Steps Forward to a Fair and Inclusive Blood Supply.

Blood transfusions save lives. Scientific advancements in infectious disease testing, immunohematology, and blood processing, coupled with an altruistic blood donor model, blood transfusion has become a safe and effective therapeutic intervention. Blood establishments are an integral part of the health care continuum. However, challenges related to access to blood as well as diversity of blood donors can reflect the broader issues within our health care system. An awareness of the social injustices while using medical evidence-based data to support change will be essential for ensuring equitable access to life-saving treatments for all individuals and the communities we serve.

The American Rare Donor Program: 25 years supporting rare blood needs.

Rare donor programs are critically important for those patients with rare phenotypes who have produced the associated alloantibodies that necessitate the provision of rare blood components. We describe the American Rare Donor Program (ARDP) and its establishment, members, and policies. The specific phenotypes meeting the ARDP criteria for inclusion are described. Data on the number of rare donors registered by year, and the number of requests for rare blood components received and fulfilled over the 25 years of the program (1998-2023) are provided, along with a description of some notable cases and discussion of how the program supports patients with sickle cell disease.

Defining blood deserts and access to blood products for 660 million people: a geospatial analysis of eight states in Northern India.

INTRODUCTION: Blood transfusion is crucial, but low-income and middle-income countries like India face a severe shortage of banked blood. This study focuses on the Empowered Action Group (EAG) states in India, where healthcare is limited, and health outcomes are poor. Our objective was to assess the blood banking infrastructure and access to blood products in these states. METHODS: We used e-Rakht Khosh, an online platform for blood availability data. We collected data on blood bank locations and stocks from 18 January to 9 February 2022 and used ArcGIS to determine the population residing within 30-60-90 min of a blood bank. Availability ratios were calculated by dividing available blood products by population in these catchment areas. Descriptive analysis characterised availability, and statistical tests evaluated differences across states and over the 4-week period. RESULTS: 806 of 824 blood banks reported data on blood stocks. Our analysis showed that 25.72% of the EAG states' population live within 30 min of a blood bank, while 61.45% and 92.46% live within 60 and 90 min, respectively. CONCLUSION: Blood availability rates were low in the EAG states, with only 0.6 units per 1000 people. Additionally, only 61% of the population had access to blood-equipped facilities within an hour. These rates fell below the standards of the Lancet Commission on Global Surgery (15 units per 1000 population) and the WHO (10 donations per 1000 population). The study highlights the challenges in meeting demand for blood in emergencies due to inadequate blood banking infrastructure.

[Modern problems of plasma donation services: global experience in solving them].

As an analysis of foreign literature on donation has shown, the global market for therapy with drugs from human plasma is growing, which leads to the need for large volumes. With significant geographic imbalances in the global plasma supply and the dependence of most countries on plasma supplies from the United States, the most vulnerable are low- and middle-income countries, where the challenge of meeting the demand for plasma products requires improvements to regional plasma donation systems. An effective tool for the development of plasma collection services is compliance with the standards of plasma donation services, the development of voluntary free plasma donation, and the optimization of donor recruitment and retention processes.

A robust optimization model for multi-objective blood supply chain network considering scenario analysis under uncertainty: a multi-objective approach.

Annually, different regions of the world are affected by natural disasters such as floods and earthquakes, resulting in significant loss of lives and financial resources. These events necessitate rescue operations, including the provision and distribution of relief items like food and clothing. One of the most critical challenges in such crises is meeting the blood requirement, as an efficient and reliable blood supply chain is indispensable. The perishable nature of blood precludes the establishment of a reserve stock, making it essential to minimize shortages through effective approaches and designs. In this study, we develop a mathematical programming model to optimize supply chains in post-crisis scenarios using multiple objectives. Presented model allocates blood to various demand facilities based on their quantity and location, considering potential situations. We employ real data from a case study in Iran and a robust optimization approach to address the issue. The study identifies blood donation centers and medical facilities, as well as the number and locations of new facilities needed. We also conduct scenario analysis to enhance the realism of presented approach. Presented research demonstrates that with proper management, crises of this nature can be handled with minimal expense and deficiency.

Mitigating the impact of blood shortages in England.

The supply of blood components and products in sufficient quantities is key to any effective health care system. This report describes the challenges faced by the English blood service, NHS Blood and Transplant (NHSBT), towards the end of the COVID-19 pandemic, which in October 2022 led to an Amber Alert being declared to hospitals indicating an impending blood shortage. The impact on the hospital transfusion services and clinical users is explained. The actions taken by NHSBT to mitigate the blood supply challenges and ensure equity of transfusion support for hospitals in England including revisions to the national blood shortage plans are described. This report focuses on the collaboration and communication between NHSBT, NHS England (NHSE), Department of Health and Social Care (DHSC), National Blood Transfusion Committee (NBTC), National Transfusion Laboratory Managers Advisory Group for NBTC (NTLM), National Transfusion Practitioners Network, the medical Royal Colleges and clinical colleagues across the NHS.

Blood Donor Incentives across 63 Countries: The BEST Collaborative Study.

Incentives for blood donors are a much-debated strategy intended to ensure a sufficient supply of blood. Yet, there is a fundamental lack of knowledge about which incentives are offered by different blood collectors. We provide a comprehensive description of incentive policies for whole blood donors across 63 countries and 50 states of the United States. We collected data on incentive policies by conducting 2 surveys among representatives of blood collection establishments. Additionally, we integrated incentive data from an existing study and the World Health Organization (WHO). Lastly, we performed a web content analysis of blood collector websites and news releases to extend incentive data for the United States as well as underrepresented regions. We present descriptive analyses illustrating the type and value of incentives and their geographical distribution around the globe. Approximately half of the countries in our sample employ financial incentives, which include cash and tax benefits, but also less conventional incentives, such as healthcare supplements and raffles. Time off work is also commonly offered to blood donors and varies across blood collection establishments in duration and whether it is granted to all donors or only to those whose employer allows it. There is a geographical clustering of incentives, such that neighboring countries are more likely to employ similar incentives. This study provides insights into the strategies used for incentivizing blood donation and highlights the global diversity of incentive policies for whole blood donors. In stark contrast to WHO guidelines, half of the countries surveyed employ some kind of high-value incentive for blood donors. More realistic guidelines that are adapted to the local cultural and institutional context may be needed to maintain an adequate blood supply.

The future of blood services amid a tight balance between the supply and demand of blood products: Perspectives from the ISBT Young Professional Council.

BACKGROUND AND OBJECTIVES: Blood services manage the increasingly tight balance between the supply and demand of blood products, and their role in health research is expanding. This review explores the themes that may define the future of blood banking. MATERIALS AND METHODS: We reviewed the PubMed database for articles on emerging/new blood-derived products and the utilization of blood donors in health research. RESULTS: In high-income countries (HICs), blood services may consider offering these products: whole blood, cold-stored platelets, synthetic blood components, convalescent plasma, lyophilized plasma and cryopreserved/lyophilized platelets. Many low- and middle-income countries (LMICs) aim to establish a pool of volunteer, non-remunerated blood donors and wean themselves off family replacement donors; and many HICs are relaxing the deferral criteria targeting racial and sexual minorities. Blood services in HICs could achieve plasma self-sufficiency by building plasma-dedicated centres, in collaboration with the private sector. Lastly, blood services should expand their involvement in health research by establishing donor cohorts, conducting serosurveys, studying non-infectious diseases and participating in clinical trials. CONCLUSION: This article provides a vision of the future for blood services. The introduction of some of these changes will be slower in LMICs, where addressing key operational challenges will likely be prioritized.

COVID-19 and the impact on blood availability and transfusion practices in low- and middle-income countries.

BACKGROUND/CASE STUDIES: The coronavirus disease 2019 (COVID-19) pandemic disrupted the global blood supply. Low- and middle-income countries (LMICs) already experienced blood supply deficits that preceded the pandemic. We sought to characterize the challenges experienced during the pandemic, and adaptations, such as COVID-19 convalescent plasma (CCP). STUDY DESIGN/METHODS: A cross-sectional survey explored blood availability, challenges, and adaptations. The survey contained 31 questions, e-mailed in English, French, or Spanish, to selected LMIC blood transfusion practitioners. Data acquisition occurred between October 28 and December 28, 2020. A mixed methods analysis followed. RESULTS/FINDINGS: A total of 31 responses from 111 invitations represented 26 LMIC countries. Languages included English (22, 71%), Spanish (7, 22.6%), and French (2, 6.4%). Most respondents (29/31, 93.5%) collected blood; 58% also transfused blood (18/31). The supply of blood came from hospital-based blood donations (61%, 11/18); blood suppliers (17%, 3/18); and both sources (22%, 4/18). Collectively, 77.4% (24/31) of respondents experienced a decline in blood availability, ranging from 10% to 50%. Contributing factors included public fear of COVID-19 (21/24); stay-at-home measures (18/24); logistics (14/24); and canceled blood drives (16/24). Adaptations included increased collaboration within and between institutions (17/27), donor eligibility changes (21/31); social media or phone promotion (22/39); and replacement donation (3/27). Fifteen of 31 responses reported CCP donation (48.4%); CCP transfusion occurred in 6 (19.4%). The primary barrier was engaging recovered patients for donation (7/15). CONCLUSION: Our survey describes challenges experienced by LMIC blood systems during the COVID-19 pandemic. While the decline in blood supplies was severe, adaptive measures included collaboration, outreach, and CCP programs.

Current state and positive impact of hospital-based blood donor centers in the United States.

BACKGROUND: The COVID-19 pandemic has brought tremendous challenges to the United States blood supply. Decreased collections have caused blood product shortages. The number of hospital-based donor centers (HBDCs) has decreased in the past decades, but they provide important support to their hospital systems. MATERIALS/METHODS: We identified 79 active HBDCs through an information request to the FDA. These centers were invited to participate in a survey about their activities, blood product collections, and perceived value. RESULTS: Thirty-six centers responded (46% response rate). The centers represented a wide range of states and geographic settings. Whole blood collection was most common, but some respondents also prepared specialized products such as COVID-19 convalescent plasma and pathogen-reduced platelets. Positive impacts of HBDCs included inventory availability, cost-effectiveness/savings, community outreach, supporting special patient populations, and collecting specialty products. All respondents anticipate at least stable operations, if not growth, in the future. CONCLUSION: HBDCs continue to be valuable assets in addressing emerging patient transfusion needs. Their unique offerings are tailored to the populations their hospitals support, and demonstrate the value in having the collection infrastructure in place to rapidly respond to critical shortages. This survey provides benchmark data about a broad group of HBDCs including products prepared, inventory self-sufficiency levels, and reasons for positive impact.

Source plasma deferral trends: A 3-year analysis of 255 centers in the United States.

BACKGROUND: Plasma contains many important proteins of therapeutic interest including albumin, clotting factors, and antibodies. Source plasma (SP) is in great demand particularly due to a shortage of immunoglobulin. To better understand how to increase supply, we examined SP donor deferrals for the previous 3 years. STUDY DESIGN: This is a description of donor deferrals at 255 plasma donation centers in the United States for April 1, 2017 to March 31, 2020. RESULTS: A total of 4 587 923 events were evaluated for the 3-year period 2017-2020. There were 873 227 deferrals analyzed for 2017-2018, 1 765 582 in 2018-2019, and 1 949 114 for 2019-2020. The most common deferral each year was for unacceptable blood pressure (BP) or pulse which comprised 27.9%, 28.2%, and 28.3% of deferrals in 2017-2018, 2018-2019, and 2019-2020, respectively. The second most common cause of deferral was for unacceptable hematocrit which comprised 14.1% of deferrals in 2017-2018, and 16.0% in 2018-2019 and 2019-2020. The majority of these deferred donors had low hematocrits and were predominately (~80%) female. Deferral for unacceptable total protein comprised a smaller percentage (~4%) of deferrals. DISCUSSION: Most donor deferrals were due to unacceptable screening results, particularly high BP, elevated pulse, low protein, and low hematocrit. Although rates of deferrals in other categories have been slightly increasing over time, they comprise a small percentage. Donor education regarding healthy lifestyle choices may improve overall donor health, decrease deferrals, and increase SP supply.

Supplemental findings of the 2019 National Blood Collection and Utilization Survey.

INTRODUCTION: Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT). METHODS: National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events. RESULTS: Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced. CONCLUSION: Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.

Results from the blood donor competence, autonomy, and relatedness enhancement (blood donor CARE) randomized trial.

BACKGROUND: This study aimed to promote competence, autonomy, and relatedness among first-time whole blood donors to enhance intrinsic motivation and increase retention. STUDY DESIGN AND METHODS: Using a full factorial design, first-time donors (N = 2002) were randomly assigned to a no-treatment control condition or to one of seven intervention conditions designed to promote donation competence, autonomy, relatedness, a combination of two (e.g., competence and autonomy), or all three constructs. Participants completed donor motivation measures before the intervention and 6 weeks later, and subsequent donation attempts were assessed for 1 year. RESULTS: There was no significant group difference in the frequency of donation attempts or in the number of days to return. Significant effects of group were observed for 10 of the 12 motivation measures, although follow-up analyses revealed significant differences from the control group were restricted to interventions that included an autonomy component. Path analyses confirmed direct associations between interventions involving autonomy and donor motivation, and indirect mediation of donation attempts via stronger donation intentions and lower donation anxiety. CONCLUSION: Among young, first-time, whole blood donors, brief interventions that include support for donor autonomy were associated with direct effects on donor motivation and indirect, but small, effects on subsequent donation behavior.