1
Armed Services Blood ProgramUpdate
COL Frank RentasDirector, Armed Services Blood Program Office
www.militaryblood.dod.mil UNCLASSIFIED
2009 Society of Armed Forces Medical Laboratory Scientists
Annual Meeting
Reno, Nevada23 March 2009
2
ASBPO Organizational Structure Service Blood Program Officers COCOM JBPOs OIF/OEF Blood Transfusion Statistics Background- Whole Blood Background- Platelets Blood Product Availability Current Policy/Guidance for HIV, HBV, HCV Screening Prior to
Deployment Transfusion-Transmitted Disease Residual Risk Estimates Transmission Countermeasures Current Initiatives Frozen Blood use in Theater Improved Rapid Test Kits DBSS Fresher Blood in Theater Non-FDA Compliant Transfusions Visit to Iraq
www.militaryblood.dod.mil UNCLASSIFIED
Agenda
3www.militaryblood.dod.mil UNCLASSIFIED
ASBPO Organizational Structure
DirectorCOL Francisco J. Rentas
Blood Donor Recruiter Supervisor
Mr. Marty Ricker
Deputy Director, Information Technology
Mr. Don Dahlheimer
Communications and Marketing
Ms. Julie Oliveri
Administrative SpecialistMs. Ginger-Rogers Bass
Deputy Director, Operations
MAJ David Lincoln
Deputy Director, Policy
LCDR Corey Jenkins
Blood Donor RecruitersMarketing Specialist
Ms. Melissa YuNCOIC
SFC Peter Maas
# Military: 4
# Civilians: 25 (5 at ASBPO, the rest all over the world)
4
Air Force Blood ProgramDirector: Lt Col Dianne Davis
QA Manager: Maj George HestilowMedical Consultant: Lt Col Joseph P.R. Pelletier
Navy Blood ProgramDirector: CDR Brian Williamson
QA Manager: Ms. Kathleen WhitlockMedical Consultant: CDR Karin M. Hollis-Perry
Army Blood ProgramDirector: LTC Mike Lopatka
QA Manager: Ms. Kathleen ElderAssistant QA Manager: Mr. Dave Reiber
Medical Consultant: LTC Frank Chiricosta
Service Blood Program Officers
www.militaryblood.dod.mil UNCLASSIFIED
5
COCOM JBPOs
www.militaryblood.dod.mil UNCLASSIFIED
USEUCOM – MAJ Jose Quesada, USA, Landstuhl, GE
USPACOM –CDR Roland Fahie, USN, Camp H. M. Smith, HI
USCENTCOM – LtCol Richard McBride, USAF, Tampa, FL MAJ Kristine Fumia, USAF, CAOC Qatar
USNORTHCOM – LTC Jonathan Branch, USA, JFHQ, Peterson AFB CO
USSOUTHCOM – Mr. Walter I. Diaz, DAC, Miami, FL
6
As of 31 December 2008
OIF/OEF Blood Transfusion Statistics
OIF - 58% reduction in the monthly average of blood products transfused during the last 12 months as compared to 2007
OEF - 23% increase in the monthly average of blood products transfused as well as a 31% increase in red cells during the last 12 months as compared to 2007
Total U.S. Only Non-U.S.Percent
U.S. OnlyPercent
Non-U.S.
Transfused Patients 20,829 4,762 16,067 22.9% 77.1%
WB 6,705 3,571 3,134 53.3% 46.7%
RBCs 112,736 29,494 83,242 26.2% 73.8%
Platelets 5,532 1,857 3,675 33.6% 66.4%
FFP 59,516 16,837 42,679 28.3% 71.7%
CRYO 14,774 5,341 9,433 36.2% 63.8%
www.militaryblood.dod.mil UNCLASSIFIED
7
Whole blood (WB) has been used extensively to resuscitate casualties in military conflicts since World War I
As of 31 December 2008, 3,571 whole blood units have been transfused in theater to 497 US patients
One documented emergency transfusion associated HCV transmission
76% of WB transfusions have taken place in Level II+ facilities (2006-2008)
WB transfusions are down 81.5%, and 83.4% from 2007 and 2006 respectively
Samples for retrospective testing collected on most donations Current JTTS CPG on Whole Blood – Updated November 2008
WB is neither intended nor indicated for routine use WB is to be used only when other blood products are unable
to be delivered at an acceptable rate to sustain the resuscitation of an actively bleeding patient or when specific components are not available
www.militaryblood.dod.mil UNCLASSIFIED
Background- Whole Blood
8www.militaryblood.dod.mil UNCLASSIFIED
Background- Whole Blood
OIF/OEF COMBINED*
308
1086851
21661948
333
0
500
1000
1500
2000
2500
YEAR
WH
OL
E B
LO
OD
T
RA
NS
FU
SIO
NS
2003 2004 2005 2006 2007 2008
*Includes all transfusions until 31 December 2008 (US and Non-US)
9www.militaryblood.dod.mil UNCLASSIFIED
Background- Whole Blood
OIF LEVEL III17%
OEF LEVEL III7%
OIF LEVEL II65%
OEF LEVEL II11%
OIF LEVEL III
OEF LEVEL III
OIF LEVEL II
OEF LEVEL II
Whole Blood Transfusions 2006-2008 OIF/OEF
10www.militaryblood.dod.mil UNCLASSIFIED
Background- Whole Blood
Whole Blood Transfusions 2006-2008 OIF
11www.militaryblood.dod.mil UNCLASSIFIED
Background- Whole Blood
Whole Blood Transfusions 2006-2008 OEF
12
As of 31 December 2008, 1,857 Platelet (PLT) units have been transfused in theater to 744 US patients
Collections in much more controlled environments than WB All collections at level III facilities Donors are pre-screened with all FDA-mandated tests before
allowed to donate Donors normally allowed to donate every two weeks Samples for retrospective testing collected during every donation HIV, HBV, and HCV Rapid testing of most donations Products tested for bacterial contamination
84% of PLT transfusions have taken place in Level III facilities (2006-2008)
PLT transfusions are down 46.5%, and 37.2% from 2007 and 2006 respectively
Current JTTS CPG on Damage Control Resuscitation addresses use of PLTs - Updated February 2009
1:6 PLT/RBC ratio memo signed by Army TSG- February 2009
www.militaryblood.dod.mil UNCLASSIFIED
Background- Platelets
13www.militaryblood.dod.mil UNCLASSIFIED
Background- Platelets
OIF/OEF COMBINED*
0 25
940
1601
1879
1043
0
300
600
900
1200
1500
1800
2100
2400
YEAR
PL
AT
EL
ET
TR
AN
SF
US
ION
S
2003 2004 2005 2006 2007 2008
*Includes all transfusions until 31 December 2008 (US and Non-US)
14www.militaryblood.dod.mil UNCLASSIFIED
Background- Platelets
OIF LEVEL III80%
OEF LEVEL III4%
OIF LEVEL II15%
OEF LEVEL II1%
OIF LEVEL III
OEF LEVEL III
OIF LEVEL II
OEF LEVEL II
Platelets Transfusions 2006-2008
15www.militaryblood.dod.mil UNCLASSIFIED
Background- Platelets
Platelets Transfusions 2006-2008 OIF
16www.militaryblood.dod.mil UNCLASSIFIED
Background- Platelets
Platelets Transfusions 2006-2008 OEF
17
Level III MTFs Red Blood Cells - all blood types but AB Fresh Frozen Plasma - all blood types Cryoprecipitate Platelets Fresh Whole Blood – as needed for emergencies. Destroyed if not
used within 24 hours Level II+ (18 in OIF, 13 in OEF)
Red Blood Cells – mostly Os Fresh Frozen Plasma – 12 MTFs in OEF, 10 in OIF, mostly A and
AB Platelets – very limited, 4 in OIF, one in OEF Fresh Whole Blood – as needed for emergencies. Destroyed if not
used within 24 hours Level II (no surgical capability) and I – No blood products
delivered* * SOF teams have blood available during missions
www.militaryblood.dod.mil UNCLASSIFIED
Blood Product Availability
18
HIV Current USCENTCOM Individual Protection and
Individual/Unit Deployment Policy (MOD Nine, September 2008) requires that HIV screening be performed within 90 days of deployment
HBV No current policy/guidance for screening prior to
deployment. Current USCENTCOM Individual Protection and Individual/Unit Deployment Policy (MOD Nine, September 2008) requires all deploying military personnel to be vaccinated against both Hepatitis A and B
HCV No current policy/guidance for screening prior to deployment
www.militaryblood.dod.mil UNCLASSIFIED
Current Policy/Guidance for HIV, HBV, HCV
Screening Prior to Deployment
19www.militaryblood.dod.mil UNCLASSIFIED
Transfusion-Transmitted Disease Residual Risk Estimates
US Military Donors Seroprevalence US Military Rapid Screen Residual Risk (New test
kits)
US FDA-Cleared Testing Residual Risk
HIV:Medical Surveillance Report 2008 - ArmyActive 1:5882ANG 1:4167AR 1:2381Retrospective testing of 17,387 samples
from actual donors in theater (caveat sample integrity):
No HIV cases identified
OraQuick Advance, WB, kit insert Sensitivity =99.6%
1:1,470,5001:1,041,7501:595,250No cases
Bihl J Trans Med 20071:2,135,000
HCV:Hyams et al. Am J Epi 2001Military 1:208Retrospective testing of 17,387 samples
from actual donors in theater (caveat sample integrity):
Military 1:1932
Axiom, WB, Sensitivity =95.2%1:43331:40,250
Bihl J Trans Med 20071:1,930,000
HBsAg:Retrospective testing of 17,387 samples
from actual donors in theater (caveat sample integrity):
Military 1:2898
First Vue, WB, Sensitivity =84.3%1:18,458
Bihl J Trans Med 20071:277,000
20www.militaryblood.dod.mil UNCLASSIFIED
Transmission Countermeasures
HIV HCV HBVForce Screen 2 years - -
Theater Entrance 90 days - -
Vaccination Not Available Not Available Required by all Services
Pre-Screens ** Yes Yes Yes
Retrospective Testing Yes Yes Yes
Improved Rapid Testing
Yes Yes Yes
** For all PLTs and some WB collections
21
HBV seroprevalence/seroincidence study of recently deployed forces to define epidemiology of HBV in deployed force pending USACHPPM EPICON per CENTCOM SG request to JS
HCV seroprevalence study of recently deployed forces to define epidemiology of HCV in deployed force pending USACHPPM EPICON per CENTCOM SG request to J4S
Draft HA policy to address rapid testing, pre-screening, retrospective testing, and follow up of recipients
Increasing fresh frozen plasma availability at level II+ facilities Making improved rapid test kits available at level II+ facilities Increasing number of facilities collecting apheresis platelets Deglycerolized RBCs available Shipments directly from BTC to Kandahar Navy laboratory technicians assigned to BSD in ATO
www.militaryblood.dod.mil UNCLASSIFIED
Current Initiatives
22
Frozen Blood Use in Theater
www.militaryblood.dod.mil
FDA-approved product: 10 year expiration Tested with all FDA-required tests Frozen fresh (w/6 days): storage lesion issue DoD freezing – ASBPO monitoring production/use Deglycerolized: 14 day expiration Supplement to liquid red cells Washed product (↓ leukocytes; removes plasma
proteins and cytokines which have been involved recently with ↑ infections in transfused recipients)
Being transfused at all 3-level III trauma centers
237
Much improved Hepatitis C and Hepatitis B kits are now available in theater
Level III MTFs and Blood Support Detachments Blood personnel making them available to level II+ facilities
Intent is to test as many whole blood units as possible and all platelet collections in theater before transfusion
HIV rapid test kits continue to perform with high degree of specificity and sensitivity
New Rapid Test Kits in Theater
www.militaryblood.dod.mil
24
DBSS COTS
www.militaryblood.dod.mil UNCLASSIFIED
Armed Services Blood Program
25www.militaryblood.dod.mil UNCLASSIFIED
Fresher Blood to Theater
26
Non-FDA Compliant Transfusions
Past Thank you for your support.
Present 1096 Individuals in system 20 Countries 7 countries presently linked into the Non-FDA database system Process on track and monitored closely
Future Incorporate NATO countries - future conflicts Establish international agreement for the exchange of
transfusion related information. Incorporate Veterans Administration into system
www.militaryblood.dod.mil UNCLASSIFIED
27
Balad
www.militaryblood.dod.mil UNCLASSIFIED
Fresher blood (<15 days old) shelf
Deglycerolized Red Cell units (frozen red cells)
28
BTC Qatar working nights
www.militaryblood.dod.mil UNCLASSIFIED
29
Good Luck!!
Best Wishes!!
30
Thanks for everything you do to take care of our customers!!