Comprehensive survey of red blood cell unit life cycle at a large teaching institution in eastern Canada

BACKGROUND: Recent blood shortages and the potential clinical impact of red blood cell (RBC) age highlight the need to understand blood supply delivery. This study addresses the characteristics and mechanics of RBC unit trafficking and storage across the transfusion service, previously undescribed in the literature. STUDY DESIGN AND METHODS: This retrospective qualitative institutionwide survey assessed the comprehensive RBC life cycle within Capital District Health Authority in Nova Scotia, Canada, during 2007. RESULTS: A total of 15,930 unique RBC units were received from the supplier with 98.6% having mean age of 12.5 days. The mean ages on receipt, transfusion, and time spent in the transfusion system before transfusion were 12, 19.6, and 7.5 days, respectively. Of 12,298 units, 9689 (78.8%) remained within the blood transfusion services (BTSs), while 2609 (21.2%) migrated having been returned a mean of 1.26 times from locations outside BTS (SD, 0.56 times), the latter spending a mean of 18.4 hours outside the BTS. Stationary units had mean age at dispense and time spent in the transfusion system of 19.2 and 6.9 days, respectively, compared to migratory units at 21.3 and 9.9 days, respectively (p < 0.005). A total of 5.2% (636/12258) of units were discarded; 423 of 636 (66.5%) were due to "unit expiry." CONCLUSION: Quantification of our institutional RBC life cycle highlighted key areas for intervention, such as the reduction of unit migration, especially D- units, as this increased RBC age at transfusion. In the era of limited resources, this method could identify areas where effort should be directed to address unnecessary wastage and aging of RBC units.