Читать книгу Transfusion Medicine - Jeffrey McCullough - Страница 34

In contrast with the worldwide supply, the US blood supply is provided by many different organizations with different organizational structures and philosophies. These organizations function rather effectively to meet the nation’s blood needs, and thus are referred to in this chapter as the US blood supply system, although they are not really a unified system.

Table 2.2 Activities related to blood availability and safety in different countries.

Source: Data are summarized from Gibbs WN, Corcoran P. Blood safety in developing countries. Vox Sang 1994; 67:377–381.

	Donor testing for
	HIV	HBV	Syphilis	All volunteer donors	Some replacement donors	Some paid donors	% Repeat donors
Developed	100	100	94	85	20	5	88
Developing	66	72	71	15	80	25	47
Least developed	46	35	48	7	93	25	20

HBC, hepatitis B virus; HIV, human immunodeficiency virus.

The US blood collection system is heterogeneous because blood centers developed for a variety of reasons mostly during the 1940s and 1950s. Some were continuations of blood collection activities initiated during World War II; others were civic or philanthropic activities, and some were formed by groups of hospitals to collect blood for their own needs. However, most hospitals have stopped collecting blood; therefore, currently about 90% of the US blood supply is collected by blood centers [25, 26].

Traditionally, blood centers were freestanding organizations, almost all of which were nonprofit. These centers were governed by a board of local volunteers; their sole or major function is to provide the community’s blood supply. Each blood center collects blood in a reasonably contiguous area. The blood center may supply hospitals in its area but may supply hospitals in other areas as well. The area covered by each center was determined by historical factors and was not developed according to any overall plan. Rather, local interests dictated whether, how, and what kind of community blood program was developed. There is a total of approximately 66 accredited blood centers in the United States [25, 26], although these are combining and it appears that soon there may be only a few blood collection organizations in the United States. As a result of the HIV epidemic [27], the regulatory environment changed [28], and the blood collection system in the United States underwent substantial revisions [26–28]. The organizations have adopted philosophies and organizational structures resembling those found in the pharmaceutical industry rather than the previous hospital laboratory and medical model. Modern quality assurance systems and good manufacturing practices [28, 29] like those used in the pharmaceutical industry have been introduced. New computer systems now provide greater control over the manufacturing process [29], and changed management structures deal with the new kinds of activities and philosophy. Blood centers and supply organizations are now operated using a very structured business and manufacturing philosophy, organization, and culture (see Chapter 21). This structure is now undergoing extensive change. Blood centers are merging, forming large national organizations that have less local focus. These organizations collect blood in the most efficient manner and sell that blood where it is more advantageous.

Most hospitals in the United States do not collect any blood but rather acquire all of the blood they use from a community center. Blood banks that are part of hospitals usually collect blood only for use in that hospital and do not supply other hospitals. However, few, if any, hospitals collect enough blood to meet all of their needs. They purchase some blood from a local or distant community blood center. Of those that do collect blood, there are no good data available to define the proportion of their needs that they collect. This can be presumed to be quite variable and involve primarily plateletpheresis.