Despite decreased blood use, blood shortages and inventory problems still occur all too often. Nancy Dunbar says we can make things better with a few simple adjustments to “the rules” about O-negative RBCs, AB plasma, and apheresis platelets.
The story is not that simple. In the face of the overall decline in blood product usage, there has been a parallel decline in blood donations. The reasons for this change are unclear. Most blood collectors are NOT saying, “Hey, we don’t need as much as before, so let’s try to collect less!” Rather, blood centers are scrambling to even keep up with the decreased demand.
When Less is More
In addition to declining collections, the proportion of “special” blood products requested by hospitals has actually increased. Blood centers see this with O-negative red cell and AB plasma orders especially. For example, a hospital may ask for 10% fewer red blood cells than in previous years (good news), but the proportion of O-negative RBCs might be increased, say to 12% of the total RBC order (not so good news). Unfortunately, the percentage of U.S. O-negative blood donors hovers at just over 8%. This “disconnect” between supply and demand sets us up for frequent, recurring “shortages” of those products in everyday practice.
So, What Can We Do?
Nancy Dunbar is medical director of a large, very busy academic transfusion service that happens to be quite rural in location. She has learned to be creative with managing her inventory by necessity. Nancy is here to share some tips on how transfusion services everywhere can make simple adjustments to “the rules” and significantly increase the efficiency with which we use O-negative RBCs, AB plasma, and apheresis platelets.
I tell clinicians, “You’re going to get group O uncrossmatched blood when you have a patient who’s exsanguinating, and it might be Rh-negative and it might be Rh-positive. That’s really my call, and so just trust me to do my job.”
About My Guest:
Nancy Dunbar, MD, is Medical Director of the Blood Bank at Dartmouth-Hitchcock Medical Center in Lebanon, NH. She is an Associate Professor of Pathology and Laboratory Medicine at Dartmouth, and she is the associate Program Director for both the Pathology Residency Program and the Transfusion Medicine Fellowship.
Dr. Dunbar is a very active researcher, and has received numerous honors for her scholarly activities. She has published over 50 original articles and reviews in Transfusion Medicine journals, and has authored several chapters in standard textbooks (including the AABB Technical Manual). She teaches regularly to learners at Dartmouth and numerous other facilities.
This podcast episode offers a FREE continuing education activity where you can earn the following types of credit: 1 AMA PRA Category 1 CreditTM, 1 ASCLS P.A.C.E. ® Contact Hour (including Florida Clinical Laboratory Credit), and American Board of Pathology Self-Assessment Modules (SAMs) for Continuing Certification (CC, formerly MOC).
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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Dr. Dunbar has received honoraria from Verax Biomedical for service on their medical advisory board. Dr. Chaffin has no relevant financial disclosures.
- O negative Red Blood Cell Use:
- Zeller MP et al. An international investigation into O red blood cell unit administration in hospitals: the GRoup O Utilization Patterns (GROUP) study. Transfusion 2017;57;2329–2337.
- Dunbar NM et al. O– product transfusion, inventory management, and utilization during shortage: the OPTIMUS study. Transfusion 2018;58:1348-1355.
- Group A Plasma Use:
- Dunbar NM et al. A possible new paradigm? A survey-based assessment of the use of thawed group A plasma for trauma resuscitation in the United States. Transfusion 2016;56;125–129.
- Dunbar NM, Yazer MH, et al. Safety of the use of group A plasma in trauma: the STAT study. Transfusion 2016;56;125–129.
- Platelet Use Strategies:
- Dunbar NM et al. Easier said than done: ABO compatibility and D matching in apheresis platelet transfusions. Transfusion 2015;55;1882–1888.
- Dunbar NM et al. ABO incompatible platelets: risks versus benefit. Curr Opin Hematol 2012;19:475–479.
- Lozano M et al. Practices associated with ABO-incompatible platelet transfusions: a BEST Collaborative international survey. Transfusion 2010;50:1743-1748.
- Ruby KN et al. Bacterial screening of apheresis platelets with a rapid test: a 113‐month single center experience. Transfusion 2018;58:1665-1669.
- Counter-arguments Against ABO Incompatible Platelets:
- Blumberg N et al. ABO matching of platelet transfusions – “Start Making Sense.” Blood Transfus 2015;13:347-50.
- Henrichs KF et al. Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence. Transfusion 2012;52:635-640.
- One of my Favorite Articles on Blood Supply & Demand: