title: Planning for pandemic influenza: effect of a pandemic on the supply and demand for blood products in the United States.
abstract: BACKGROUND
  Influenza causes episodic pandemics when viral antigens shift in ways that elude herd immunity. Avian influenza A H5N1, currently epizootic in bird populations in Asia and Europe, appears to have pandemic potential.
  
  
  METHODS
  The virology of influenza, the history of the 1918 pandemic, and the structure of the health care and the blood transfusion systems are briefly reviewed. Morbidity and mortality experience from the 1918 pandemic are projected onto the current health care structure to predict points of failure that are likely in a modern pandemic.
  
  
  RESULTS
  Blood donor centers are likely to experience loss of donors, workers, and reliable transport of specimens to national testing laboratories and degradation of response times from national testing labs. Transfusion services are likely to experience critical losses of workers and of reagent red cells (RBCs) that will make their automated procedures unworkable. Loss of medical directors, supervisors, and lead technicians may make alternative procedures unworkable as well.
  
  
  CONCLUSIONS
  Lower blood collection capacity and transfusion service support capability will reduce the availability of RBCs and especially of platelets. Plans for rationing medical care need to take the vulnerability of the blood transfusion system into account.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Ann B
authors.initials: AB
authors.lastname: Zimrin
authors.forename: John R
authors.initials: JR
authors.lastname: Hess
mesh_terms: D001771:Blood Banks / Q000600:supply & distribution; D001782:Blood Donors / Q000600:supply & distribution*; D001792:Blood Platelets; D004196:Disease Outbreaks / Q000266:history; D017707:Erythrocyte Transfusion; D004912:Erythrocytes; D015276:Health Care Rationing; D049673:History, 20th Century; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000266:history; D017056:Medical Laboratory Personnel / Q000600:supply & distribution; D017713:Platelet Transfusion