BOOKS OF RtfiDIfGS - PAHO/WHO

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reponed. Thec Nutional Heart, Lung and Blood Institute Resources Panel in its 1973
recommendations, which were a major factor in formulating the National Blood
Policy [4], stated that:
One of ihe strongect arguliculs I'ivoring tihe introduction ol s)'slcins management lo
blood service is that it will result in improved service. in more economical utilization of ihe
blood resources, and most important. in iniproved effectiveness and efficiency. For these
reasons ii is recommended ihat emphiasis be placed on developing micasures of activity und
relalting thcse io objectives. Only ii ihis wa;y will it bc Ipossiblc to oill;lio secire antl credillc
cvaluatioin of the chaigcs lo ble mi'dc.
This study addressed these issues by:
(1) creating a model for relating measures of blood banking activity to
availability and utilization;
(2) developing a management tool called the Programmed Blood Distribution
System (PBDS) to implement a regional blood distribution strategy that is based upon
this model;
(3) evalluating the effectiveness of PBDS in a prototype region (LIBS).
Complexity of the problemn
The complexity of the blood distribution problenm is primarily due lo the perish.able
characteristics of blood, to the uncertainties involved in its availability to the
RBC, and in the variable daily demand and usage for it at each of the HBB's. Thc
situation is complicated by the large variation in the size of the HBB's supplied, the
incidence of the different blood groups, and the rcquircments for wholc blood and red
blood celis at individull hospitals.
Since it is a national policy for blood to be derived from volunteer donors, its
availability is uncertain and is a function of a number of factors thait canniot be
controlled by the RBC. The demand and usage of blood at HBB's arc also unicerlain
and vary from day to day and between hospital facilities. The HBB's within a region
may range from those transfusing a few hundred units per year to those transfusing
tens of thousands of units per year. The most frequently occurring blood type (0
positive) occurs in approximately 39% of the population, while the least frequently
occurring blood type (AB negative) occurs'in only about 0.5% of the population.
While most medical authorities agree that at least 90% of all blood trans.fusions could
be in the form of red blood cellis, sonme hospitals transfuse almost cntirely red blood
cells while others transfuse entirely whole blood with the ratio of whole blood to red
blood cells frequently changing with time as transfusion practices improve.
Approach
The transfusion services throughout the nation are characterized by diversity.
Each RBC has independently evolved its own philosophies and tcchniques for blood
distribution. Each region strives for "self-sufficiency" iii supplying the blood nceds
of the hospitais in its region from donors who also reside in approximately the same
area. Because of these factors, it is essential that any strategy devised be defensible
from the point of view of both the RBC and caclh of the wide range of HiB13's that it
serves. Furthermore, any strategy that involves interactions between RBC's niust
provide for clearly defined benefits for all participants. In addition, it is desirable that
INTERFACES November 1979