A Study of Supply and Clinical U liza on 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, Centre Hospitalier de l’Universite de Montreal
BACKGROUND BLOOD COLLECTION AND DONOR DEMOGRAPHICS AT CANGE
• The adequacy of the blood supply, transfusion prac ces, 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 collec on in Hai is well below the recommended WHO 17-24 700 • 67.86% were in the age group 600 20 Female collec on 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 organiza on 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 Mirebalais 0 seroposi vity. (HUM), a 300 bed ter ary 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 transi on of inpa ent care and blood collec on du es PROJECTED ANNUAL UTILIZATION from Cange to HUM was planned 13.33% • Blood distribu on to other reques ng sites will be Lascahobas 27.18% HUM’s eventual responsibility when blood collec on PURPOSE Mirebalais Units transi ons from Cange • Evaluate the blood supply Belladere • 195 units were distributed to six different sites led by In Daily projected need 3.27 Hinche • Quan fy 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 u liza on 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 collec on tool to help be er es mate future + Internal Medicine opening 1605.24 blood needs + Area blood distribu on 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 u liza on from Cange Hospital (January 1, 2012 to December 31, 2012) and HUM (May 29, 2013 to units per day. Extrapola ng 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 pa ent blood Total Unit ED 61 6.28% 2.10 1018 period of data was collected at Cange to be er 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 u liza on • OBGYN was the highest requester for whole blood (not shown, METHODS Surg 168 17.28% 1.65 Units 1016 frac onated products are not available) Indica on For RBC transfusion Int Med 339 34.88% 1.88 Delivered • Almost all units requested were fulfilled (99.8%) • Current rate of blood collec on at Cange is insufficient for HUM's future needs Appropriate Controversial Inappropriate Overall 972 99.80% • Dona on rates among females and older popula on (age 35+) Hgb < 8 g/dL AND Maintaining hgb ≥ • Stable, are low and may represent targeted popula ons for donor symptoms related to 10g/dL in “at-risk” asymptoma c BLOOD UTILIZATION AT HUM recruitment anemia OR acute pa ents (co-exis ng anemia • 343 units were transfused • According to u liza on 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 resul ng in ischemic vascular correctable anemia % Units/request • 65.93% of the units requested were filled currently open during the data collec on period at HUM Dept Filled request Unfilled Total symptoma c anemia disease) (e.g., Iron, Vit. B12 • Of the 165 requests for blood, 84 pa ents • 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 reac ons or mortali es 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 pa ents who received blood products HUM opening as medical services fully open in physical ac vity Oncology 14 4.08% 3.50 6 42.86% 8 Delivered died during the study period, none directly • Further development of blood collec on 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 reac ons adequate blood supply for this new ter ary hospital