Blood Shortages

You may be contacted at night or on the weekend to help deal with a blood shortage. These generally fall into the following two categories. See Shortage of Rh negative RBCs for a discussion of a shortage of Rh negative red cells.

A. Group O RBCs.

We must not use every single unit of group O RBCs that we have because we must maintain a minimum inventory to deal with emergencies where we don't know the patient's type, or emergency transfusions of group O patients. Therefore, as the inventory drops, we must assess numerous variables to determine the course we must take. You may get involved with this in certain circumstances.

Minimum inventory. Our minimum comfortable inventory is 100 units of O positive RBCs (not counting directed and autologous units) and 30 units of O negative RBCs.
We are more nervous about low inventory if:

1. A holiday weekend is approaching.
2. A nationwide shortage is occurring.

If we are below critical levels and the chances of getting more blood in the near future are grim, consider the following:

• How busy are the OR schedules for the next day? The schedules usually are available after 2:30 pm the day prior to surgery.
• How many patients on the OR schedule are group O? If you don't know the blood group of the patients, see if they're already in the hospital and if nursing will go ahead and send their pre-op specimen early.
• How many units of RBCs are the group O surgery patients expected to use? This is also listed on the OR schedule.
• How many of the group O patients are having elective surgery and how many must go to the OR the next day? (Burn debridements, for example, generally cannot be postponed).

Taking action to preserve the remaining O blood. If the inventory is low enough (usually less than 60 units of O pos RBCs or less than 20 units 0 neg RBCs), and the prospect of getting more units soon is dim, we will have to announce that there will be no group O blood for elective surgeries at any of the three campus hospitals for the following day. This is not a popular pronouncement: get blood bank faculty involved in making this decision. We cannot forbid the surgeons to go ahead with surgeries (please don't say we're "cancelling surgery"), but they must understand we are very serious when we say there will be no blood for their patients.

B. Platelets.

A shortage of platelets is not infrequent. It usually occurs from unexpectedly heavy use. If no ABO compatible platelets are available, refer to Compatible Blood Groups for Transfusion. If few platelets of any type are available, assess the following:

• Are there platelets that can be obtained within a few hours or the next day from BloodCare, either coming out of processing or being shipped in from outside sources?

If the answer is no, then we need to take conservative steps.

1. Make sure the standard pool size is six units or less. Do not issue larger pools without your approval.
2. Talk to the physicians about each individual request. Tell them the situation -- that there are no platelets from outside to be had -- and see if they can postpone transfusion. If not, can they take a smaller pool, for example 3 or 4 units instead of six. Be assertive. If you don't really think they need the platelets, don't be shy about saying so or involving faculty to help you question them further.
3. Consult with blood bank faculty or fellow.

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