Stochastic Inventory Model for Minimizing Blood Shortage and Outdating in a Blood Supply Chain under Supply and Demand Uncertainty.

Purpose: Blood, like fresh produce, is a perishable element, with platelets having a limited lifetime of five days and red blood cells lasting 42 days. To manage the blood supply chain more effectively under demand and supply uncertainty, it is of considerable importance to developing a practical blood supply chain model. This paper proposed an essential blood supply chain model under demand and supply uncertainty. Methods: This study focused on how to manage the blood supply chain under demand and supply uncertainty effectively. A stochastic mixed-integer linear programming (MILP) model for the blood supply chain is proposed. Furthermore, this study conducted a sensitivity analysis to examine the impacts of the coefficient of demand and supply variation and the cost parameters on the average total cost and the performance measures (units of shortage, outdated units, inventory holding units, and purchased units) for both the blood center and hospitals. Results: Based on the results, the hospitals and the blood center can choose the optimal ordering policy that works best for them. From the results, we observed that when the coefficient of demand and supply variation is increased, the expected supply chain cost increased with more outdating units, shortages units, and holding units due to the impacts of supply and demand fluctuation. Variation in the inventory holding and expiration costs has an insignificant effect on the total cost. Conclusions: The model developed in this paper can assist managers and pathologists at the blood donation centers and hospitals to determine the most efficient inventory policy with a minimum cost based on the uncertainty of blood supply and demand. The model also performs as a decision support system to help health care professionals manage and control blood inventory more effectively under blood supply and demand uncertainty, thus reducing shortage of blood and expired wastage of blood.

The global need and availability of blood products: a modelling study.

BACKGROUND: Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally. METHODS: We did a modelling study involving 195 countries and territories. We used blood component preparation data from 2011-13 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need. FINDINGS: In 2017, the global blood need was 304 711 244 (95% uncertainty interval [UI] 293 064 637-314 049 479) and the global blood supply was 272 270 243 (268 002 639-276 698 494) blood product units, with a need-to-supply ratio of 1·12 (95% UI 1·07-1·16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102 359 632 (95% UI 93 381 710-111 360 725) blood product units, equal to 1849 (1687-2011) units per 100 000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs. INTERPRETATION: Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries. FUNDING: National Institutes of Health.

The supply chain of migrant blood donors: an organisational interview study.

BACKGROUND AND OBJECTIVES: Migrant blood donors are underrepresented worldwide resulting in shortages of compatible blood products. Prior studies focused on individual barriers and motivators of potential blood donors, but no studies addressed organisational factors of the blood supply chain. This study explored the perceptions and experiences in recruitment and retention of migrant - and potentially rare-blood donors among staff members within the blood supply chain and identified obstacles and solutions in this chain. MATERIALS AND METHODS: The study was conducted at Sanquin, the national blood supply organisation of the Netherlands. Qualitative in-depth interviews were done among key staff members (N = 17). Expert validity was assessed in three feedback meetings. RESULTS: Seven staff members believed there is a shortage of migrant blood donors, while five believed there is not. However, there was a consensus that it may become a problem in the future due to demographic changes. The perceived obstacles to recruit and retain migrant donors were difficulties in determining how many migrant donors are needed and recruiting them, excluding potentially rare donors prior to donation, limited use of extended phenotyping and high blood typing and frozen storage costs. The possible solutions to increase blood pool diversity lay in registering donor ethnicity, specialised information provision for donors, reconsidering eligibility criteria and optimising blood typing strategies. CONCLUSION: Whilst recruitment of migrant blood donors is perceived by staff as difficult, various organisational policies and guidelines seem to hinder retention. Improvements in the blood supply chain may be achieved by addressing logistics, current procedures and registration of ethnicity.

Estimating Tanzania's National Met and Unmet Blood Demand From a Survey of a Representative Sample of Hospitals.

Estimating blood demand to determine collection goals challenges many low-income countries. We sampled Tanzanian hospitals to estimate national blood demand. A representative sample based on probability proportional to size sampling of 42 of 273 (15%) Tanzanian transfusing hospitals was selected. Blood bank registers, patient medical records, and blood component disposition records were reviewed prospectively from June to September 2013 to determine the number of components requested and the number and proportion issued, not issued due to nonavailability, and not issued for other reasons. Data were estimated for an annual national estimate. Of an estimated 278 371 components requested in 2013, 6648 (2.4%) were not issued due to nonavailability, 34 591 (12.4%) were not issued for other reasons, and 244 535 (87.8%) were issued. Of these 278 371 components, 86 753 (31.2%) were requested by adult medical, 74 499 (26.8%) by pediatric medical, and 57 312 (20.6%) by obstetric units. In these 3 units, the proportion of units not issued due to nonavailability was 1.8%. Private (4.1%) and large (6%) hospitals had the largest proportion of units not issued because of nonavailability. Of 244 535 issued components, 91 690 (37.5%) were collected, tested, and issued from blood banks that are not part of the Tanzania National Blood Transfusion Services (TNBTS). Nearly 98% of blood component demand was met. However, a large portion of the blood supply for the hospitals came from non-TNBTS blood banks. TNBTS could increase availability of safe blood through assuring the quality of donor selection and donation testing at non-TNBTS blood banks.

Continued decline in blood collection and transfusion in the United States-2015.

BACKGROUND: In 2011 and 2013, the National Blood Collection and Utilization Survey (NBCUS) revealed declines in blood collection and transfusion in the United States. The objective of this study was to describe blood services in 2015. STUDY DESIGN AND METHODS: The 2015 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated. RESULTS: Response rates for the 2015 NBCUS were 78.4% for blood collection centers and 73.9% for transfusing hospitals. In 2015, 12,591,000 units of red blood cells (RBCs) (95% confidence interval [CI], 11,985,000-13,197,000 units of RBCs) were collected, and 11,349,000 (95% CI, 10,592,000-11,747,000) were transfused, representing declines since 2013 of 11.6% and 13.9%, respectively. Total platelet units distributed (2,436,000; 95% CI, 2,230,000-2,642,000) and transfused (1,983,000; 95% CI, 1,816,000 = 2,151,000) declined by 0.5% and 13.1%, respectively, since 2013. Plasma distributions (3,714,000; 95% CI, 3,306,000-4,121,000) and transfusions (2,727,000; 95% CI, 2,594,000-2,859,000) in 2015 declined since 2013. The median price paid per unit in 2015-$211 for leukocyte-reduced RBCs, $524 for apheresis platelets, and $54 for fresh frozen plasma-was less for all components than in 2013. CONCLUSIONS: The 2015 NBCUS findings suggest that continued declines in demand for blood products resulted in fewer units collected and distributed Maintaining a blood inventory sufficient to meet routine and emergent demands will require further monitoring and understanding of these trends.

Results of a Nationwide Capacity Survey of Hospitals Providing Trauma Care in War-Affected Syria.

IMPORTANCE: The Syrian civil war has resulted in large-scale devastation of Syria's health infrastructure along with widespread injuries and death from trauma. The capacity of Syrian trauma hospitals is not well characterized. Data are needed to allocate resources for trauma care to the population remaining in Syria. OBJECTIVE: To identify the number of trauma hospitals operating in Syria and to delineate their capacities. DESIGN, SETTING, AND PARTICIPANTS: From February 1 to March 31, 2015, a nationwide survey of 94 trauma hospitals was conducted inside Syria, representing a coverage rate of 69% to 93% of reported hospitals in nongovernment controlled areas. MAIN OUTCOMES: Identification and geocoding of trauma and essential surgical services in Syria. RESULTS: Although 86 hospitals (91%) reported capacity to perform emergency surgery, 1 in 6 hospitals (16%) reported having no inpatient ward for patients after surgery. Sixty-three hospitals (70%) could transfuse whole blood but only 7 (7.4%) could separate and bank blood products. Seventy-one hospitals (76%) had any pharmacy services. Only 10 (11%) could provide renal replacement therapy, and only 18 (20%) provided any form of rehabilitative services. Syrian hospitals are isolated, with 24 (26%) relying on smuggling routes to refer patients to other hospitals and 47 hospitals (50%) reporting domestic supply lines that were never open or open less than daily. There were 538 surgeons, 378 physicians, and 1444 nurses identified in this survey, yielding a nurse to physician ratio of 1.8:1. Only 74 hospitals (79%) reported any salary support for staff, and 84 (89%) reported material support. There is an unmet need for biomedical engineering support in Syrian trauma hospitals, with 12 fixed x-ray machines (23%), 11 portable x-ray machines (13%), 13 computed tomographic scanners (22%), 21 adult (21%) and 5 pediatric (19%) ventilators, 14 anesthesia machines (10%), and 116 oxygen cylinders (15%) not functional. No functioning computed tomographic scanners remain in Aleppo, and 95 oxygen cylinders (42%) in rural Damascus are not functioning despite the high density of hospitals and patients in both provinces. CONCLUSIONS AND RELEVANCE: Syrian trauma hospitals operate in the Syrian civil war under severe material and human resource constraints. Attention must be paid to providing biomedical engineering support and to directing resources to currently unsupported and geographically isolated critical access surgical hospitals.

Assessment of Acute Burn Management in 32 Low- and Middle-Income Countries.

BACKGROUND: The purpose of this study is to ascertain whether acute burn management (ABM) is available at health facilities in low- and middle-income countries (LMICs). METHOD: The study used the World Health Organization situational analysis tool (SAT) which is designed to assess emergency and essential surgical care and includes data points relevant to the acute management of burns. The SAT was available for 1413 health facilities in 59 countries. RESULTS: A majority (1036, 77.5 %) of the health facilities are able to perform ABM. The main reasons for the referral of ABM are lack of skills (53.4 %) and non-functioning equipment (52.2 %). Considering health centres and district/rural/community hospitals that referred due to lack of supplies/drugs and/or non-functioning equipment, almost half of the facilities were not able to provide continuous and consistent access to the equipment required either for resuscitation or to perform burn wound debridement. Out of the facilities that performed ABM, 379 (36.6 %) are capable of carrying out skin grafts and contracture release, which is indicative of their ability to manage full thickness burns. However the magnitude of full thickness burns managed was limited in half of these facilities, as they did not have access to a blood bank. CONCLUSION: The initial management of acute burns is generally available in LMICs, however it is constrained by the inability to perform resuscitation (19 %) and/or burn wound debridement (10 %). For more severe burns, an inability to perform skin grafting or contracture release limits definitive management of full thickness burns, whilst lack of availability to blood further compromises the treatment of major burns.

Regulação de sangue no Brasil: contextualização para o aperfeiçoamento / Blood regulation in Brazil: contextualization for improvement

A utilização dos produtos do sangue como medicamentos essenciais e o reconhecimento das dimensões dos riscos transfusionais demandam dos países uma ação regulatória com foco em qualidade e segurança. Nesse campo, os órgãos reguladores têm papel fundamental em imprimir socialmente a garantia de que os componentes do sangue serão produzidos e utilizados de acordo com as normas técnicas vigentes. Assim, na busca para gerenciar os riscos sanitários envolvidos no processamento e uso do sangue, o modelo regulatório brasileiro, baseado na construção de uma política nacional de sangue, sob gestão do Estado, vem passando por aprimoramento conceitual e inovação de seus instrumentos. Com a inserção das boas práticas de fabricação preconizadas pela Organização Munidal da Saúde nas normativas brasileiras, o país avança na visão dos estabelecimentos de sangue como centros produtores de produtos biológicos originados do sangue para fins terapêuticos e fortalece a necessidade de desenvolvimento de mecanismos para a segurança no atendimento a doadores e receptores. O desenvolvimento de uma política nacional de sangue coordenada pelo Estado e a instituição de um sistema nacional de vigilância sanitária com poder fiscalizatório legitimado são elementos essenciais utilizados no Brasil para garantia de sangue em quantidade, qualidade, segurança e em tempo oportuno à população. Este artigo tem por objetivo discutir o contexto atual do modelo regulatório de sangue no Brasil na perspectiva de apontar desafios para o aperfeiçoamento desse modelo.

The use of blood products as essential medicines and the recognition of the high risk associated with blood transfusions require governments to take regulatory action with a focus on quality and safety. In this scenario, regulatory agencies play an essential role in socially advancing the guarantee that blood components will be produced according to current operating rules. Thus, in the effort to manage sanitary risks involved in the processing and use of blood, the Brazilian regulatory model, based on the construction of a national blood policy overseen by the State, has undergone conceptual improvement and review of the tools employed to achieve its goals. With the inclusion of good manufacturing practices as part of the Brazilian norms, as recommended by the World Health Organization, the country has moved forward in its view of blood facilities as manufacturing centers producing blood-derived biologics for therapeutic applications. It has also strengthened the need to develop safety mechanisms for blood donors and recipients. The development of a State-coordinated national blood policy and the institution of a national surveillance system with legitimate power of inspection are essential elements used in Brazil to guarantee the amount, quality, safety, and timeliness of blood supply to the population. The present article aims to discuss the present context of the blood regulatory model in Brazil so as to identify the challenges for improvement of this model.

[How do I assess requirement of a blood bank and its kind for a healthcare establishment?]. / Comment j'évalue la nécessité d'un dépôt de sang et son type pour un établissement de santé ?

Access to blood components is required for healthcare establishments, particularly for emergency situation and hospital blood bank was often a response to this requirement. However, the complexity of regulation and economic pressures lead healthcare establishment to review regularly their need for a blood bank. This assessment requires analysis of need for transfusions in terms of delay, quantity and clinical situations to which they must respond. When a blood bank is required, three kinds could be under consideration: emergency blood bank, intermediate blood bank and issuance blood bank. According to requirements, advantages and disadvantages of each kind, healthcare establishments would select the most suitable one.

International challenges of self-sufficiency in blood products.

To face known and emerging threats to public health, all countries have to overcome the challenges of providing sufficient supplies of blood and blood products of the highest quality and safety. Unfortunately, self-sufficiency is not yet a reality in many countries. In 2011, experts from WHO addressed the urgent need to establish strategies and mechanisms for achieving this goal. A summary of these recommendations is further discussed.

[Blood donation in urban areas]. / La collecte en milieu urbain (Maisons Du Don, sociologie).

Medical and technical developments increase the difficulty to provide sufficient safe blood for all patients in developed countries and their sociodemographic and societal changes. Sufficient national blood supply remains a reached, however still actual, challenge. Tomorrow is prepared today: the management of blood donation programs both in line with these developments and with social marketing strategies is one of the keys to success. If the main components of this organization are well known (mobile blood drives in various appropriate environments, and permanent blood donation centers) their proportions in the whole process must evolve and their contents require adaptations, especially for whole blood donation in urban areas. We have to focus on the people's way of life changes related to increasing urbanization of the society and prominent position taken by very large cities. This requires targeting several goals: to draw the attention of the potential blood-giving candidate, to get into position to collect him when he will decide it, to give meaning and recognition to his "sacrifice" (give time rather than donate blood) and to give him desire and opportunity to come back and donate one more time. In this strategy, permanent blood centers in urban areas have significant potential for whole blood collection, highlighted by the decrease of apheresis technology requirements. This potential requires profound changes in their location, conception and organization. The concept of Maison Du Don (MDD) reflects these changes.

Assessment of obstetric and neonatal health services in developing country health facilities.

OBJECTIVE: To describe the staffing and availability of medical equipment and medications and the performance of procedures at health facilities providing maternal and neonatal care at African, Asian, and Latin American sites participating in a multicenter trial to improve emergency obstetric/neonatal care in communities with high maternal and perinatal mortality. STUDY DESIGN: In 2009, prior to intervention, we surveyed 136 hospitals and 228 clinics in 7 sites in Africa, Asia, and Latin America regarding staffing, availability of equipment/medications, and procedures including cesarean section. RESULTS: The coverage of physicians and nurses/midwives was poor in Africa and Latin America. In Africa, only 20% of hospitals had full-time physicians. Only 70% of hospitals in Africa and Asia had performed cesarean sections in the last 6 months. Oxygen was unavailable in 40% of African hospitals and 17% of Asian hospitals. Blood was unavailable in 80% of African and Asian hospitals. CONCLUSIONS: Assuming that adequate facility services are necessary to improve pregnancy outcomes, it is not surprising that maternal and perinatal mortality rates in the areas surveyed are high. The data presented emphasize that to reduce mortality in these areas, resources that result in improved staffing and sufficient equipment, supplies, and medication, along with training, are required.

Collaboration and research as key elements for strengthening blood donation in developing nations: the case of Grenada, West Indies / La colaboración y la investigación como elementos importantes para fortalecer la donación de sangre en las naciones en vías de desarrollo: el caso de Granada, West Indies

OBJECTIVE: The purpose of the study was to identify ways to strengthen the collaboration between the Grenadian Blood Bank, the St George's University (SGU) chapter of the American Medical Students Association, and St George's University Health Clinic in order to improve the promotion of blood drives and increase the number of volunteer donors. METHODS: The study had two phases. Phase 1: an assessment of the strengths and needs of the collaborators and of the blood drives. Phase 2 consisted of three student assessments: a cross-sectional survey of second year medical students, a cross-sectional survey of students in the School of Arts and Sciences and a case-control study of factors affecting student donation on the day of blood drives. Embedded within both phases were service-learning opportunities for students. Both phases received approval from SGU's Institutional Review Board. RESULTS: Preliminary achievements included a transient increase in blood donation of twenty per cent during five months though advertising of blood drives remains inadequate. Assessments reveal that most students lack knowledge about the drives, and time (medical students) and fear of needles and infection (Arts and Science students) are potential hindrances to blood donation. CONCLUSIONS: The Blood Bank needs to increase its profile on the university campus and develop a more effective promotion of the blood drives addressing the concerns of students. St George's University needs to continue supporting student involvement in health promotion activities and identify ways to ensure the sustainability and continuity of these activities. Collaboration and research are useful and effective means to promote blood donation. College students are potentially an excellent source of collaborators and donors if provided with the promotion skills and participation is made convenient.

OBJETIVO: El propósito del estudio fue identificar maneras de fortalecer la colaboración entre el Banco de la Sangre de Granada, la Universidad de San Jorge (SGU), la Asociación Médica Estudiantil Estadounidense, y la Clínica de la Salud de la Universidad de San Jorge, con el fin de mejorar las campañas de donación de sangre y aumentar el número de donantes voluntarios. MÉTODOS: El estudio tuvo dos fases. Fase 1: una valoración de las fortalezas y necesidades de los colaboradores y de las campañas de donación de sangre. Fase 2, consistente en tres valoraciones de estudiante: una encuesta transversal de los estudiantes de segundo año de medicina, una encuesta transversal de estudiantes en la Escuela de Artes y Ciencias, y un estudio de caso-control de los factores que afectan la donación del estudiante el día de la campaña de la donación de sangre. Insertadas entre ambas fases se encuentran las oportunidades de aprendizaje-servicio para los estudiantes. Ambas fases recibieron la aprobación de la Junta de Revisión Institucional de SGU. RESULTADOS: Los logros preliminares incluyeron un aumento transitorio de un veinte por ciento en donaciones de sangre por un período de cinco meses, si bien los anuncios de las campañas de donación de sangre continúan siendo inadecuados. Las evaluaciones revelan que a la mayoría de los estudiantes les falta conocimientos sobre las campañas de donación, y que el tiempo (estudiantes de medicina) y el miedo a las agujas y las infecciones (estudiantes de Artes y de Ciencia) constituyen obstáculos potenciales a la donación de sangre. CONCLUSIONES: El Banco de Sangre necesita aumentar su perfil en el campus universitario y desarrollar una promoción más eficaz de las campañas de donación de sangre sobre la base de prestar atención a las preocupaciones de los estudiantes. La Universidad de San Jorge necesita continuar apoyando la participación de los estudiantes en las actividades de promoción de la salud, así como identificar maneras de asegurar la sostenibilidad y continuidad de estas actividades. La colaboración e investigación son medios útiles y eficaces de promover la donación de sangre. Los estudiantes de la universidad son potencialmente una fuente excelente de colaboradores y donantes, si se les da la oportunidad de promover sus habilidades y participar de la manera más conveniente.

The great East Japan earthquake of March 11, 2011, from the vantage point of blood banking and transfusion medicine.

BACKGROUND: The Great East Japan Earthquake of March 11, 2011, and subsequent tsunami took nearly 20 000 lives in Tohoku, the northeastern part of Japan's main island. Most victims were either carried away by the tsunami or drowned. The ability to collect blood was disrupted on the Pacific coast of Tohoku. Inland areas were less affected, but allogeneic blood collected in Tohoku is tested at the Miyagi Red Cross Blood Center (Miyagi Center) in the coastal city of Sendai. Miyagi Center was damaged and could not test for 2 months. OBJECTIVES: The aims of this study are as follows: (1) to assess transfusion practice at 8 disaster response hospitals in Tohoku's Fukushima Prefecture, for equal intervals before and after March 11, 2011; (2) to report activities related to blood collection and distribution in response to the disaster; and (3) to describe the Great East Japan Earthquake in the context of other disasters. METHODS: Data were collected through a survey of transfusion services at 8 major disaster response hospitals, communication at transfusion conferences, and literature review. RESULTS: Transfused patients and units transfused were about 70% and 60% of normal in the surveyed hospitals because this was a disaster of mass casualty rather than mass injury, and patients requiring chronic care were evacuated out. A nationally coordinated effort allowed excess blood collected outside Tohoku to be transported in, despite infrastructure damage. CONCLUSION: Japan's national system of blood collection and distribution responded effectively to local needs after the Great East Japan Earthquake. Disasters such as Japan's 3.11 should guide discourse about emergency preparedness and centralization of services.