A Study of Supply and Clinical Ulizaon of Blood Products in the Central Plateau, Hai

Tony Chang MD1, Benjamin Rioux-Masse MD FRCPC2, Elizabeth Donegan MD1 1 Department of Anesthesiology, University of California San Francisco, San Francisco, 2Department of Hematology, Hospitalier de l’Universite de Montreal

BACKGROUND BLOOD COLLECTION AND DONOR DEMOGRAPHICS AT CANGE

• The adequacy of the blood supply, transfusion pracces, and DONOR SEX DONOR AGE (yrs) DONOR BLOOD TYPE DONOR SEROPOSITIVITY • 1672 units were collected 900 30 associated clinical outcomes in Hai are unknown 800 • 75.84% were male donors 25 • Blood collecon in Hai is well below the recommended WHO 17-24 700 • 67.86% were in the age group 600 20 Female collecon rate 25-34 500 15 17-24 and 27.45% were 25-34 Male 35-44 400 10 years old • Global Healing is a non-govermental organizaon with the goal 300 Units of Blood 45-54 Units of Blood 5 • 64 units (3.83%) were of establishing a safe, sustainable and self-sufficient, modern 200 0 55+ 100 discarded due to transfusion program at the Hopital Universitaire de 0 seroposivity. (HUM), a 300 bed terary teaching hospital serving the Central O+ O- A+ A- B+ B- AB+ AB- unk

Plateau that opened May 2013 CANGE BLOOD DISTRIBUTION • Prior to May 2013, Cange Hospital was the primary area

treatment facility and blood center in this region

• Slow transion of inpaent care and blood collecon dues PROJECTED ANNUAL UTILIZATION from Cange to HUM was planned 13.33% • Blood distribuon to other requesng sites will be 27.18% HUM’s eventual responsibility when blood collecon PURPOSE Mirebalais Units transions from Cange • Evaluate the blood supply Belladere • 195 units were distributed to six different sites led by In Daily projected need 3.27 • Quanfy the blood shortage reported by local physicians 7.69% six months 35.38% Weekly projected need 22.87 Saint-Marc • • Prior to HUM’s opening, Port-au-Prince was the leading Study the clinical ulizaon of blood products Monthly projected need 99.09 • CNTS receiver of blood from Cange Assess clinical outcomes of transfusion and shortages 12.31% Annual projected need 1189.07 • 4.10% Develop a data collecon tool to help beer esmate future + Internal Medicine opening 1605.24 blood needs + Area blood distribuon 1995.24 METHODS + Discarded 2095.00 BLOOD UTILIZATION AT CANGE • 343 units were used in 105 days at the opening of HUM averaging 3.27 Data regarding blood ulizaon from Cange Hospital (January 1, 2012 to December 31, 2012) and HUM (May 29, 2013 to units per day. Extrapolang to 1 year, 1189 units will be needed. Taking Units Requested by Total Filled September 16, 2013) were obtained via chart review % Units/request into account the full opening of internal medicine services, 1605 units will Dept • Since full clinical services were not yet open at HUM, a one year be needed. With HUM’s future role as blood center, 1995 units will be • Evidence-based transfusion guidelines of paent blood Total Unit ED 61 6.28% 2.10 1018 period of data was collected at Cange to beer predict the amount needed. Given the studied discard rate, a total of 2095 units should be management at the University of California San Francisco Demand of blood that will be requested once HUM is at full capacity Ped 136 13.99% 1.01 collected to match its needs. Medical Center were used to define the appropriateness of • Highest overall requester of blood was internal medicine OBGYN 268 27.57% 2.18 Total ulizaon • OBGYN was the highest requester for whole blood (not shown, METHODS Surg 168 17.28% 1.65 Units 1016 fraconated products are not available) Indicaon For RBC transfusion Int Med 339 34.88% 1.88 Delivered • Almost all units requested were fulfilled (99.8%) • Current rate of blood collecon at Cange is insufficient for HUM's future needs Appropriate Controversial Inappropriate Overall 972 99.80% • Donaon rates among females and older populaon (age 35+) Hgb < 8 g/dL AND Maintaining hgb ≥ • Stable, are low and may represent targeted populaons for donor symptoms related to 10g/dL in “at-risk” asymptomac BLOOD UTILIZATION AT HUM recruitment anemia OR acute paents (co-exisng anemia • 343 units were transfused • According to ulizaon data at Cange, internal medicine is a bleeding likely heart / lung disease, • Medically Units Requestedt by Units % of filled Units Total Filled • OBGYN was the largest consumer of blood significant consumer of blood products, which was not resulng in ischemic vascular correctable anemia % Units/request • 65.93% of the units requested were filled currently open during the data collecon period at HUM Dept Filled request Unfilled Total symptomac anemia disease) (e.g., Iron, Vit. B12 • Of the 165 requests for blood, 84 paents • Almost one third of units requested at HUM were not filled ED 96 27.99% 2.40 62 64.58% 34 Units 361 deficiency with mild had recorded pre-transfusion hemoglobins, • No recorded major transfusion reacons or mortalies resulted Ped 5 1.46% 1.00 4 80.00% 1 Demand symptoms averaging 5.8 during the study period OBGYN 141 41.11% 2.14 91 64.54% 50 • All transfusions were appropriate according responsive to Total • to guidelines Current shortages will likely worsen within the first year of temporary decrease Surg 87 25.36% 2.07 61 70.11% 26 Units 238 • Five paents who received blood products HUM opening as medical services fully open in physical acvity Oncology 14 4.08% 3.50 6 42.86% 8 Delivered died during the study period, none directly • Further development of blood collecon strategy and future while the anemia is Overall 343 65.93% related to unfulfilled blood requests or analysis of transfusion data collected are needed to ensure being corrected) transfusion reacons adequate blood supply for this new terary hospital