Monitoring the nation's blood supply
Monitoring the nation's blood supply
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监测全国血液供应
DOI：
10.1046/j.1537-2995.2003.00371.x
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发表时间：
2003
期刊：
影响因子：
2.9
通讯作者：
E. Wallace
中科院分区：
文献类型：
--
作者：
E. Wallace
维持充足的国家血液供应一直是联邦政府的长期目标，仅次于确保供应安全。在过去30年中，卫生、教育和福利部及其继任者卫生和人类服务部通过国家心肺血液研究所赞助了许多关于血液采集、库存和输血的调查和研究，目的是评估供应是否充足。早在1973年，卫生、教育和福利部就发布了《国家血液政策》，规定了联邦政策的四个主要目标和10个要点。1，2其中两个目标涉及确保所有人都能获得充足的供应。这10点中包括发展数据收集和处理系统，以汇编统计数据，持续评估和规划国家血液需求。1975年，在联邦的推动下，三个主要的血液服务组织和其他机构和组织联合起来，成立了一个非政府机构，美国血液委员会，目的是执行国家血液政策。美国血液委员会，反过来，创建了国家血液数据中心，开发，测试，并在1977年至1982年期间在NHLBI的支持下运行第一个国家血液信息系统。该系统收集的1979年和1980年汇总数据于1983年发表在《国家血液资源》上。3从20世纪80年代初开始，随着艾滋病毒流行的出现和美国血液委员会的解散，联邦机构和血液服务组织的主要注意力从充足性问题转向确保供应安全的手段。在整个20世纪80年代和90年代初，安全性问题主导了联邦资助的血液研究。直到20世纪90年代末，维持足够的供应再次成为DHHS关注的问题，主要是由于对供体资格的新限制以及近年来异体红细胞采集量在输血期间的年度利润率大幅下降。2000年1月，卫生和保健部（通过NHLBI）由国家血液数据资源中心（NBDRC）赞助开发一个由25个美国血液中心组成的全国代表性样本的血液供应活动月度报告系统。2001年，DHHS卫生助理部长办公室的代表用一个基于26家哨点医院和3个全方位服务血液中心的每日报告的监测系统取代了NBDRC系统。这一最新DHHS系统运行第一年的结果在本期《输血》的其他地方有报道。5过去联邦政府赞助的调查、专门研究和监测系统的主要目标是避免或尽量减少血液短缺。对这些努力成功与否的评价取决于如何界定和衡量“充足”和“短缺”这两个词。虽然人们似乎普遍认为，未能及时履行合法的手术或医疗所需血液订单构成特定的血液短缺，但对于如何准确地衡量总体短缺或短缺威胁，以及在其他方面足够的血液供应范围内发生特定短缺的程度是可以接受的，存在着分歧。例如，在Nightingale等人5在本期《输血》杂志上发表的文章的表1中，作者列出了一系列关于从输血服务角度定义实际短缺（手术延迟或取消）或短缺威胁（订单发生不利变化）的事件的问题。虽然清单很广泛，但不包括推迟血液的医疗需求作为短缺的证据。这份清单确实很好地说明了可以用来界定医院实际短缺或短缺威胁的多种事件。然而，对于血液中心来说，这样的列表可能会有所不同。例如，一些中心经理认为未能满足每个医院订单上的每个ABO/Rh项目是中心短缺的证据。其他人则通过现有中心库存违反预设库存控制限制（根据现有ABO/Rh血型供应天数）的程度的既定措施来定义短缺或短缺威胁。在努力评估国家血液供应充足性的各方之间也存在类似的分歧。有些人认为，每当推迟或取消一次手术或医疗时，供应就不足。其他人则认为出现“局部和临时”短缺是完全可以接受的。输血的例子2003;43：299-301。
M aintenance of an adequate national blood supply has been a longstanding aim of the federal government, second only to assuring the safety of that supply. Over the past three decades, the Department of Health, Education and Welfare and its successor, the Department of Health and Human Services (DHHS), have sponsored through the National Heart, Lung and Blood Institute (NHLBI) numerous surveys and studies of blood collections, inventories and transfusions for the purpose of assessing the adequacy of supply. As early as 1973, the Department of Health, Education and Welfare issued National Blood Policy setting forth four principal goals and 10 points of Federal policy.1,2 Two of the goals involved ensuring an adequate supply accessible to all. Among the 10 points was the development of data collection and processing systems to compile statistics for evaluating and planning national blood needs on a continuing basis. In 1975, with federal prompting, the three major blood services organizations and an assortment of other agencies and organizations coalesced to form a nongovernment agency, the American Blood Commission, for the purpose of implementing National Blood Policy. The American Blood Commission, in turn, created the National Blood Data Center, which developed, tested, and operated the first national blood information system in the period between 1977 and 1982 with the support of NHLBI. Summary data collected by this system for 1979 and 1980 were published in 1983 in The Nation’s Blood Resource.3 Beginning in the early 1980s with the advent of the HIV epidemic and demise of the American Blood Commission, primary attention of federal agencies and blood services organizations shifted from matters of adequacy to means of ensuring the safety of supply. Throughout the 1980s and early 1990s, safety issues dominated federally sponsored blood studies. It was not until the late 1990s that maintenance of an adequate supply again became a concern of DHHS, largely as a result of new restrictions on donor eligibility and recent substantial declines in annual margins of allogeneic RBC collections over transfusions.4 To monitor this situation, in January 2000 DHHS (through NHLBI) sponsored development by the National Blood Data Resource Center (NBDRC) of a monthly reporting system of blood supply activities by a nationally representative sample of 25 US blood centers. In 2001, representatives of the Office of the Assistant Secretary of Health, DHHS supplanted the NBDRC system with a monitoring system based on daily reports from a set of 26 sentinel hospitals and three full-service blood centers. Results from the first year of operation of this latest DHHS system are reported elsewhere in this issue of TRANSFUSION.5 A primary objective of past federally sponsored surveys, special studies, and monitoring systems has been to avoid or minimize blood shortages. Evaluation of the success of these efforts depends on how the terms adequacy and shortage are defined and measured. While there appears to be general agreement that a failure to fulfil a legitimate order for blood required for surgical or medical purposes in timely manner constitutes a specific blood shortage, differences exist as to how exactly shortages or threats of shortages are to be measured in the aggregate and the extent to which the occurrence of specific shortages is acceptable within an otherwise adequate blood supply. For example, in Table 1 of the article by Nightingale et al.5 in this issue of TRANSFUSION, the authors list a series of questions regarding events that define an actual shortage (delayed or canceled surgery) or threat of shortage (adversely altered order) from a transfusion service perspective. While extensive, the list does not include postponement of a medical need for blood as evidence of a shortage. The list does illustrate well a multiplicity of events that can be used to define an actual shortage or threat of shortage in hospital. For blood centers, however, such a list likely would be different. For example, some center managers consider failure to fulfil every ABO/Rh item on every hospital order as evidence of a center shortage. Others define a shortage or threat of a shortage by established measures of the extent to which existing center inventories breach preset inventory control limits stated in terms of number of days supply of ABO/Rh blood types on hand. Similar differences exist among parties endeavoring to assess the adequacy of the nation’s blood supply. Some perceive an inadequate supply whenever there is postponement or cancellation of a single surgery or medical treatment. Others find the occurrence of “local and temporary” shortages quite acceptable. Examples of TRANSFUSION 2003;43:299-301.