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


METHODS
Based 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.


RESULTS
Simulation 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.


CONCLUSIONS
To 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.
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America.
Arianna
http://orcid.org/0000-0003-4711-7858
A
Simonetti
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America.
Hussein
H
Ezzeldin
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America.
Mikhail
M
Menis
Acumen LLC, Burlingame, CA, United States of America.
Stephen
S
McKean
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America.
Hector
H
Izurieta
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America.
Steven A
SA
Anderson
Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America.
Richard A
RA
Forshee
D001771:Blood Banks; D001782:Blood Donors; D001793:Blood Preservation / Q000379:methods; D003198:Computer Simulation; D016638:Critical Illness / Q000628:therapy*; D004865:Equipment and Supplies, Hospital; D017707:Erythrocyte Transfusion / Q000379:methods*; D006295:Health Resources; D006801:Humans; D013997:Time Factors; D014481:United States