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The Business of Blood: How the Mississippi Valley Regional Blood Center Prepares for the Future - Page 2 PDF Print E-mail
News/Features - Feature Stories
Written by Jeff Ignatius   
Wednesday, 22 July 2009 08:25

Biovigilance

Once it was identified and understood, HIV could be eliminated from the blood supply straightforwardly - through a test for antibodies.

Dr. Louis Katz"We've picked the low-hanging fruit now," Katz said. "Since the onset of the HIV epidemic - that's 30 years - we've been consumed with transfusion-transmitted infectious diseases," including non-A/non-B hepatitis. Because the risk of transmitting those through blood donation has been nearly eradicated - there hasn't been a transfusion-related HIV infection in at least eight years, and the transmission risk is now estimated at less than one in 2 million, Katz said - the focus has now shifted to transfusion risks that are hard to pinpoint.

"We're beginning to ask questions about very difficult-to-measure adverse effects of blood and talking to physicians about using less," he said.

The U.S. Biovigilance Network (AABB.org/biovigilance) was formed in 2006, and Genesis Medical Center (through it relationship with Katz) is one of nine hospitals in a nationwide biovigilance pilot project underway this spring.

"Let's start counting cases" so priorities can be set, Katz said.

Katz said these negative effects might play out over weeks or months following the transfusion. "There are lots of studies that suggest that people who get more blood rather than less blood may have more infections acquired in the hospital, may have worse outcomes over the long run," he said. "There's a lot of discussion about whether blood transfusion alters the immune system or causes inflammation that could be causing long-term adverse outcomes."

Further complicating the issue is the fact that "these are people who are already sick. ... These are things that might happen to a sick person - sick enough to get transfusion - anyway. And so the relationship to transfusion is the critical issue."

By carefully tracking these events, the hope is that their relationship (if any) to transfusion can be identified, and the frequency will help hospitals and the blood-transfusion community determine which are the most important to address.

And while it's impossible at this point to know which of these suspected negative outcomes are serious problems, optimizing transfusion practices is the smart path. "We don't know how bad these other problems are," Katz said, "but we do know that an adverse event doesn't occur if you don't transfuse."

Anticipating the Next Threat

Even though HIV - through testing and donor screening - has been almost eliminated, infectious diseases could still pose a threat to the blood supply.

Katz and five colleagues in the American Association of Blood Banks' Transfusion-Transmitted Diseases Committee polled 20 members of the committee about the diseases they viewed as the next threat. Sixty-eight diseases "had at least a theoretical possibility of causing trouble in the blood supply now or someday," Katz said. So they prioritized them and assigned three or four to each committee member, who wrote a fact sheet describing the discrete characteristics of each.

"We're trying to be proactive," Katz said. "Instead of waiting for something to hit us, we're out there scouring the literature, reading the case reports, talking to regulators, talking to docs in Europe ... . We're trying to put stuff on the radar screen ... . We've been doing this reactive thing since HIV. ... Now we're trying to anticipate the problem."

Some diseases are not expected to threaten the safety of blood but still threaten the supply. There is minor concern about the transmission of the H1N1 (swine flu) virus through the blood supply, for example, but the larger concern would be a pandemic's effect on blood donation.

Katz is chair of the American Association of Blood Banks' Interorganizational Task Force on Pandemic Influenza & the Blood Supply, which is looking to get a specific exemption for blood donation from the U.S. Department of Health & Human Services' "social distancing" guidelines. In a presentation (HHS.gov/bloodsafety/presentations/DrKatz0806.pdf), Katz estimated donor absenteeism of 40 percent during a pandemic. If blood-donation sites take certain precautions, Katz said, blood donation should remain safe, even during a flu outbreak.

Size Matters

The Mississippi Valley Regional Blood Center territory map. Click for a larger version.These are some of the medical issues facing the Mississippi Valley Regional Blood Center, but the organization is also a fascinating business.

It started in 1974 providing blood to Scott and Rock Island counties and now serves hospitals in northwestern Illinois, eastern Iowa, southwestern Wisconsin, and the St. Louis area. President/CEO Green said the organization has had a "visionary board," and that its original director saw what it could offer to other communities.

The expansion in 2005 to St. Louis created formal relationships in an area to which the blood center was already supplying a lot of product, and it gave it access to the donation program of a bankrupt blood bank that had been serving the metro area.

"It really gave us a volume opportunity," Green said.

The organization's growth has been conscientious, he added; the board will only expand into areas where there is not reliable service.

The blood center also has connections beyond its served hospitals. There's an emergency benefit there - "We have a network out there that is prepared to help us in a time of need," Green said - but also a financial one. "We have an established network throughout the United States such that we're able to provide those blood products to other communities that don't have as supportive a donor base as we do," Green said. "And historically, we have charged more for those products, and then that money comes back into this community and allows us to keep costs down ... ."

The aim is always to have more supply than demand, so that there's never a blood shortage at the hospitals served by the blood center. The surplus - roughly 35 percent a year, Green said - financially supports its core functions.

The center in 2004 moved to its current location, more than doubling its Locust Street facility's 30,000 square feet. And because the center was able to bring its nucleic acid testing back to the Quad Cities (instead of sending it to Minneapolis because of a lack of space), the larger building doesn't actually cost more. "The savings annually for bringing that back in house cover the carrying cost of the debt related to the facility," Green said. Including property and equipment, the center cost $14 million.

"We intentionally built larger than we needed at the time, but consistent with what we would expect based upon the growth that we had seen ... ," Green said.

The center provides payroll and accounting services for a Springfield, Illinois, blood-donation program, and donor infectious-disease testing for St. Luke's Blood Bank in Cedar Rapids.

That revenue, Green said, has helped to offset some price increases from the Mississippi Valley Regional Blood Center's vendors, although the organization has also had to eliminate some positions and nonessential functions.

"We are mindful of opportunities ... ," Green said.

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