Life Cycle of a Unit of Blood

8/2/2019 Life Cycle of a Unit of Blood

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The Life Cycle of a Unitof Blood

and why it matters

Calvino Cheng, MD, FRCPC

Associate Professor, Laboratory Medicine and Pathology,Dalhousie University

Hematopathologist, Capital District Health Authority

[email protected]

2010 Blood Matters Conference

October 29, 2010

Atlantica Hotel, Halifax, Nova Scotia


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Disclosure

The presenter does not have any

involvement with industry that may beperceived as potentially influencing the

presentation of the educational material

contained within


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Objectives

1. To provide a framework for evaluating

RBC unit trafficking and storage.

2. To provide an overview of the causes of

red blood cell discards.3. To provide recommendations on how to

minimize red blood cell discards.


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Outline

Background

Methodology

Results

Conclusions and recommendations


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Background:

Red Blood Cell Unit Lifecycle

Recent literature suggesting that RBC age

impacts patient morbidity and mortality

Continuous effort to decrease RBC expiryor discard rates

RBCs migrate in the system and thus the

system must be understood


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Background:

Red Blood Cell Unit Lifecycle

How does a red blood cell travel in our

institution? How does it get here? (what characteristics

does it have?)

Where does it go in our transfusion system?

Are there areas where RBCs unnecessarily

age?

What happens to RBCs that are in our

inventory?


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Inventory

Static and dynamic


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Methodology:

Inventory Dynamics

Analysis period: January December

2007

15930 unique units in inventory, earliest

unit received Nov 30, 2006


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Static Inventory Statistics

3830 (24.0)11,919 (74.8)12.4, 9.8, 7.915930(100.0)Total

1084 (16.8)4862 (75.5)11.7, 10.6, 5.16436(40.4)OPOS

549 (37.4)1172 (79.9)10.8, 7.7, 7.21467(9.2)ONEG

36 (2.0)112 (9.3)27.3, 29.7, 8.91202 (7.5)BPOS

18 (30.7)228 (87.4)9.7, 8.5, 5.8261(1.6)BNEG

1807 (37.7)4635 (94.1)8.9, 7.6, 4.04925(30.9)APOS

190 (19.3)755 (76.6)11.5, 10.5, 5.8985(6.2)ANEG10 (2.0)57 (11.4)29.0, 32.5, 8.6501(3.1)ABPOS

24 (15.7)98 (64.1)14.5, 13.5, 7.7153(1.0)ABNEG

Number of units

less than seven

days old on

receipt N(%)

Number of units

less than 14

days old on

receipt N(%)

Age at receipt

from supplier

(mean, median,

standard

deviation) (days)

Frequency of

total

(percent)

Blood

Group


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Dynamic Inventory Plot


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Inventory Knowledge

Units received mostly with


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Transfused RBCCharacteristics

With and without system

interaction


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Transfused RBC Characteristics

Study period: March-December 2007

12,298 unique red cell units

Mean age of RBC unit at receipt = 12 days

Mean age of RBC unit at dispense = 19.6 days

Mean time spent in transfusion system= 7.5

days

1.5% (182/12298)


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Transfused RBC Characteristics

182 (1.5)2533 (28.7)19.6, 17.5, 8.512,298 (100)Total

39 (0.8)1430 (20.4)18.7, 17.0, 7.15038 (41.0)OPOS

25 (2.3)189 (17.6)22.6, 21.7, 8.81074 (8.7)ONEG

5(0.6)45 (5.2)30.3, 32.5, 8.5873 (7.1)BPOS7 (4.9)44 (30.8)21.9, 21.3, 10.4143 (1.2)BNEG

100 (2.5)1691 (41.6)16.0, 14.9, 6.34069 (33.1)APOS

6 (0.8)97 (13.1)23.3, 22.9, 8.5740 (610)ANEG

0 (0)11 (4.0)33.4, 36.3, 8.0274 (2.2)ABPOS

0 (0)26 (29.9)22.5, 18.6, 10.187 (0.7)ABNEG

Number of units

less than seven

days old at

dispense N(%)

Number of units

less than 14 days

old at dispense

N(%)

Age at dispense

(mean, median,

standard

deviation) (days)

Frequency of

total

N (%)

Blood

Group


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Transfused RBC units with priorsystem interaction

9689/12,298 (78.8%) units remained in

BTS 2609 (21.2%) were returned a mean of

1.26 times from locations outside BTS

Mean time outside BTS = 18.4 hours Mean age of the dispense 21.3 vs. 19.2 days

(p


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Transfused RBC Knowledge A significant proportion of our transfused

units have been previously returned (1/4) Returned units are globally transfused at

more advanced age vs. units resident in BTS

Some blood group units age 5 days more

With uncommon blood groups

Received into inventory later, and age in the

system prior to transfusion effect worsened bybeing returned


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Discarded RBCs


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Discarded RBC units Study period: March-December 2007

636/12258 (5.2%) wasted

Most common groups: AB+, B+, O+

410/636 (64.4%) remained resident in BTS Time spent outside BTS: 28 hours vs. 18.4

hours (comparing discarded vs. transfused

units) Most common return location was ORH


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Discarded RBC Units

13.835.021.2636Total

6.320.914.688OPOS

23.134.611.674ONEG7.841.333.5120BPOS

30.741.410.742BNEG

7.921.213.373APOS

22.135.011.950ANEG

10.641.731.2151ABPOS

25.640.815.238ABNEG

Mean time spent

system prior todiscard (days)

Mean RBC

age at

discard(days)

Mean RBC age

at receipt fromsupplier (days)

N


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Discarded RBC Knowledge Significant discards occur within BTS itself

Most common reason: expiry

A+ and O+ units

discarded with half of shelf life remaining

Had frequently unacceptable characteristics on return(visual/temp failure, bag broken)

Non A/O units (less common blood groups)

Expiry is very commonly the cause of discard Other characteristics not as common


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Overall lessons learned from

RBC lifecycle analysis

Red cell units are received from the

supplier with 2/3 shelf life remaining Red cells spend approximately 1 week in

the BT system

Units of uncommon blood groups tend to

be older at transfusion

Almost 2/3 of discarded units never leaveblood transfusion services


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Conclusions By understanding the lifecycle, it is

possible to target systemic intervention toimprove quality of RBCs delivered

Age

Discard rates

Unnecessary handling, and reduced quality of

RBC unit delivered


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Recommendations


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Reality Check

1. Blood is a precious resource,altruistically donated

2. Global economic constraints,especially in Nova Scotia.

3. We need to think outside the box

and put aside geo-political barriersto serve patients better

4. We are all in this together.


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8-15 year maturity provincial bonds


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Recommendations More supplier intervention to decrease age

of red cells received especially in blood groups that are more

uncommon

Reduce inventory levels within BTS (3 day

vs. 4 day inventory)

Especially with more uncommon blood groups(accept lower inventory thresholds)


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Recommendations Implement more efficient inventory

management system within BTS andoutside (i.e. operating rooms)

Especially with O+ and A+ units

Fresher blood should be sent outside

blood transfusion services (i.e. in blood

fridges in ER, OR etc.) to reduce overallaging within system


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Recommendations Minimize RBC transitions

Global management of blood supply Single unified adult and pediatric inventory to

reduce transition states and handling

Geographical blood management Decrease transition of units in and out of blood

transfusion services

Minimal laboratory information system transitions

reduces electronic transition of units


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Questions

Life Cycle of a Unit of Blood

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