Donor blood is in short supply. Despite awareness drives from the National Blood Service aimed at encouraging more people to donate, the risk of a shortage continues to loom. Under normal circumstances, where supply meets demand, enough blood is available to satisfy requirements and it is fair to say that normal circumstances, for the most part, tend to prevail. However, the question that raises concerns is what happens when the normal becomes abnormal and, most importantly, how will allocation of blood be prioritised in the event of a shortage?
The Integrated Blood Shortage Plan was implemented in 2005 by the Chief Medical Officer's Blood Transfusion Committee with a view to answering this question by developing a national framework for the management of both acute and chronic blood shortages. This has strong links to a previous publication circulated by the Department of Heath in 2002 called Better Blood Transfusion 2 (BBT2). The purpose of BBT2 was to ensure that there were sufficient mechanisms in hospital trusts to guarantee the most appropriate use of blood and to ensure that patients were provided with better information about blood transfusion. Key elements of both documents aim to reduce the unnecessary use of banked blood with the objective of avoiding a shortage, and also to provide a clear plan of action, including effective prioritisation of blood, should a shortage occur.
The implications, for current transfusion requirements, of an acute or chronic shortage could be quite different and resulting challenges may need to be managed differently. For instance, an acute shortage of blood caused by a flu epidemic, or similar situation, which temporarily prevents donors from attending donor sessions may be enough to require action. However, couple this with a greater demand for blood due to an unforeseen incident requiring immediate allocation and a more critical acute shortage may occur. Management of such an event could include immediate awareness campaigns encouraging people to donate and may also be donor driven with donors themselves volunteering additional blood in order to provide assistance. Situations such as this have occurred when the need for blood is a particularly public event, such as in the aftermath of 9/11 and the London bombings in July 2005.
Additionally, there is a risk of surgical cancellations being employed in order to help manage shortages. Indeed, in June 2005, hospitals in Ireland were called upon to cancel all elective surgery over a period of 4 days due to a shortage of blood. Legislative reasons were cited as one of the driving forces behind these cancellations and it is such reasons that could lead to the acute shortages of today becoming the chronic shortages of tomorrow. More recently (June 2007), it was identified that only 3 days stock of some blood groups were available in Scotland.
UK legislation set in 2004 prevents anyone who has received a blood transfusion since 1st Jan 1980 from donating blood due to the risk of transmission of vCJD. In Ireland, the legislation extended to anyone who had lived in the UK for a year or more between 1980 and 1996. In the UK, the legislation resulted in a reduction in the donor pool of around 55,000 donors. This has undoubtedly had a significant impact on the current and future availability of blood. On top of this, the much discussed implementation of a vCJD screening test has led to fears of more donors refusing to continue making donations due to concerns surrounding the potential socioeconomic effects of an individual knowing, and in some cases having to declare (for example for the purposes of life assurance) that they are a carrier. With these issues plus the fact that fewer younger people are donating, increasing the average age of donors, there are, unsurprisingly, continued concerns about the potential for chronic supply problems.
The key to success surely lies with avoidance of the necessity to manage such a shortage by focussing on preventative measures. In the face of such potential adversity, it becomes even more important to ensure compliance with BBT2 to ensure that banked blood is only being used when it is really needed and to implement methods that may help to reduce transfusion requirements in order to avoid surgical cancellations and, in the worst case, the need to prioritise blood allocation in emergencies. With Better Blood Transfusion 3 due for publication imminently, there is likely to be renewed interest and action in the blood transfusion arena and a continued drive towards further improvements.
So, how can the unnecessary use of blo