Modeling the potential impact on the US blood supply of transfusing critically ill patients with fresher stored red blood cells

Abstract

BackgroundAlthough some studies have suggested that transfusion recipients may have better medical outcomes if transfused with red blood cell units stored for a short time, the overall body of evidence shows mixed results. It is important to understand how using fresher stored red blood cell units for certain patient groups may affect blood availability.MethodsBased on the Stock-and-Flow simulation model of the US blood supply developed by Simonetti et al. 2014, we evaluated a newly implemented allocation method of preferentially transfusing fresher stored red blood cell units to a subset of high-risk group of critically ill patients and its potential impact on supply.ResultsSimulation results showed that, depending on the scenario, the US blood total supply might be reduced between 2-42%, when compared to the standard of care in transfusion medicine practice. Among our simulated scenarios, we observed that the number of expired red blood cell units modulated the supply levels. The age threshold of the required red blood cell units was inversely correlated with both the supply levels and the number of transfused units that failed to meet that age threshold.ConclusionTo our knowledge, this study represents the first attempt to develop a comprehensive framework to evaluate the impact of preferentially transfusing fresher stored red blood cells to the higher-risk critically ill patients on supply. Model results show the difficulties to identify an optimal scenario.

Evaluación de la incidencia de aislamiento de<i> Acinetobacter baumannii</i> y su relación con la transfusión de productos sanguíneos en terapia intensiva

“…18 Es importante entender cómo el uso de glóbulos rojos almacenados por menos tiempo puede afectar la disponibilidad de sangre para ciertos grupos de pacientes mediante un modelo stock-and-flow para el uso de sangre más reciente con preferencia en un subgrupo de enfermos de alto riesgo, lo que permite una distribución relativamente efi ciente de la sangre; sin embargo, no se comprobó la disminución en el suministro. 25 Karkhane y sus colegas, en su estudio prospectivo de 217 pacientes admitidos a UCI, encontraron una tasa transfusional de 64.1% y reportaron 26.6% de IN en los transfundidos, siendo más común a nivel respiratorio, con 6.5% de los casos. A pesar de la frecuencia de transfusiones, no hubo relación estadísticamente signifi cativa (p = 0.268) con las IN.…”