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Blood and Blood Products
Topic Collection
August 28, 2019

Topic Collection: Blood and Blood Products

Traditional mass casualty incidents (MCIs) rarely place significant stress on the blood bank or require community blood drives. However, victims of blast and penetrating trauma may require massive transfusions, and when multiple victims present at once, this may create challenges for local blood banks, including problems with unidentified patients (and the risk of transfusion reactions), the need to run multiple massive transfusion protocols at once, and the need to perform many crossmatches on numerous patients in a short period of time. More than 400 units of packed red blood cells were used after the Aurora (CO) movie theatre shooting.  A similar number were used after the Pulse Nightclub shooting in Orlando, and 222 were given by a Las Vegas trauma center after the 2017 mass shooting. Hospitals should plan internally and with their external blood suppliers for these types of MCIs to ensure adequate supplies are available.

In the aftermath of MCIs and natural disasters, people from affected communities and across the nation often feel the urge to “do something” to help. In many cases people rush to donate blood, which can add another challenge to incident management. Realistically, hospitals will almost always use blood that has already been donated to treat the patients affected by the incident. Fresh blood must be put through safety testing (24-48 hours), and can only be stored for several few weeks. In 2017, donors overwhelmed blood donation centers after the Las Vegas shooting; thousands of people also lined up to donate blood after the Pulse Nightclub shooting. Having enough product readily available at the site of transfusion (and tracking which patient receives which unit) presents another planning challenge.  Early and frequent communication via the media regarding blood donation needs (or alternative needs such as water, toiletries, or device chargers) can help community members contribute to the overall response without overwhelming donation centers or hospitals.

This Topic Collection includes links to guidance, lessons learned (from disasters, no-notice incidents, and specific to transfusions), plans, tools, and templates, general research, and research specific to the disaster blood supply chain. Related information can be found in the following ASPR TRACIE resources (listed alphabetically): Burns; Crisis Standards of Care; Disaster Ethics; the infectious disease-specific guidance on blood issues in the VHF/Ebola and Zika Topic Collections; the Mass Gatherings/Special Events and Pre-Hospital Topic Collections; and the Select Materials on Drug Shortages and Scarce Resources web page.   

Must Reads


Doughty, H. (2009). Can We Deliver Pre-Thawed and High-Dose Frozen Plasma? Trauma Coagulopathy & Massive Transfusion - State of the Art Symposium.
The speaker describes the challenges and logistics associated with providing plasma in response to a mass casualty incident.
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Green, L., Cardigan, R., Beattie, C., et al. (2016). Addendum to the British Committee for Standards in Haematology (BCSH): Guidelines for the Use of Fresh-Frozen Plasma, Cryoprecipitate and Cryosupernatant, 2004. (Abstract only.) British Journal of Haematololgy. 180: 735-760.
This amendment includes the authority for the pre-thawing of fresh-frozen plasma together with an extension of the post thaw shelf-life. The practice facilitates the timely delivery of a plasma based protocol especially in the context of several patients.
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Hunt, B., Allard, S., Keeling, D., et al. (2015). A Practical Guideline for the Haematological Management of Major Haemorrhage. (First page only.) British Journal of Haematology. 170(6):788-803.
The authors provide recommendations and guidance related to managing major hemorrhage which emphasizes collaboration between emergency departments, blood banks, and hospitals in general. The authors also highlight the potential role of antifibrinolytics in these cases.
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Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. (n.d.). 12.2: Jehovah’s Witnesses and Blood Transfusion. (Accessed 6/20/2018).
The authors list the following substitutes for those who refuse whole blood: albumin solutions, cryoprecipitate, clotting factor concentrates (including fibrinogen concentrate), immunoglobulins, intraoperative cell salvage (ICS), apheresis, hemodialysis, recombinant products (e.g., erythropoiesis stimulating agents and granulocyte colony stimulating factors), and pharmacological agents such as intravenous iron or tranexamic acid.
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Leahy, M.F. and Mukhtar, S. (2012). From Blood Transfusion to Patient Blood Management: A New Paradigm for Patient Care and Cost Assessment of Blood Transfusion Practice. (Abstract only.) Internal Medicine Journal. 42(3):332-8.
This article addresses ways in which individual patient management decisions, applied systematically, can reduce blood product waste. There are discussions on patient types, blood needs and blood transfusion options.
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Mulcahy, A., Kapinos, K., Briscombe, B., et al. (2016). Building a More Sustainable U.S. Blood System. RAND Corporation.
Recent medical advances have contributed to a lower demand for blood and blood products. This presents an economic and supply-related challenge (e.g., seasonal shortages). The authors share how changing payment policies, improving emergency/surge capacity, and technological advances can help ensure a safe, sustainable blood supply.
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Perera, G., Hyam, C., Taylor, C., and Chapman, J. (2008). Hospital Blood Inventory Practice: The Factors Affecting Stock Level and Wastage. (Abstract only.) Transfusion Medicine.
The authors describe the issues and mitigation options affecting stock level and blood wastage in hospitals in the United Kingdom. These are factors to include and consider in a systems level plan to reduce waste.
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Seed, C. (2015). Arboviral Risks to Blood Safety in Australia. Australian Red Cross Blood Service ISBT TTD-WP Meeting.
The author provided an overview of the Arboviral Risks to Blood Safety which describes a number of risk management options and recommendations. The presentation was from 2015 and includes dengue, Ross River virus, West Nile virus, chikungunya, Zika, and other endemic viruses. They are currently not recommending geographically based fresh component restrictions during high transmission periods as there is a donor/product sufficiency concern.
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Stanger, S. (2012). Blood Inventory Management: Hospital Best Practice. (Abstract only.) Transfusion Medicine Reviews. 26(2): 153-163.
The authors conducted a literature review for sample perishable supply chain examples. Electronic cross-matching, transparency of the inventory, and simple management procedures facilitate good performance, but the key finding was the quality of the transfusion laboratory staff who must be skilled, regularly trained, and experienced.
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The Community Blood Center (Appleton, WI). (2013). Blood Needs in Times of Disaster.
This presentation gives an overview of the Nation’s blood supply/donation process and shares data on the amount of blood used after recent incidents.
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Lessons Learned and Clinical Practice


Algora-Weber, M. (2011). Madrid Train Bombings: What We Have Learnt From That Sad Event. ISBT Science Series. 13.
This paper focuses on blood product utilization and donation following the Madrid train bombings resulting in approximately 200 injuries and close to 200 deaths. Main lessons included the need for managing donors, collaboration with the media, an effective distribution of blood received from other regions, and having one voice, one image, and a single message.
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While fresh frozen plasma needs to be stored at -18 degrees Celsius, freeze-dried plasma does not require refrigeration or dry ice and has been successfully used to treat service members injured on the battlefield. Donation practices are also covered in this article.
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This study highlights findings specific to blood and blood product transfusions following suicide bombings in Israel from 2000 to 2005. The authors share that more than one third of casualties received transfusions (mainly in the first two hours post-incident). One-tenth of casualties received a massive transfusion. Healthcare facilities can incorporate the data from this study into their mass casualty incident response plans.
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Dann, E.J., Bonstein, L., Arbov, L., et al. (2007). Blood Bank Protocols for Large-Scale Civilian Casualty Events: Experience from Terrorist Bombing in Israel. (Abstract only.) Transfusion Medicine. 17(2):135-139.
The authors reviewed nine terror attacks to develop recommendations for minimizing patient misidentification and excessive blood requests. They suggested the use of select wristbands, a barcode-based system, or radiofrequency identification tags to increase mass casualty incident patient identification reliability.
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Doughty, H. (2009). Can We Deliver Pre-Thawed and High-Dose Frozen Plasma? Trauma Coagulopathy & Massive Transfusion - State of the Art Symposium.
The speaker describes the challenges and logistics associated with providing plasma in response to a mass casualty incident.
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Foster, J., Sappenfield, J., Smith, R., and Kiley, S. (2017). Initiation and Termination of Massive Transfusion Protocols: Current Strategies and Future Prospects. (Abstract only.) Anesthesia & Analgesia. 125(6):2045–2055.
The authors review literature and recommendations on the initiation and termination of massive transfusion protocols. They also present information on two massive transfusion prediction scores: the Assessment of Blood Consumption and Trauma-Associated Severe Hemorrhage scores.
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Gates, J., Arabian, S., Biddinger, P., et al.. (2014). The Initial Response to the Boston Marathon Bombing: Lessons Learned to Prepare for the Next Disaster. (Abstract only.) Annals of Surgery. 260(6):960-6.
The authors provide an overview of the medical response to the Boston Marathon bombing, and list the factors that contributed to positive outcomes. They note that 10% of patients required immediate transfusion of packed red blood cells in the emergency department.
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Glasgow, S., Allard, S., Doughty, H., et al. (2012). Blood and Bombs: The Demand and Use of Blood Following the London Bombings of 7 July 2005-A Retrospective Review. (Abstract only.) Transfusion Medicine. 22(4): 244-250.
The authors collected data from the United Kingdom’s National Blood Service and the hospitals involved in caring for patients after the 2005 bombings. They describe the blood components requested and used, blood stock levels at the time of the incident, and patient injury profiles. They conclude by emphasizing that incidents involving patients suffering from major hemorrhage will cause an increased demand for plasma, platelets, and cryoprecipitate.
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Glasgow, S., Davenport, R., Perkins, Z, et al. (2013). A Comprehensive Review of Blood Product Use in Civilian Mass Casualty Events. (First page only.) The Journal of Trauma and Acute Care Surgery. 75(3):468-474.
The authors discuss findings from a comprehensive literature search specific to blood use after mass casualty incidents. Their goal was to determine if post-MCI blood requirements were predictable. A median of 38 units of packed red blood cells was used per incident, with an average of 55 casualties. However, victims of terrorist events that were severely injured required an average of 5.9 units of packed cells each. These findings may help with predicting blood product needs based on event type and the number of casualties.
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Glynn, S., Busch, M., Schreiber, G., et al. (2003). Effect of a National Disaster on Blood Supply and Safety: The September 11 Experience. Journal of the American Medical Association. 289(17): 2246-2253.
The authors examine data gathered four weeks before and after 9/11/2001 and compared it to the same period in 2000. They found an increase in donations and a three-fold increase in donations confirmed positive for certain viruses (e.g., HIV and hepatitis B and C) one week before September 11 (0.1%) and one week after the attacks (0.3%). This was explained by the increase in first-time and lapsed repeat donors. The authors emphasize the need for better education that could encourage repeat donations.
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Heinrich, J. (2002). Maintaining an Adequate Blood Supply Is Key to Emergency Preparedness. U.S. General Accounting Office.
This post-9/11 report discusses the adequacy of the blood supply after the incident; how blood suppliers responded to the 9/11 attacks; and how blood suppliers planned for future incidents.
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Compared to room-temperature platelets that are at risk of bacterial growth, cold storage allows healthcare providers to use platelets immediately, without testing.
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Pidcoke, H., Aden, J., Mora, A., et al. (2012). Ten-year Analysis of Transfusion in Operation Iraqi Freedom and Operation Enduring Freedom: Increased Plasma and Platelet Use Correlates with Improved Survival. (Abstract only.) The Journal of Trauma and Acute Care Surgery. 73(6 Suppl 5):S445-52.
The authors reviewed data in the Joint Theater Trauma Registry database to analyze blood transfusions and time, survival, and the effect of increasing transfusion ratios. They found that high transfusion ratios of fresh frozen plasma and plasma and platelet to red blood cells were correlated with higher survival but not decreased blood requirement.
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Propper, B., Rasmussen, T., Davidson, S., et al. (2009). Surgical Response to Multiple Casualty Incidents Following Single Explosive Events. (Abstract only.) Annals of Surgery. 250(2): 311-315.
This study describes surge response to multiple casualty incidences following explosive events handled at a U.S. trauma hospital in Iraq. The authors noted that 48% of the mass casualty military patients needed blood, but 4 patients consumed 43% of the blood used, emphasizing the importance of related resource utilization planning.
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Ramsey, G. (2017). Blood Component Transfusions in Mass Casualty Events. Vox Sanguinis. 112: 648-659.
The author describes the results of a literature review (n=24 articles) on mass casualty incident blood component usage (articles on natural disasters were excluded). He writes, “Five RBCs per admission would have sufficed for 87% of events” and notes that more current data would help establish predictive models.
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  • Bridget Kanawati Thank you, Mr. Ramsey. We have updated the resource citation.
    8/30/2018 7:52:09 PM
  • Glenn Ramsey Source display should read: Vox Sanguinis 112:648-59, 2017
    8/30/2018 4:03:49 PM
Schmidt, P. (2002). Blood and Disaster—Supply and Demand. (Abstract only.) The New England Journal of Medicine. 346:617-620.
This article focuses on blood use and safety after “conventional disasters” (i.e., explosions and natural disasters versus mass shootings. The author notes that after the 9/11 attacks, the federal government and American Red Cross issued a call for blood donations. They received almost 500,000 units, but only used 258.
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Shinar, E., Yahalom, V., and Silverman, B.G. (2006). Meeting Blood Requirements Following Terrorist Attacks: The Israeli Experience.. (Abstract only.) Current Opinion in Hematology. 13(6):452-456.
The authors reviewed attacks between 2000 and 2005 and found “Requests for blood averaged 1.3 blood units and 0.9 components per casualty, or 6.7 units and 4.5 components per severe and moderately injured patient.” They also highlight the strengths of having a comprehensive blood management program after an emergency.
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The author emphasizes the importance of controlling bleeding after a mass casualty incident and pre-hospital in this article. One of the doctors interviewed is examining various tools that would give first responders the ability to manage trauma similar to that which occurred after the Boston Marathon bombing (e.g., polymer that expands when it comes in contact with blood and injectable substances that help with coagulation).
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Plans, Tools, and Templates


This handbook was created to help blood centers, hospital blood banks, and transfusion services plan for natural and human-caused disasters that can affect the blood supply. It can help the appropriate officials determine the medical need for blood, effectively transport it from one facility to another, and communicate internally and externally about the status of the blood supply.
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While it does not address internal policies, this handbook can help hospitals plan for and ensure that they have enough blood for transfusion in the event of a disaster. It includes a flow chart and a needs assessment chart that can help with calculating the total number of units needed from the task force.
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These four steps summarize how an incident would be handled by the AABB and partners, from start (blood collector assesses medical need for blood) to finish (coordinated messaging and implementation of task force recommendations).
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California Blood Bank Society. (2014). Disaster Response Plan.
This plan highlights how the activities of all California Regional Blood Centers will be coordinated in the event of a local, regional, or national emergency.
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This plan addresses four phases of inventory availability (green, amber, red, and recovery) and describes the roles and responsibilities of key stakeholders. Appendix G, beginning on page 92 of the document provides an algorithm (triage tools) for making decisions during Red Phase Blood Shortages.
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DC Emergency Healthcare Coalition. (n.d.). Intra-hospital Blood Bank Needs Identification Tool. (Accessed 6/6/2018.)
This template was developed to improve and expedite the communication of needs from clinical departments to their intra-facility blood bank. Facilitating this interaction can expedite the transmission of projected blood product needs to regional blood banks, reducing the probability that blood products will be delayed or insufficient to meet emergency needs.
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This instruction explains responsibilities and procedures associated with carrying out the Armed Services Blood Program.
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Erickson, M., Champion, M., Klein, R., et al. (2008). Management of Blood Shortages in a Tertiary Care Academic Medical Center: The Yale-New Haven Hospital Frozen Blood Reserve. (Abstract only.) Transfusion .
The authors describe a plan for emergency supply shortages and crosswalked the alert stage with management strategies.
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* Hunt, B., Allard, S., Keeling, D., et al. (2015). A Practical Guideline for the Haematological Management of Major Haemorrhage. (First page only.) British Journal of Haematology. 170(6):788-803.
The authors provide recommendations and guidance related to managing major hemorrhage which emphasizes collaboration between emergency departments, blood banks, and hospitals in general. The authors also highlight the potential role of antifibrinolytics in these cases.
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This tool was developed to predict blood transfusion requirements in the military deployed hospital environment. Emergency planners may consider using it for mass casualty incidents in the civilian world.
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Minnesota Department of Health, Office of Emergency Preparedness, Minnesota Healthcare System Preparedness Program. (2014). Patient Care: Strategies for Scarce Resource Situations.
This card set can help facilitate an orderly approach to resource shortfalls (e.g., blood, IV fluids) at a healthcare facility. It is a decision support tool to be used by key personnel, along with incident management, who are familiar with ethical frameworks and processes that underlie these decisions.
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This framework is used to guide all transfusion rationing decisions made during a Red Phase in Canada. It recommends establishing an interdisciplinary triage team, making decisions based on the clinical presentation and guidelines in the plan, and thorough documentation of all decisions. The algorithm begins on page 18.
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National Health Service (UK). (2012). The Appropriate Use of Group O RhD Negative Red Cells.
Because Group O RhD Negative is the “blood group of choice” in an emergency, overuse may influence the blood stock. This document presents guidelines and principles related to the clinical use of these red cells in individual and large-scale emergency situations.
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This plan includes traditional sections (scope, roles and responsibilities) and appendices that illustrate red cell shortage plans, platelet shortage plans, and platelet usage guidance. Additional appendices include sample e-mail messages and a communications plan that can be used during a shortage. Part of Appendix C is included below as an example.
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Authors from the U.S. Food and Drug Administration describe the recently-developed blood supply model that estimates the amount of blood available nationally during routine and emergency conditions. This model can also be customized to help planners understand various scenarios.
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The Chief Medical Officer’s National Blood Transfusion Committee (UK). (2016). A Plan for NHS Blood and Transplant and Hospitals to Address Platelet Shortages.
This plan can help hospital staff prioritize patients for treatment during a shortage. It includes appendices that can support decision-making.
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The Chief Medical Officer’s National Blood Transfusion Committee (UK). (2016). A Plan for NHS Blood and Transplant and Hospitals to address Red Cell Shortages.
This framework was designed to ensure that national blood and transplant agency and hospitals in England and north Wales work in an integrated manner to manage blood shortages.
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Yale New Haven Hospital. (n.d.). Development and Design of the Disaster Prediction Model. (Contact ASPR TRACIE for this document: askasprtracie@hhs.gov.)
This appendix describes a tool developed by Yale New Haven Hospital to predict the blood needs of a particular disaster.
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Research and Supply Chain Modeling


Carson, J., Terrin, M., Noveck, H., et al. (2011). Liberal or Restrictive Transfusion in High-Risk Patients after Hip Surgery. The New England Journal of Medicine. 365: 2453-2462.
Using a randomized trial, the authors examined whether a higher threshold for blood transfusion would improve patient recovery from hip fracture surgery. They found no reduction in death or inability to walk independently at 60-day follow up in liberal vs. restrictive transfusion strategy recipients.
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Doughty, H., Glasgow, S., and Kristoffersen, E. (2016). Mass Casualty Events: Blood Transfusion Emergency Preparedness Across the Continuum of Care. Transfusion. 56(Suppl 2). S208-S216.
The authors describe two models of transfusion planning for mass casualty incidents and suggest exploring the use of alternative transfusion products and other means to promote community resilience.
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Dunbar, N. and Yazer, M. (2017). Safety of the Use of Group A Plasma in Trauma: The STAT Study. (Abstract only.) Transfusion. 57(8):1879-1884.
This study examined the use of thawed group A plasma for the initial resuscitation of trauma patients (i.e., before blood type is known). There was no difference in in-hospital mortality, early mortality, or hospital length of stay for the patients treated with group A plasma versus those treated with group B and AB.
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The authors found cryopreserved red blood cells (RBCs) to be as safe and efficient as refrigerated RBCs. This type of storage also extends the life span of RBCs to 10 years.
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Fahimnia, B., Jabbarzadehab, A., Ghavamifarb, A., and Bella, M. (2015). Supply Chain Design for Efficient and Effective Blood Supply in Disasters. (Abstract only.) Emergency Medicine Journal. 26(12):899-902. .
The authors share a “stochastic bi-objective supply chain design model” that examines the cost- and time-efficient delivery of blood after disasters.
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Glasgow, S., Vasilakis, C., Perkins, Z., et al. (2016). Managing the Surge in Demand for Blood Following Mass Casualty Events: Early Automatic Restocking May Preserve Red Cell Supply. (Abstract only.) The Journal of Trauma and Acute Care Surgery. 81(1): 50-57.
In this article, the authors describe the development of a computerized simulation model of a major trauma transfusion system. After 35,000 simulations, the authors found positive results for the early-automated push approach to restocking red blood cells compared with holding excess stock permanently at trauma centers.
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Hebert, P., Wells, G., Blajchman, M., et al. (1999). A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care. The New England Journal of Medicine. 340: 409-417.
The authors compared death rates in critically ill patients from all causes at 30 days and the severity of organ dysfunction to evaluate the difference between restrictive and liberal red-cell transfusion. Thirty-day mortality was similar between the two groups and the authors suggest that the restrictive method is at least as effective as the liberal method.
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Holcomb, J., Tilley, B., Baraniuk, S., et al. (2015). Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients with Severe Trauma: The PROPPR Randomized Clinical Trial. (Abstract only.) Journal of the American Medical Association. 313(5): 471-482.
The authors sought to evaluate the safety and effectiveness of transfusing patients with major bleeding (as a result of severe trauma) using a different ratio of plasma, platelets, and red blood cells. No significant differences were detected in mortality at 24 hours or at 30 days.
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Prat, J., Meyer, A., Ingalls, N., et al. (2017). Rotational Thromboelastometry Significantly Optimizes Transfusion Practices for Damage Control Resuscitation in Combat Casualties. (Abstract only.) The Journal of Trauma and Acute Care Surgery. 83(3):373-380.
A high proportion of combat casualties with a truncal injury die of hemorrhage before reaching a surgeon. This article describes damage control resuscitation methods, which are “focused on replacing shed whole blood by empirically transfusing blood components in a 1:1:1:1 ratio of platelets : fresh frozen plasma : erythrocytes : cryoprecipitate.”
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Samani, M., Torabi, S., and Hosseini-Motlagh, S. (2017). Integrating Blood Supply Chain Planning for Disaster Relief. I.
The model described comprehensively in this article accounts for traditional aspects of the blood supply chain and also “provides a trade-off analysis between the cost efficiency…responsiveness …and effectiveness of the designed network.” The authors base a case study using the model on a relatively earthquake-prone city in Iran.
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Shackelford, S., Del Junco, D., Powell-Dunford, N., et al. (2017). Association of Prehospital Blood Product Transfusion During Medical Evacuation of Combat Casualties in Afghanistan With Acute and 30-Day Survival. Journal of the American Medical Association. 318(16): 1581–1591.
A retrospective cohort study of U.S. military combat casualties found that prehospital transfusion was linked to improved survival at both 24 hours and 30 days.
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Simonetti, A., Ezzeldin, H., Walderhaug, M., et al. (2018). An Inter-regional US Blood Supply Simulation Model to Evaluate Blood Availability to Support Planning for Emergency Preparedness and Medical Countermeasures. (Abstract only.) Disaster Medicine and Public Health Preparedness. 12(2): 201-210.
The authors created an inter-regional blood transfer system including multiple blood collectors and distributors and tested it on mass pandemic and mass casualty incident scenarios across U.S. regions.
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Spinella, P. (2008). Warm Fresh Whole Blood Transfusion for Severe Hemorrhage: U.S. Military and Potential Civilian Applications. (Abstract only.) Critical Care Medicine. 36(7 Suppl):S340-5.
The authors examined data from 6,000 units of warm, fresh blood transfused between 2003 and 2007 in Afghanistan and Iraq to patients with life-threatening injuries. They wrote, “Preliminary results in approximately 500 patients with massive transfusion indicate that the amount of fresh warm whole blood transfused is independently associated with improved 48-hr and 30-day survival and the amount of stored red blood cells is independently associated with decreased 48-hr and 30-day survival for patients with traumatic injuries that require massive transfusion. Risks of warm fresh whole blood transfusion include the transmission of infectious agents and the potential for microchimerism.”
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Stevens, W., Morse, B., Bernard, A., et al. (2017). Incompatible Type A Plasma Transfusion in Patients Requiring Massive Transfusion Protocol: Outcomes of an Eastern Association for the Surgery of Trauma Multicenter Study. (Abstract only.) The Journal of Trauma and Acute Care Surgery. 83(1):25-29.
The authors reviewed data on 1,536 patients (92% received compatible plasma transfusions and 8% received incompatible type A plasma). There were no differences in morbidity or mortality between the two groups.
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Stinger, H., Spinella, P., Perkins, J., et al. (2008). The Ratio of Fibrinogen to Red Cells Transfused Affects Survival in Casualties Receiving Massive Transfusions at an Army Combat Support Hospital. (Abstract only.) The Journal of Trauma. 64(2 Suppl): S79-85.
The authors sought to determine whether increased ratios of fibrinogen (a soluble protein present in blood plasma) to red blood cells (RBCs) decreased mortality in combat casualties requiring massive transfusion. They found that “the transfusion of an increased fibrinogen: RBC ratio was independently associated with improved survival to hospital discharge, primarily by decreasing death from hemorrhage.”
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Select Resources on Cost Considerations


This interactive webpage provides answers to questions regarding coding and billing of blood products and transfusion services reimbursable under the Medicare program.
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* Leahy, M.F. and Mukhtar, S. (2012). From Blood Transfusion to Patient Blood Management: A New Paradigm for Patient Care and Cost Assessment of Blood Transfusion Practice. (Abstract only.) Internal Medicine Journal. 42(3):332-8.
This article addresses ways in which individual patient management decisions, applied systematically, can reduce blood product waste. There are discussions on patient types, blood needs and blood transfusion options.
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* Mulcahy, A., Kapinos, K., Briscombe, B., et al. (2016). Building a More Sustainable U.S. Blood System. RAND Corporation.
Recent medical advances have contributed to a lower demand for blood and blood products. This presents an economic and supply-related challenge (e.g., seasonal shortages). The authors share how changing payment policies, improving emergency/surge capacity, and technological advances can help ensure a safe, sustainable blood supply.
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Agencies and Organizations


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American Red Cross. Biomedical Services.
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American Red Cross. Disaster Relief.
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Blood Centers of America. Disaster Response.
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