Bloodhound and Puppy: determining the indications and urgency of transfusion
Information about where blood is used and the clinical urgency with which it is required is essential when developing blood supply contingency plans. There are very few data to guide planning for a blood shortage either in Australia or internationally, therefore ARCBS and Monash Institute of Health Services Research designed a study to determine the clinical urgency of red cell use.
The aim of Bloodhound was to determine what proportions of red cells issued in Victoria were used for urgent and elective indications, and then ascertain the proportion of red cells issued which could potentially be deferred in an emergency.
Over six months, 5000 randomly selected red cell units were tagged with a case report form. When the red cells were issued for transfusion by the hospital transfusion laboratory, the form was completed, with information regarding the clinical use and clinical urgency of the transfusion. The response rate was excellent with more than 98% of case report forms returned.
Approximately 1/3 of tagged red cells were used to support surgery, 1/3 for haematology/oncology and 1/3 for other medical and miscellaneous indications.
Just under 10% of transfused red cells were used to support elective surgery or non-urgent medical conditions, much lower than the 20% proportion commonly used in emergency blood supply contingency plans. Additionally, fewer than 40% of red cell transfusions were judged to have been deferrable for more than 24 hours.
These results suggest that triaging of red cells may only have a very short-term impact on actual use, and cancellation of elective surgery would only partially assist in the setting of a major blood shortage. Therefore additional strategies are required to ensure maintenance of red cell supply during potential future blood shortages
The data collected during the Bloodhound project have assisted in the development of the National Blood Supply Contingency Plan and will help ensure that blood products are available for urgent transfusion in the event of a pandemic or other national emergency resulting in a blood shortage. Complete results will soon be appearing in a peer-reviewed publication.
ARCBS has now also commenced a follow-up study in Victoria, Puppy (Prospective Utilisation of Platelets and Plasma), to determine the clinical urgency of use for platelets and fresh frozen plasma.
Bloodhound would not have been possible without the enthusiastic participation of scientists and other staff from more than 80 transfusion laboratories throughout Victoria.
For further information regarding Bloodhound and Puppy, please contact;
Ms Mary Comande
Senior Transfusion Scientist
Transfusion Medicine Services
Phone: +61 3 9696 0253 Fax: +61 3 9694 0108
Email: mcomande@arcbs.redcross.org.au