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From: EdGlaze DelphiPlus Member Icon Posted by host1/20/17 3:24 PM 
To: All  (1 of 10) 
 1826.1 

 

I want your blood.
No really, your blood is urgently needed

The blood supply chain is extremely vulnerable, because blood is extremely perishable
Anna Nagurney, THE CONVERSATION
16 Jan 17

When we talk about supply chains, we may conjure up images of manufacturing plants, warehouses, trucks and shipping docks. There is another, truly unique supply chain for a product vitally important to health care and life, and it is very volatile at the moment: the blood supply chain.

Human blood, unlike computers, smartphones and cars, cannot be manufactured, and no substitute for it has yet been invented. At the same time, blood, like fresh produce, is a perishable product, with platelets lasting five days and red blood cells 42.

This blood industry is now at a crossroads, due to fluctuating demand over the past decade. Hospitals are now requiring less blood as compared to a few years ago because of changes in medical practices, leading, at times, to a surplus in overall supply. In 2011, a total of 1.2 million fewer units of blood were used in hospitals as compared to 2009, bringing them a US$274 million savings in terms of costs. This has resulted in a relatively strong supply and a weak demand for blood at the blood banks, which gives hospitals the upper hand while negotiating with the suppliers.

In fact, hospitals are now demanding lower prices from the suppliers, and many are even considering switching to alternative blood banks. An example of this was at the Indiana Blood Center in 2014, where three of their major under-contract hospitals opted for a cheaper price offered by the Red Cross. This led to a one-third shrinkage in Indiana Blood Center’s revenue, forcing the company to revise its business model by cutting the costs as much as possible.

The excess supply, along with increased competition, force the blood suppliers to lower their prices. The hospital cost of a unit of red blood cells in the U.S suffered an almost 10 percent drop from 2011 to 2014.

A simultaneous drop in the demand and the price of blood products has tremendously affected the players involved in the blood supply chain, with the blood banking industry revenue dropping to US$1.5 billion per year in 2014, down from US$5 billion in 2008. Being hit by such a severe revenue loss over a short period, one of the first actions taken by blood providers was to lower their costs by cutting jobs. It is expected that, over the next few years, the blood banking industry in the U.S. will lose 12,000 jobs, roughly a quarter of its workforce, due to the financial stress.

My area of research in business supply chains holds some clues as to how the blood industry can address some of its supply chain challenges.

A lifesaving commodity that can’t be manufactured

We probably can all understand that a blood shortage can have devastating consequences in the face of disaster. What may be less recognized is that a continued budget deficit for blood services leads to a reduced budget for research on blood banking and related fields. Such an impact may not only threaten the effectiveness and safety of various activities in the blood supply chain but may also negatively affect the responsiveness at times of crises and disasters.

Blood is a hard commodity to manage for many reasons. First, regular replenishment of the blood supply is necessary. Also, supply is completely dependent on donations by individuals to the blood banks and blood service organizations collecting blood, which, for the most part, are nonprofits.

Still, a multi-billion dollar industry has evolved out of the demand for and supply of blood, with the global market for blood products projected to reach $41.9 billion by 2020. The United States constitutes the largest market for blood products in the world. Donors in the U.S. and some others countries are typically not paid.

In the U.S., the American Red Cross supplies about 40 percent of the blood, with America’s Blood Centers, with 600 blood donor centers, providing about 50 percent (and about one-quarter of the blood in Canada). The remainder is collected by hospitals and medical centers themselves or, lately, by profit-maximizing blood suppliers.

 

  • Edited January 20, 2017 3:25 pm  by  EdGlaze
 
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From: EdGlaze DelphiPlus Member Icon Posted by host1/20/17 3:35 PM 
To: All  (2 of 10) 
 1826.2 in reply to 1826.1 

A drop in demand brings uncertainty

Prior to 2008, hospitals and other surgical centers consistently reported blood shortages every year. This resulted in the cancellation and postponement of elective surgeries.

Things changed. In part because of medical advances, some procedures do not require as many pints for transfusion. This decrease in demand for blood is posing great challenges for the industry, resulting in consolidations and mergers of testing labs and processing facilities.

In response to the drop in demand, suppliers formed partnerships. Mergers have taken place to counteract rising costs of blood banking operations and even to work for enhanced safety, availability and affordability of blood for hospital partners and patients. At times, the reconfigurations have included the closing of testing facilities as done by the Red Cross.

According to the America’s Blood Centers, the largest network of nonprofit community blood centers in North America, 19 partnerships and mergers were formed in the five years from 2010-2015 among their member blood banks, reducing the size of the network from 87 to 68 members. That represents a doubling from the 1990s, when 19 mergers took place during 10 years rather than five.

Supply chain analytics tools can assist

My colleagues and I have been researching blood supply chains, from enhancing their operations with collection, testing and distribution to hospitals and medical centers. The goal is to minimize costs as well as risk and waste and to optimize the supply chain network design.

More recently, our research has turned to the assessment of mergers and acquisitions, since some of its evolving features have taken on the characteristics of corporate supply chains, which we can learn from and take advantage of.

Identifying potential synergies prior to a merger or acquisition (M&A) can provide quantitative measures; indeed, real numbers, as to whether or not such an M&A should take place. In addition, there may be synergies associated with cooperation, rather than a complete merger or acquisition. For example, different blood service organizations may benefit from utilizing shared testing facilities, common facilities for procurement and even vehicles for the delivery of their blood products to hospitals and medical centers.

In addition, donors must be nurtured. Donors, who are the raw material suppliers of blood products, typically can donate no more than three times per year. An estimated 38 percent of the U.S. population is eligible to donate blood at any given time, but less than 10 percent of that eligible population actually donates blood each year.

A demand surge could prove challenging

The future for blood supply chains is fraught with uncertainty.

There could be another rise in demand in coming years due to population increases. Second, changing demographics, such as baby boomers’ aging, will be a new influence. The unpredictability of natural and man-made disasters mandates that all blood banks stay alert and be responsive to fluctuating demand and supply.

It is imperative to apply supply chain analytics tools derived from industry to assist in both supply side and demand management to make for the best utilization of a lifesaving product that cannot be manufactured — that of human blood.

_____________

 

 
From: EdGlaze DelphiPlus Member Icon Posted by host1/20/17 3:48 PM 
To: All  (3 of 10) 
 1826.3 in reply to 1826.2 

I am O-negative and have donated about 12 gallons.

Lately I've been donating double red cells, though it is frustrating to have to wait longer between donations.

 

 

 

 
From: PFurnee2/16/17 9:32 AM 
To: EdGlaze DelphiPlus Member Icon  (4 of 10) 
 1826.4 in reply to 1826.1 

Thank you so much. I have been diagnosed with Myelofibrosis and it is now in a fairly advanced stage. The ONLY thing that keeps me going is regular blood and platelet infusions. Currently I need one unit of platelets twice a week and two units of blood once a week. Been doing this for almost 4 years. There is no cure or treatment for this other than continuous blood infusions. To those who give blood, I owe you!

 

 
From: EdGlaze DelphiPlus Member Icon Posted by host2/26/17 9:16 AM 
To: All  (5 of 10) 
 1826.5 in reply to 1826.4 

I donated double red cells yesterday and that brought my donation count up to either 97 or 99 (depending on whether they counted before or after my donation) though it likely doesn't count some other donations I made when I was younger.

 

Double Red Cell Donation

Double Red is similar to a whole blood donation, except a special machine is used to allow you to safely donate two units of red blood cells during one donation while returning your plasma and platelets to you.

During your double red cell donation, blood is drawn from one arm and drawn through a sterile, single-use needle set to a machine. The machine separates and collects two units of red cells and then safely returns the remaining blood components, along with some saline, back to you through the same arm. •Save time and make your donation go further: If you are extremely busy, committed to donating blood and an eligible type O, A negative or B negative donor, double red cell donation may be ideal for you. Each procedure lets you give more of the product that is needed most by patients. Double red cell donation takes approximately 30 minutes longer than a whole blood donation and you can donate approximately every four months.

Advantages for Donors

A double red cell donation takes about 45 minutes to complete, compared to about 10 minutes for a regular blood donation. However, the waiting period between donations is 16 weeks, rather than 8 weeks for a regular donation. This makes the Double Red Cell Program ideal for donors who cannot routinely give blood every eight weeks, but like to give blood once or twice a year. They can give the same number of blood products with only half the number of trips to the blood center.

Benefits

Patients also benefit from a double red cell product by receiving two units from the same donor, reducing exposure to multiple donors which can sometimes cause post-transfusion complications.

The final advantage is to the blood supply. Red Cross often has shortages of certain types of red blood cells, especially type O and type B. Double red cell collections allow us to get two red blood cells from an O or B donor, greatly increasing our ability to supply hospital and patient needs for these types. And in areas where the donor population is limited, this technology allows us to maximize the impact of donations made.

 

 

  • Edited April 12, 2019 1:43 am  by  EdGlaze
 

 
From: EdGlaze DelphiPlus Member Icon Posted by hostApr-12 12:54 AM 
To: All  (6 of 10) 
 1826.6 in reply to 1826.5 

You have probably had a Complete Blood Count or CBC test done before. It is a blood test that is commonly requested at regular check-ups to give your physician an idea of your general health. The test takes six measurements.

Red blood cells (RBC): carry oxygen to cells and remove carbon dioxide from cells.

White blood cells (WBC): are involved in fighting infections.

Platelets: clot the blood and stop bleeding.

Hemoglobin: is the iron that carries oxygen in the blood.

Hematocrit: is a measure of the amount of space that red blood cells take in the blood.

Mean Corpuscular Volume (MCV): measures the average size of your red blood cells.

Below is an infographic providing you with normal ranges for these measures and what might be wrong if your numbers don’t match. Often other factors can impact these numbers so if your numbers are “abnormal” you will probably be tested further.

 

 

 

  • Edited April 12, 2019 1:38 am  by  EdGlaze
 

 
From: EdGlaze DelphiPlus Member Icon Posted by hostApr-12 1:19 AM 
To: All  (7 of 10) 
 1826.7 in reply to 1826.6 

Phlebotomists must collect blood samples using collection tubes in a specific order while performing venipuncture on patients to avoid cross-contamination of the various additives between tubes. This process is known as the order of draw.

 

Remembering the proper order during a venipuncture procedure on a patient is important for a few reasons:

  • Decrease the time it takes to perform the procedure
  • Reduce patient discomfort
  • Avoid complications for patient
  • Prevent misdiagnosis of patient
  • Prevent cross-contamination of additives between blood collection tubes

As a result of applying the proper order of collection tubes, you’re providing a safer, more comfortable experience for your patient, which is always the number one priority when drawing blood. Above all, this also ensures that the patient’s results will come back accurate and result in proper diagnosis and treatment.

 

 

Another mnemonic to help remember the proper order:
Boys Love Roses; Girls Love DaisiesLilacs, and Gardenias.

 

 

 

These inversions are necessary to mix the blood specimen with each tube’s additive to ensure that there is no cross-contamination between tubes.

Therefore, cross-contamination of the additives might result in misdiagnosis or mistreatment of the patient.

Infographic below displays what constitutes as one full inversion.

 

 
From: EdGlaze DelphiPlus Member Icon Posted by hostApr-12 1:23 AM 
To: All  (8 of 10) 
 1826.8 in reply to 1826.7 

 

 

  • Edited April 12, 2019 1:28 am  by  EdGlaze
 

 
From: Bike (URALTOURIST1) DelphiPlus Member IconApr-13 2:45 PM 
To: EdGlaze DelphiPlus Member Icon  (9 of 10) 
 1826.9 in reply to 1826.1 

Your bit on order of draw sounds almost dated, with evacuated tubes and valved sampling devices, cross contamination is almost certainly an impossibility.  In 20+ years as a CCRN, I never heard of that acronym/mnemonic about ravishing girls.

-------------

Back to donation:  I gave regularly and often as I had the old O- high demand type, that is, until I started using O2 at night, I was disqualified automatically, sort of weird as my use of O2 was for ME, not for the donation.  If I had said nothing on my medical questions, I could have continued to donate as there was no way of telling I was using O2 at any time.

 

Warren
 
USCG Engineer 1961-1982
 
 
 

 
From: heim618Apr-17 6:47 AM 
To: EdGlaze DelphiPlus Member Icon  (10 of 10) 
 1826.10 in reply to 1826.1 

Great posts and thank you for doing so.

I used to donate frequently, but when they upped the required hemoglobin level a couple of years ago it pushed me from being borderline to nearly impossible to qualify.  It saddens me that I cannot donate like I used to.

 

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