National Plan for the Management of Shortages of Labile Blood Components
The specific purpose of the Plan is to maximize the effectiveness of a national response to any crisis which impacts the adequacy of the blood supply in Canada, with primary emphasis on the jurisdictions served by CBS, but also in contemplation of close collaboration with participants of the blood system in Québec.
Dr. Heather Hume, Co-Chair
Executive Medical Director, Transfusion Medicine
Canadian Blood Services
Dr. Susan Nahirniak, Co-Chair
Chair, National Advisory Committee
Alberta Health Services, Edmonton, AB
Executive Summary
Labile blood components, i.e. those blood components collected, produced and distributed by Canadian blood suppliers, are a vital resource supporting health care in Canada. The supply of these resources could be compromised by a number of external threats such as labour disruptions, endemic disease outbreaks, extreme weather disturbances or disruptions in transportation systems. In times of severe shortages, the allocation of blood components could present a significant challenge to the provision of health care. To prepare for such a challenge, the Canadian Blood Services (CBS) Provincial/Territorial (P/T) Blood Liaison Committee asked the National Advisory Committee on Blood and Blood Products (NAC) to develop a framework to determine the equitable allocation of labile blood components in times of severe shortage. In response to that request NAC, in collaboration with CBS, produced a draft framework document which was then widely circulated among potential stakeholders for comment, and then revised, taking into consideration the comments received. This document, the National Plan for the Management ofShortages of Labile Blood Components (hereafter called the Plan) is the recommended framework developed through that process.
The specific purpose of the Plan is to maximize the effectiveness of a national response to any crisis which impacts the adequacy of the blood supply in Canada, with primary emphasis on the jurisdictions served by CBS, but also in contemplation of close collaboration with participants of the blood system in Québec. The Plan assumes that all efforts to increase the available supply of blood components have been exceeded and addresses the allocation of the available scarce blood supply. The Plan addresses labile blood components; however many of the principles would also be applicable to a shortage of fractionated or recombinant plasma protein products.
The Plan provides a framework which will enable P/T Ministries of Health and hospitals/regional health authorities (RHA) to develop their own blood shortage management plans in a manner that is congruent with the national Plan. This approach is aimed at achieving the consistency and collaboration crucial to the effective management of a blood shortage.
Based on a number of stated assumptions, the Plan addresses four phases of inventory availability – Green, Amber, Red and Recovery.
- Green Phase implies that normal blood component inventory levels exist and supply generally meets demand. This phase includes a broad range of inventory levels ranging from an ideal inventory to shortages that occur periodically and can be managed with existing CBS and hospital/RHA actions.
- Amber Phase implies that the national blood inventory is insufficient to continue with routine transfusion practices and hospitals/RHA will be required to implement specific measures, as outlined in this document, in order to reduce blood usage.
- Red Phase implies that blood inventory levels are insufficient to ensure that patients with non-elective indications for transfusion will receive the required transfusion(s).
- Recovery Phase implies that blood component inventories have begun to increase and are expected to be maintained at a level which would enable the return from Red to Amber and subsequently to Green Phase.
The roles and responsibilities of the principal participants, namely CBS, P/T Ministries of Health and Canadian hospitals/RHA, in each of these phases is described in this document. The emergency blood management committees that would be required to successfully manage a blood shortage as well as a proposed communication plan are also described.
The optimal management of a severe blood shortage will depend upon the commitment of all stakeholders in the blood system to work collaboratively to assure that scarce resources are used in a fair and equitable manner. The Plan is intended to provide a framework, which if followed, will ensure that optimisation. It is nevertheless recognized that lessons will be learned in each shortage situation and it is anticipated that the Plan will undergo modification following each situation in which it is implemented.