Damage Control Resuscitation by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030208202
Publisher: Springer International Publishing

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Over 75 million units of blood are donated every year worldwide, with blood services depending on the altruism of the donors [31]. In the United States, blood donation, distribution, and transfusion services all operate within a blood supply network consisting of collection centers (hospital and community) and transfusing facilities. Basic economics of supply and demand apply, with the hope that blood banks will always have enough blood in storage for emergent demands. Since 1971, national surveys have been administered for the blood supply network to assess supply and demand. Recent National Blood Collection and Utilization Survey (NBCUS) Reports published by the US Department of Health and Human Services have described a decrease in donor blood collection, with an 11.6% decrease between 2013 and 2015 [32]. This echoes a steady decrease in demand as well, which has been a trend seen in earlier surveys [33]. This is likely due to a focused effort to reduce transfusions, such as minimally invasive surgeries, restrictive transfusion practices, success with cytokine-based therapies, and immunosuppression for aplastic anemia [33]. However, this raises concern that hospitals do not have enough supply to accommodate for surge demand in times of crises or major disaster. One example is the Zika virus outbreak in 2016, where blood collection was halted in Puerto Rico until nucleic acid testing could be implemented under investigational new drug protocols. With their inherent supply cut off, Puerto Rico depended on the importing of blood products from the non-Zika-affected blood centers in the mainland United States. Another important issue is wastage of blood products, which may occur from time expiry, wasted imports, blood that was medically or surgically ordered but not used, stock time expiration, hemolysis, or miscellaneous reasons. The 2011 NBCUS survey reported a 12% wastage rate, with causes attributed to unacceptable test results, units sacrificed by collectors for unspecified reasons, and outdated units [34]. Recent results from three level I trauma centers’ utilization of blood products during massive transfusion protocols also showed an RBC wastage rate of 9% [35]. Even with the FDA extension of liquid RBC shelf life from 21 to 42 days, fRBCs can still be stored for over 10 years, thus decreasing the wastage of blood through outdating by thawing the blood needed ahead of time [21].

Ever since the terrorist attack on September 11, 2001, a focus has been placed on the availability of blood products to prepare for possible future catastrophic events. This event initiated the American Red Cross (ARC), America’s Blood Centers (ABC), and other government agencies to produce weekly data reflecting that blood centers and hospitals each maintain on average a 3- to 5-day supply of RBCs to create an estimated 10-day reserve [36]. However, a 2006 ABC newsletter showed less than half of their centers maintained a blood supply of 3 or more days. In addition, seasonal shortages are common, especially in the winter and summer months due to inclement weather, seasonal viral infections, decrease in donor pool, and vacations [37]. These seasonal shortages could be alleviated by the availability of fRBCs in blood centers and hospitals.

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