[How do I assess requirement of a blood bank and its kind for a healthcare establishment?]

Access to blood components is required for healthcare establishments, particularly for emergency situation and hospital blood bank was often a response to this requirement. However, the complexity of regulation and economic pressures lead healthcare establishment to review regularly their need for a blood bank. This assessment requires analysis of need for transfusions in terms of delay, quantity and clinical situations to which they must respond. When a blood bank is required, three kinds could be under consideration: emergency blood bank, intermediate blood bank and issuance blood bank. According to requirements, advantages and disadvantages of each kind, healthcare establishments would select the most suitable one.

[Blood products delivery by hospital blood banks in emergency situations in France]

In France, 13.5% of labile blood products (LBP) are delivered by 644 hospital blood banks, 472 being devoted to emergency only. A nation-wide survey aimed to describe their activity in emergency situations was carried out from September 12th to 26th, 2011. All of 26 French regions but two participated, 548 (85%) of their hospital blood banks answered a questionnaire, of which 56% had actually issued blood in emergency situations. A total of 5241 LBP were delivered, 24% for utmost vital emergencies (UVE), 25% for vital emergencies (VE) and 51% for relative emergencies (RE). In UVE and VE, 47% of the packed red blood cells (PRBC) delivered were O RH1. Females were half of the 2102 patients, mean age was 67 years. In UVE, banks devoted to emergency only, issued LBP for 228 patients (57%) and other banks for 169, acute digestive tract and surgical hemorrhage being the most frequent indications. The average number of PRBC transfused in 24 hours per patient varied with the criticality of the emergency: 2.3 for RE, 3.9 for VE and 6.1 for UVE. The mortality rate at 24 hours of first delivery was 1.2% in RE, 2.8% in VE and 10.1% in UVE. Time between prescription and start of transfusion of PRBC in UVE was within 15 minutes in 50% of cases and within 25 minutes in 75% of cases for emergency devoted banks but respectively 25% and less than 50% for others. The proportion of surviving patients having received more than three LBP in 24 hours was 58% in UVE, 33% in VE and 10% in RE. The proportion of over the limit waiting time for PRBC transfusion in UVE is critical, mainly for banks not only devoted to emergencies. The high proportion of UVE and VE patients receiving three PRBC or less in 24 hours may also be an indicator that some physicians do not comply with emergency prescription rules. An effort should be made to improve the activity, in emergencies, of a part of hospital blood banks and the way physicians use them.