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

Arianna Simonetti; Hussein Ezzeldin; Mikhail Menis; Stephen McKean; Hector Izurieta; Steven A Anderson; Richard A Forshee

doi:10.1371/journal.pone.0174033

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

PLoS One. 2017 Mar 20;12(3):e0174033. doi: 10.1371/journal.pone.0174033. eCollection 2017.

Authors

Arianna Simonetti¹, Hussein Ezzeldin¹, Mikhail Menis¹, Stephen McKean², Hector Izurieta¹, Steven A Anderson¹, Richard A Forshee¹

Affiliations

¹ Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America.
² Acumen LLC, Burlingame, CA, United States of America.

Abstract

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.

Conclusion: 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.

MeSH terms

Blood Banks*
Blood Donors
Blood Preservation / methods
Computer Simulation
Critical Illness / therapy*
Equipment and Supplies, Hospital
Erythrocyte Transfusion / methods*
Health Resources*
Humans
Time Factors
United States

Grants and funding

This research was supported in the form of grant n. Z01 BS 03005-03 OBE from MCMi and by internal FDA/CBER funding. This project was also supported in part by the Research Participation Program at the Center for Biologics Evaluation and Research administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and the US Food and Drug Administration (HE). Furthermore, Acumen LLC provided support in the form of salary for author SM. The funders did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the 'author contributions' section.