Impacts of Reducing the Shelf Life of Red Blood Cells: A View from Down Under

Abstract

Red blood cells (RBCs) are the most commonly used blood product. A body of literature is available to both support and oppose the concept that patient outcomes are negatively impacted when older blood is transfused. This has led to further research to analyze the impacts of reducing the shelf life of RBCs through the lenses of wastage and cost, and most importantly, sufficiency of supply. In this study, we look at the implications of decreasing the shelf life of RBCs in the state of New South Wales (NSW). We develop a discrete-event simulation model that considers the complexities of a two-echelon inventory system, as characterized by the blood product supply chain in Australia. The results show that reducing the shelf life of RBCs would, as we expect, result in fresher blood being transfused to patients. However, a reduction of 21 days would not be tolerated by that system based on current policy and practices; would result in a loss of control, vastly increased shortages, and (or) outdated RBCs; and would result in greater risk to patient care. Our model also evaluates the impact of operational policies on the NSW blood supply chain. The electronic companion is available at https://doi.org/10.1287/inte.2017.0899 .

Proactive transshipment in the blood supply chain: A stochastic programming approach

“…Kamp et al [43] studied the availability of blood products in pandemic situations in Germany using simulation methods. Abbasi et al [3] and Blake et al [13] used simulation modeling to evaluate the impact of reducing the shelf life of red blood cells in Australian and Canadian blood supply chains, respectively. Statistical analysis methods, such as linear regression, survival analysis, and logistic regression, have been used to support decision making in the blood supply chain.…”

“…The author presented an algorithm to determine the optimal quantities of orders and transshipment for a single perishable product with a two-period lifetime ('old' or 'fresh') in a single period planning horizon, which does not allow capturing the dynamics of inventory system. The proposed model is not applicable to the blood supply chain management without considerable simplification, since the shelf life of products are greater than two; red blood cells units have a shelf life of 42 days and platelets have a shelf life of 5 days [3]. Nakandala et al [62] considered a periodic review two-stage inventory system with compound Poisson demand for a fresh food supply chain and formulated a decision rule system to minimize the total cost considering reactive lateral transshipment.…”

“…Moreover, transshipment supports hospitals in dealing with shortages more efficiently by using nearby hospitals' stocks. Furthermore, Abbasi et al [3] indicated that blood transshipment in a large network of hospitals can improve the performance measures of blood supply chains and possibly help to reduce the shelf life of red blood cells to ensure that patients receive fresher units. Although transshipment has been considered in the literature [32,83,25], few studies have considered the effect of relying on lateral transshipment when managing inventories of perishable items, and of blood in particular.…”

Postdisaster Volatility of Blood Donations in an Unsteady Blood Supply Chain*

“…Decision support systems to ameliorate interregional policies would fall also under this category. Like any other supply chain, researchers have tried to maximize throughput by end‐to‐end optimization of the chain; for example, building a simulation model to assess the entire chain (Rytilä & Spens, ; Abbasi et al., ); emphasizing on the necessity of effective collaboration among blood centers and hospital transfusion services (Fontaine et al., ); and evaluating the performance of the entire blood supply chain (Katsaliaki, ).…”

“…Red blood cells (RBCs) have a shelf life of 35–42 days depending on the government regulations (Pierskalla, ), platelets have a shelf life of five days and plasma can be stored for up to one year (Osorio, Brailsford, & Smith, ). Processing and testing time also decrease the shelf life of blood products taking about two days before the blood products are ready for delivery to hospitals (Abbasi, Vakili, & Chesneau, ). This processing and testing time effectively makes the practical shelf life of RBCs and platelets 40 and 3 days, respectively.…”