implemented to maximize the use of the limited available inventory include increasing patient blood management efforts, using split units, finding alternate blood suppliers, trading blood products with other hospital transfusion services, developing a patient priority list, assembling a hospital committee to decide on triaging priorities, using expired products in extreme situations, and accepting nonconforming products after performing safety checks. Blood centers and transfusion services must choose the appropriate strategies to implement based on their needs.

To assess patient blood management (PBM) practices across the globe, the Association for the Advancement of Blood and Biotherapies (AABB) conducted a survey on PBM in 2022 which was unique due to its transcontinental outreach and served as a worldwide snapshot of the prevalent practices. AABB's Transfusion Safety/PBM subsection formed a workgroup to construct the survey and obtain data for 2021 conducted from May 31, 2022 through June 15, 2022. It was distributed to global AABB hospital members and non-AABB members. As a subset analysis, the North American (NA) responses were compared with the results from AABB's 2013 Blood Survey. Responses were received from 274 facilities including 69 non-NA member responses across 5 WHO regions as compared to 14 non-US member responses in 2013. Globally, 126/274 (45.9%) respondents reported having a PBM program vs NA cohort (2022) 103/205 (50.2%) versus 207/555 (37.3%) in 2013. Globally, the PBM programs involved pathologists 71 (56.3%), blood bank supervisor/managers 53 (42.1%) and transfusion medicine consultants 26(21.1%) with pathologists 70/103 (67.9%) highest in the NA cohort. Globally, transfusion thresholds were derived from AABB 205/267 (76.8%), College of American Pathologists 111/267 (41.6%) and hospital-developed guidelines 119 (44.6%) used individually or combined. In the NA cohort, AABB was used by 91/103 (88.3%). Out of the 206/274 (75.1%) who reported the usage of alternates to blood products, the majority used vitamin K 188(91.2%), tranexamic acid 167 (81.1%), and fibrin sealant 85 (41.2%). In the NA cohort, 151/205 (73.6%) reported similar distribution. Blood is not an option programs (BNAO) were available at 110/273 (40.3%) of respondents' facilities with the NA cohort having similar results 86/204 (41.9%). Globally, 60/272 (22.1%) had a formal service to manage the patient's anemia, in the NA cohort (2022) 41/204 (20.0%) versus 36/87 (41.4%) in 2013. Regarding the promotion of single-unit transfusions, this was reported globally by 101/126 (80.2%) versus NA cohort (2022) 86/205 (41.9%) versus 27/55(52.0%) in 2013. Formal PBM training and education was conducted globally at 62/126 (49.2%) centers versus NA cohort (2022) 47/103(45.6%) versus 366/555 (65.9%) in 2013. This global PBM survey captured more facilities outside of the NA than in 2013. The percentage of PBM programs reported has increased since the last survey, however, it is still in a minority of hospitals outside of NA. The majority have implemented transfusion thresholds based upon professional association recommendations and promote single-unit red blood cell transfusions. Areas of improvement (response <50%) include BNAO programs, anemia management and educational programs which have decreased since the last survey. This survey tells us where we are today and may serve as our roadmap ahead.

ABSTRACT Introduction The COVID-19 pandemic has resulted in a historic public health crisis with widespread social and economic ramifications. The pandemic has also affected the blood supply, resulting in unprecedented and sustained blood shortages. Areas Covered This review describes the challenges of maintaining a safe and sufficient blood supply in the wake of natural disasters, humanitarian emergencies, and pandemics. The challenges, which are accentuated in low- and high-income countries, span the impact on human capacity (affecting blood donors and blood collections personnel alike), disruption to supply chains, and economic sustainability. COVID-19 imparted lessons on how to offset these challenges, which may be applied to future pandemics and public health crises. Expert Opinion Pandemic emergency preparedness plans should be implemented or revised by blood centers and hospitals to lessen the impact to the blood supply. Comprehensive planning should address the timely assessment of risk to the blood supply, rapid donor recruitment, and communication of need, measures to preserve safety for donors and operational staff, careful blood management, and resource sharing.

A patient blood management (PBM) strategy can be applied to the process of intraoperative cell salvage for re-infusion during surgery. Stoneham et al. describe an effective PBM strategy applied to abdominal aortic aneurysm repair and emphasise the importance of a qualified and experienced intraoperative cell salvage practitioner to improve the safety and effectiveness of the approach. Commentary on: Stoneham et al. Intraoperative cell salvage using swab wash and serial thromboelastography in elective abdominal aortic aneurysm surgery involving massive blood loss. Br J Haematol 2023;200:652-659.

In addition to antigen-negative red blood cells (RBC), Immunohematology Reference Laboratories (IRL) must provide RBCs that are cytomegalovirus (CMV) seronegative. Due to high percentage of CMV seropositive individuals, it is challenging to find CMV and antigen-negative RBC. The IRL selects predominantly group O donors tested for CMV, and these RBC are sometimes needed to fill orders for nongroup O patients. This study evaluated units sent that were out of group to fulfill CMV-seronegative requests. Requests for CMV-seronegative and antigen-negative RBCs were divided into Period 1 (January 1, 2019-February 29, 2020) before intervention and Period 2 (March 1, 2020-May 31, 2020) post intervention. ABO Rh units requested were compared to ABO Rh units provided. Period 1: 537 CMV-seronegative RBC units were provided. 99/188(52.66%) B-positive requests were fulfilled using O RBCs. 58/504 (11.51%) of D-negative units were sent to D-positive patients. Period 2: 119 CMV-seronegative RBC units were provided. 18/51 (35.29%) B positive requests were fulfilled using O RBCs. Only 7/113 (6.19%) D-negative units were sent to D-positive patients. For 239/656 (36.43%) CMV-seronegative antigen orders requested for B-positive patients, more than half of these orders were filled with O RBCs. To decrease group O usage for nongroup O patients, the IRL practice has changed to increase CMV testing for group B donors. Since the change in algorithm, there was a 17.37% decrease group O usage for group B patients.

After a dilated eye examination, many patients experience symptoms of prolonged light sensitivity, blurred vision, and cycloplegia associated with pharmacological mydriasis. Phentolamine mesylate ophthalmic solution (PMOS) may expedite the reversal of mydriasis in patients, potentially facilitating return to functional vision and reducing barriers to obtaining dilated eye examinations. The protracted reversal time after pharmacologically induced pupil dilation impairs vision. We tested the hypothesis that PMOS rapidly reduces pupil diameter in this acute indication. In this double-masked placebo-controlled, randomized, two-arm crossover phase 2b trial, we evaluated the effects of one drop of 1% PMOS applied bilaterally in subjects who had their pupils dilated by one of two common mydriatic agents: 2.5% phenylephrine or 1% tropicamide. End points included change in pupil diameter, percent of subjects returning to baseline pupil diameter, and accommodative function at multiple time points. Thirty-one subjects completed the study (15 dilated with phenylephrine and 16 with tropicamide). Change in pupil diameter from baseline at 2 hours after maximal dilation with 1% PMOS was -1.69 mm and was significantly greater in magnitude compared with placebo for every time point beyond 30 minutes (P < .05). At 2 hours, a greater percentage of study eyes given 1% PMOS returned to baseline pupil diameter compared with placebo (29 vs. 13%, P = .03), which was this also seen at 4 hours (P < .001). More subjects treated with PMOS in the tropicamide subgroup had at least one eye returning to baseline accommodative amplitude at 2 hours (63 vs. 38%, P = .01). There were no severe adverse events, with only mild to moderate conjunctival hyperemia that resolved in most patients by 6 hours. Phentolamine mesylate ophthalmic solution at 1% reversed medically induced pupil dilation more rapidly than placebo treatment regardless of which mydriatic was used (adrenergic agonists and cholinergic blockers) with a tolerable safety profile.

TransfusionVolume 59, Issue S3 p. 8A-220A Abstract Abstract Presentations from the AABB Annual Meeting San Antonio, TX, October 19–22, 2019 First published: 05 September 2019 https://doi.org/10.1111/trf.15462Citations: 7Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume59, IssueS3Special Issue: A Supplement to TRANSFUSION Abstract Presentations from the AABB Annual Meeting San Antonio, TX, October 19–22, 2019September 2019Pages 8A-220A RelatedInformation