The author of this article: Tun Tun
Recently, Xiamen Central Blood Station stated that the current platelet inventory is low, and it is more prone to clinical sudden use of a certain blood type of platelets, resulting in insufficient supply.
Xiamen City Center Blood Station appeals, hoping that more citizens can donate apheresis platelets.
Source: Xiamen Daily
Under the scorching sun of July, delayed surgeries, difficult deployment, urgent patient needs…The anxiety of “insufficient blood” haunts the doctors’ heads.
Blood-stressed winter and summer vacations
Every winter and summer vacation, the use of blood in the hospital becomes tense.
At present, the main force of voluntary blood donation in my country is young and middle-aged people aged 18-35, of which the blood donation rate of 18-25 years old is the highest. College students are an important part of the voluntary blood donation population. In some areas, 35% of voluntary blood donations come from college students.
With the holidays of these major blood donors, coupled with the high temperature and severe cold weather, the blood collection volume of mobile blood collection vehicles on the streets plummeted.
Many departments have canceled or postponed operations due to insufficient blood preparation, and the admission of new patients has to be buffered. There is a saying among surgeons, “When the students start school, there will be blood.”
Surgeon Zhang Xin (pseudonym) said that after October, it is obvious that blood preparation for surgical patients has become easier, and 2U of blood preparation does not require additional blood donation by family members. “Thanks to universities for awarding comprehensive test scores to blood donation students, I really want to thank the universities.”
In the internal medicine department, the situation of non-surgical blood is not optimistic. Dr. Zhu Chen (pseudonym) from a tertiary hospital in Beijing recalled that he once received a patient with hemolytic anemia with only 2.8 hemoglobin. “When we went to apply again, the blood bank said there was no more.”
Doctor Wang Yue (pseudonym) from the Department of Hematology said that he was most afraid of the New Year. During the Spring Festival and the winter vacation, the number of people who go out to donate blood has dropped sharply.
Wang Yue recalled that during the Chinese New Year period in the past few years, the local blood supply was tight, and it was only supplied to emergency surgeries and critically ill patients in major hospitals. And an old man in his 70s with aplastic anemia in the department waited for 4 days with only 3 platelets. “He was wary, fidgety, and sometimes crying and begging me every day. I can feel his pain, but I can’t help it.“
Breakout
Blood products are like a flowing red river from collection to use.
Based on the particularity of blood, the shelf life of whole blood and platelets is about 35 days and about 5 days respectively. “.
Blood Center will set upper and lower limits for the inventory of different blood types. Once the blood reserve of a certain blood type is lower than the lower limit, a request for emergency blood collection will be issued, and the “emergency” of the corresponding blood type will be posted at the blood collection point; on the contrary, once the upper limit is exceeded, the collection will be suspended to avoid waste.
Xiamen Blood Center is in shortage of platelets this time. Compared with whole blood, the collection of blood components has encountered greater obstacles.
On the one hand, collecting platelets is more demanding on the donor. According to the “Health Checkup Requirements for Blood Donors” published in 2012, compared to pre-donation blood testing for whole blood donors, apheresis platelet donors also need to check hematocrit, pre-blood platelet count, and predicted post-blood platelet count.
Blood Donor Health Checkup Requirements
The paper “Analysis of the Reasons for Unqualified Blood Preliminary Screening of Machine-collected Platelet Donors” pointed out that the total unqualified rate of platelet donors’ blood preliminary screening in some areas was as high as 16.22%.
On the other hand, collecting platelets is relatively more complicated.
To donate platelets, whole blood is drawn first, plasma is collected by centrifugation, and the remaining blood cells are returned to the donor. It takes 1 to 2 hours to collect 1 to 2 units of platelets, and it needs to go to a blood donation house with a machine for collecting platelets. At present, only blood centers in various places have the conditions, and not all blood collection points can be carried out.
“Investigation and Analysis of the Reasons for the Loss of Apheresis Platelet Blood Donors and Their Willingness to Donate Blood Again” shows that the top 3 reasons for the loss of apheresis platelet donors are: busy work or inconvenient time and place (35.93%) , health reasons (24.40%), and machine mining time is too long (15.72%).
This red river is always at risk of being cut off, and hospitals cannot get blood on time and in sufficient quantities.
The transportation of blood is also inconvenient. In addition, the stocks of different blood types in the country are different. It is not practical to prepare blood across the country, and it is still necessary to rely on local stocks. The situation varies greatly from place to place. In some county-level areas, a patient with multiple injuries may use up all the blood stored in the local blood bank.
Without the flow, the doctor is caught between the blood bank and the patient.
In order to encourage unpaid blood donation, some places have issued some local regulations, stipulating that medical institutions can give priority to the use of blood for unpaid blood donors in addition to guaranteeing emergency blood.
Shenzhen Special Economic Zone Regulations on Voluntary Blood Donation
Many patients came to the hospital with “Free Blood Donation Certificates” and asked doctors to “use blood for free” for themselves or their family members as advertised. A look of reconciliation and questioning.
However, under the circumstance of clinical blood shortage, limited blood resources must first meet the needs of critically ill patients, and only if they are completely “equal” (the severity of the disease and the medical demand for blood) Basically the same), the “priority” of unpaid blood donors can be satisfied.
On the other hand, although the blood donation certificate has the propaganda of “free blood”, it is actually achieved by reducing the fee. In some areas, patients need to pay the fees at the hospital first, and then go to the blood station to apply for a refund with the relevant certificates.
Because the blood bank and the hospital operate independently of each other, clinicians have limited knowledge of the refund policy. When faced with the patient’s question, “Isn’t it free?”, the doctor is at a loss.
In September 2019, the National Health Commission issued the “Notice on Carrying out Direct Reduction and Exemption of Clinical Blood Expenses for Unpaid Blood Donors”, requiring the full realization of unpaid blood donation in provincial blood stations and blood-using medical institutions The information interconnection of patients enables medical institutions to obtain information on voluntary blood donation of patients and their relatives during the fee settlement process, simplifying procedures and streamlining materials.
Open source: 15% of department blood donation indicators
The amount of blood collected during the winter and summer periods is reduced, but the amount of blood used for clinical use has not decreased.
A study on the blood supply in Shijiazhuang in the past three years shows that before the new crown epidemic, the total amount of blood used by the hospital increased year by year, and the red blood cells and platelets increased significantly.
In contrast, according to data released by the National Health Commission, the blood donation rate in my country in 2020 is only 11.2‰.
In order to keep the red river that connects life flowing, doctors have joined the ranks of unpaid blood donations.
When I have seen too much the reality of “a bag of blood saves a life” in clinical practice, Zhang Xin said, “I am very aware of how important blood products are, and I will do it when I am not busy. I donate blood, basically once a year, and there are many colleagues like me.”
However, there are also many hospitals where “unpaid blood donation” has become a “performance indicator”.
Some doctors said that the hospital requires 15% of the people in the department to participate in blood donation, with at least 300ml per person, and the indicators of blood donation are linked to performance. “Our county hospital has a small number of people. In order to complete the target, people in Keli often drag their family members to donate blood together.”
But summer is just over halfway through.
Planning: yuu. | Producer: gyouza
Image source: Visual China
References:
[1] Yu Chengpu. “Blood shortage” as an organizational problem: a sociological inquiry [J]. Open Times, 2010(01):111-128.
[2] Zou Meixin, Xu Jianrong, Li Julin, Xie Wenying, Chen Xingzhi, Zhong Hua. Investigation and analysis of the reasons for the loss of blood donors with platelet apheresis and their willingness to donate blood again [J]. Guangxi Medicine, 2016, 38 (03):434-436.
[3] Xie Wentao, Zhao Fengmian, Wang Xianwei, Zhang Yaping, Tan Yanwei, Zhao Wenjing, Liu Jia. Analysis of blood supply in Shijiazhuang from 2017 to 2020 [J]. Hebei Medicine, 2022, 44(01) :139-142.
[4] Chen Aihua, Yu Langxing. Analysis of the reasons for the failure of primary blood screening of platelet donors by machine collection [J]. Zhejiang Preventive Medicine, 2015, 27(02): 206-207.