The Blood Supply Chain
The blood supply chain is a complicated, and costly process. However every step of it is completely necessary to save lives around the world. Within the blood supply chain there are numerous challenges, not least of which is regulating the environment in which blood supply products are maintained.
Temperature control is a necessary practice at every step within the blood supply chain. If even one step fails to maintain proper temperatures, the blood supplies may spoil or degrade.
How the Blood Supply Chain Works
Blood supplies are sent to their final destination through the cold chain. The cold chain is essentially a temperature controlled transportation process. However, the cold chain involves every aspect of shipping an item, from packaging it, to loading it, transporting, unloading it, and ultimately storing and receiving it at the end facility. That also includes all materials, vehicles, equipment, and personnel that take part in the shipping.
Outside of the cold chain, blood supplies need to go through their own chain of procedures, including:
This is the first step in the blood supply chain. The donor goes to a center or donation site and gives their blood.
Initial storage and transport
Once the donor gives blood, the donation site personnel properly store the supply. After storing, the blood has to go to a blood bank. Depending on the distance to the blood bank, the supplies may need refrigeration. Blood can remain at ambient temperatures (68-75 degrees fahrenheit), for up to six hours before processing. However, transportation to a blood bank can often take longer, so most blood supplies go into cold storage containers to preserve them.
Arrival at the blood bank
Once the blood arrives at the blood bank, the personnel test it, process it, and properly store it. Blood may undergo processing to extract specific components (such as platelets or plasma) for special transfusions or treatments. Depending on whether it’s processed into certain components, it has different storage requirements.
Order for transport
Once a medical facility needs supplies from the blood bank, they order them, and the blood supplies are packaged for transport. Again, the blood supplies go into cold storage, with temperatures specific to their storage needs. This is where blood again enters the cold chain, and goes to the medical facility in need. Blood supplies should ship in climate regulated transport, like a refrigerated truck.
Arrival at the destination
After the transport, blood supplies arrive at their destination. According to regulations, staff should test the blood supplies to ensure a proper temperature. Again, the blood supplies go into temperature controlled storage that meets their specific requirements.
Distribution to the patient
After going into storage at the hospital, the blood supplies stay in strictly regulated temperatures until they’re needed. Once a patient needs the blood supplies, they’re prepared and delivered to the patient for treatments and transfusions.
Opportunities for Error
The blood supply chain includes many steps, and each step presents a plethora of opportunities for error. Each error in turn is another chance that these valuable supplies might be wasted. Blood supplies do expire, and issues with temperature management, unforeseen delays, and more may decrease the supply’s viability.
Common opportunities for error include:
- Transportation delays
- Failure to follow proper protocols
- Cold shipping equipment failure
- Unnoticed temperature excursions
- Errors during collection
- Improper packaging
- Packaging that lacks proper insulation
What Waste Costs in the Blood Supply Chain
Blood might be donated, but the blood supply chain is far from cheap. Blood has to undergo testing, processing, storage, and transportation in very strict environments, which cost both patients and providers. Within Europe and the United States, blood product transfusions cost, on average, between $522 and $1,183 (Shander et al. 2010; Abraham and Sun 2012).
According to a study published in 2014, blood waste in surveyed hospitals can range from 1.93% to 30.7%, and averages 9.8%. In the United States, blood supply and component waste typically ranges from 1% to 5%, according to the American Journal of Clinical Pathology.
That means that anywhere up to one million units can be wasted. Ultimately, this can cost between $46 million to $230 million each year. Unfortunately, these wastes aren’t primarily due to blood products reaching their expiration dates.
In fact, much of this blood product waste is ‘in-date.’ That means that these products are unusable due to factors outside of a typical expiration date. Some of the causes are improper procedure, failure to return unused products, and improper storage, especially when the blood reaches unacceptable temperatures.
Reducing Waste in the Blood Supply Chain
In the United States alone, wastage of blood supplies can cost hundreds of millions of dollars annually. As mentioned above, much of this waste isn’t due to normal expiration, and is therefore preventable. However, the blood supply chain is highly complex, and involves many steps and moving parts. Therefore, the solution to reducing blood product waste has to simplify the process and allow greater control of the blood supply products.
Blood products go through the cold chain to reach their final destination. Within the cold chain are multiple opportunities for blood supply spoilage, even when they’re undetected. Ultimately, a more accurate, thorough method for monitoring blood products in transport is one key to preserving the supply.
An advanced temperature sensor can record temperatures in the cold storage from the beginning of transport to the end destination. These temperature sensors go inside the insulated storage along with the blood products. Then, the sensors log temperature readings every few minutes. This continues as long as the supply is in transit. If, for any reason, the supplies have a temperature excursion, it will be reported upon reaching the final destination.
This solves the issue of blood products losing integrity due to unnoticed temperature excursions. Once the blood supplies arrive, personnel unpack the sensor with the supplies, and upload the information from the sensor. A historical log showing every reading is available in mere moments, verifying the validity of the products.
Another issue causing unnecessary waste happens on-site. Whether in a blood bank, hospital, or other biorepository, medical freezers and refrigerators can malfunction. CDC regulations state that temperature readings should be taken at least twice daily. However, like an unnoticed temperature excursion during the cold chain, this may mean missing a temperature variation.
Much like sensors can monitor blood supply during shipping, a temperature logger can monitor supplies on site. The temperature logger simply goes into the cold storage, near the sensitive supplies. Then, much like the sensor, it takes readings of the temperature every few minutes. It uploads temperature readings via a gateway, and transmits the data to a system that shows readings over time.