Objective To estimate the long-term effect of the changing demography in China on blood supply and demand. Methods We developed a predictive model to estimate blood supply and demand during 2017-2036 ...in mainland China and in 31 province-level regions. Model parameters were obtained from World Population Prospects, China statistical yearbook 2016, China's report on blood safety and records from a large tertiary hospital. Our main assumptions were stable age-specific per capita blood supply and demand over time. Findings We estimated that the change in demographic structure between 2016 (baseline year) and 2036 would result in a 16.0% decrease in blood supply (from 43.2 million units of 200 mL to 36.3 million units) and a 33.1% increase in demand (from 43.2 million units to 57.5 million units). In 2036, there would be an estimated shortage of 21.2 million units. An annual increase in supply between 0.9% and 1.8% is required to maintain a balance in blood supply and demand. This increase is not enough for every region as regional differences will increase, e.g. a blood demand/supply ratio > 1.45 by 2036 is predicted in regions with large populations older than 65 years. Sensitivity analyses showed that increasing donations by 4.0% annually by people aged 18-34 years or decreasing the overall blood discard rate from 5.0% to 2.0% would not offset but help reduce the blood shortage. Conclusion Multidimensional strategies and tailored, coordinated actions are needed to deal with growing pressures on blood services because of China's ageing population. Objectif Estimer I'effet a long terme de revolution demographique en Chine sur l'approvisionnement et la demande en produits sanguins. Methodes Nous avons elabore un modele de prevision pour estimer l'approvisionnement et la demande en produits sanguins en Chine continentale et dans 31 provinces entre 2017 et 2036. Les parametres du modele ont ete definis a partir des Perspectives de la population mondiale, de l'Annuaire statistique 2016 de la Chine, du Rapport de la Chine sur la securite transfusionnelle et des dossiers d'un important hopital de soins tertiaires. Nous sommes partis de l'hypothese que l'approvisionnement et la demande en produits sanguins par habitant et par groupe d'age etaient stables dans le temps. Resultats Nous avons estime que Revolution de la structure demographique entre 2016 (annee de reference) et 2036 entrainerait une diminution de l'approvisionnement en produits sanguins de 16,0% (de 43,2 millions d'unites de 200 mL a 36,3 millions d'unites) et une augmentation de la demande de 33,1% (de 43,2 millions d'unites a 57,5 millions d'unites). Nous estimons qu'en 2036, il manquera 21,2 millions d'unites. Une augmentation annuelle de l'approvisionnement de 0,9% a 1,8% est necessaire pour maintenir un equilibre entre l'approvisionnement et la demande en produits sanguins. Cette augmentation n'est pas suffisante pour toutes les regions, car les differences regionales vont s'accentuer. Par exemple, un rapport demande/approvisionnement en produits sanguins greater than or equal to 1,45 d'ici a 2036 est prevu dans les regions qui comptent un nombre eleve d'habitants ages de plus de 65 ans. Les analyses de sensibilite ont montre qu'une augmentation des dons de 4,0% chaque annee par des individus ages de 18 a 34 ans ou une diminution du taux global de rejet de produits sanguins de 5,0% a 2,0% ne permettrait pas de reduire a neant la penurie de produits sanguins, mais aiderait a la resorber. Conclusion Des strategies multidimensionnelles et des actions adaptees et concertees sont necessaires pour faire face aux pressions croissantes qui pesent sur les services de transfusion sanguine en raison du vieillissement de la population chinoise. Conclusion Se necesitan estrategias multidimensionales y acciones coordinadas y adaptadas para hacer frente a la creciente presion sobre los servicios de transfusion de sangre debido al envejecimiento de la poblacion de China. Objetivo Estimar el efecto a largo plazo de los cambios demograficos en China sobre la oferta y la demanda de sangre. Metodos Se desarrollo un modelo predictivo para estimar la oferta y la demanda de sangre durante el periodo en China continental y en 31 provincias. Los parametros del modelo se obtuvieron de World Population Prospects (Perspectivas mundiales de poblacion), China statistical yearbook 2016 (Anuario estadistico de China 2016), China's report on blood safety (Informe de China sobre seguridad de la sangre) y de registros de un gran hospital terciario. Los supuestos principales eran la estabilidad de la oferta y la demanda de sangre per capita especifica de la edad a lo largo del tiempo. Resultados Se estimo que el cambio en la estructura demografica entre 2016 (ano inicial) y 2036 resultaria en una disminucion del 16,0% en el suministro de sangre (de 43,2 millones de unidades de 200 ml a 36,3 millones de unidades) y un aumento del 33,1% en la demanda (de 43,2 millones de unidades a 57,5 millones de unidades). En 2036, habria una escasez estimada de 21,2 millones de unidades. Se requiere un aumento anual de la oferta de entre el 0,9% y el 1,8% para mantener un equilibrio entre la oferta y la demanda de sangre. Este aumento no es suficiente para todas las regiones, ya que las diferencias regionales aumentaran, por ejemplo, se pronostica una relacion entre la demanda y la oferta de sangre mayor que o igual a = 1,45 para el ano 2036 en regiones con grandes poblaciones mayores de 65 anos. Los analisis de sensibilidad mostraron que el aumento de las donaciones en un 4,0% anual por parte de las personas de 18 a 34 anos o la disminucion de la tasa general de descarte de sangre del 5,0% al 2,0% no compensaria sino que ayudaria a reducir la escasez de sangre.
Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions ...is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally.
We did a modelling study involving 195 countries and territories. We used blood component preparation data from 2011-13 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need.
In 2017, the global blood need was 304 711 244 (95% uncertainty interval UI 293 064 637-314 049 479) and the global blood supply was 272 270 243 (268 002 639-276 698 494) blood product units, with a need-to-supply ratio of 1·12 (95% UI 1·07-1·16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102 359 632 (95% UI 93 381 710-111 360 725) blood product units, equal to 1849 (1687-2011) units per 100 000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs.
Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries.
National Institutes of Health.
This policy statement is intended to provide information to guide pediatricians, obstetricians, and other medical specialists and health care providers in responding to parents' questions about cord ...blood donation and banking as well as the types (public versus private) and quality of cord blood banks. Cord blood is an excellent source of stem cells for hematopoietic stem cell transplantation in children with some fatal diseases. Cord blood transplantation offers another method of definitive therapy for infants, children, and adults with certain hematologic malignancies, hemoglobinopathies, severe forms of T-lymphocyte and other immunodeficiencies, and metabolic diseases. The development of universal screening for severe immunodeficiency assay in a growing number of states is likely to increase the number of cord blood transplants. Both public and private cord blood banks worldwide hold hundreds of thousands of cord blood units designated for the treatment of fatal or debilitating illnesses. The procurement, characterization, and cryopreservation of cord blood is free for families who choose public banking. However, the family cost for private banking is significant and not covered by insurance, and the unit may never be used. Quality-assessment reviews by several national and international accrediting bodies show private cord blood banks to be underused for treatment, less regulated for quality control, and more expensive for the family than public cord blood banks. There is an unquestionable need to study the use of cord blood banking to make new and important alternative means of reconstituting the hematopoietic blood system in patients with malignancies and blood disorders and possibly regenerating tissue systems in the future. Recommendations regarding appropriate ethical and operational standards (including informed consent policies, financial disclosures, and conflict-of-interest policies) are provided for physicians, institutions, and organizations that operate or have a relationship with cord blood banking programs. The information on all aspects of cord blood banking gathered in this policy statement will facilitate parental choice for public or private cord blood banking.
Fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridioides difficile infection and is potentially beneficial in other microbiota‐related disorders. The provision of ...FMT in routine clinical practice requires an extensive infrastructure that is reliant on voluntary donors. Alongside an increasing demand for FMT, the logistic barriers of a large‐scale donor‐dependent operation and the difficulties among health authorities to regulate FMT limit the dissemination of sustainable FMT services. Blood centers are large organizations that handle a multitude of donor‐dependent operations on a daily basis. Blood and feces share many of the same dependencies, and feces may present a new opportunity for the blood services to handle. In this paper, we describe how an FMT service may be established and embedded within the blood service infrastructure, and we explain the benefits of using blood donors as feces donors. We further explore the current indications of FMT, the challenges related to the lack of legislation, and the future perspectives for blood banks to meet a new and increasing demand.
BACKGROUND
In 2011 and 2013, the National Blood Collection and Utilization Survey (NBCUS) revealed declines in blood collection and transfusion in the United States. The objective of this study was ...to describe blood services in 2015.
STUDY DESIGN AND METHODS
The 2015 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated.
RESULTS
Response rates for the 2015 NBCUS were 78.4% for blood collection centers and 73.9% for transfusing hospitals. In 2015, 12,591,000 units of red blood cells (RBCs) (95% confidence interval CI, 11,985,000‐13,197,000 units of RBCs) were collected, and 11,349,000 (95% CI, 10,592,000‐11,747,000) were transfused, representing declines since 2013 of 11.6% and 13.9%, respectively. Total platelet units distributed (2,436,000; 95% CI, 2,230,000‐2,642,000) and transfused (1,983,000; 95% CI, 1,816,000 = 2,151,000) declined by 0.5% and 13.1%, respectively, since 2013. Plasma distributions (3,714,000; 95% CI, 3,306,000‐4,121,000) and transfusions (2,727,000; 95% CI, 2,594,000‐2,859,000) in 2015 declined since 2013. The median price paid per unit in 2015—$211 for leukocyte‐reduced RBCs, $524 for apheresis platelets, and $54 for fresh frozen plasma—was less for all components than in 2013.
CONCLUSIONS
The 2015 NBCUS findings suggest that continued declines in demand for blood products resulted in fewer units collected and distributed Maintaining a blood inventory sufficient to meet routine and emergent demands will require further monitoring and understanding of these trends.
Summary
Unrelated cord blood (CB) units, already manufactured, fully tested and stored, are high‐quality products for haematopoietic stem cell transplantation and cell therapies, as well as an ...optimal starting material for cell expansion, cell engineering or cell re‐programming technologies. CB banks have been pioneers in the development and implementation of Current Good Manufacturing Practices for cell‐therapy products. Sharing their technological and regulatory experience will help advance all cell therapies, CB‐derived or not, particularly as they transition from autologous, individually manufactured products to stored, ‘off‐the shelf’ treatments. Such strategies will allow broader patient access and wide product utilisation.
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