why "we" should care presented to: international blood safety forum jed gorlin md, mba...
TRANSCRIPT
Why "We" should Care
Presented to: International Blood Safety ForumJed Gorlin MD, MBAMarch 20, 2015
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Win-Win solutions
• Advantages for industry– Growing markets
• Advantages for 1st world blood programs– Motivating Staff
S/D Factors
Increase Decrease
Demand Aging populationAggressive Cancer therapy for older patientsIncreased insurance coverageCord blood vs PBSC TransplantOther cell RxPathogen Rx (if product loss during manufacture)Broader use of anticoagulants
High deductible health plans decrease elective proceduresBlood management (fewer units per transfusion, lower Tx triggersClinical trialsBlood substitutes? Trends towards smaller family size (decreased childbirth)
Supply 16 yo donors, tattoo licensingDouble RBCABO inventory issuesMore rationale malaria deferrals/testBlood center importers increasing collections to achieve independence
Aging population Increase in Hgb eligibility, deferral period (to protect donor Iron)Trials showing older blood is “bad”Additional required tests (Babesia, Dengue, Chikungunya) or travel deferrals
Innovative Blood ResourcesRBC Local Usage FY2010 – FY2014
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Advantages for industry
• US RBC market is shrinking 2-5%/year (and decline shows little sign of leveling off)– Usage was >50 RBC units/1000 population
• Now below 45 but Canada is in mid 30’s • Group purchasing and health care systems formally
adopting blood management programs• Choosing Wisely encouraging lower RBC
use/transfusion volume (1 vs. 2 units)• Accountable care intended to make all hospital
spending a cost center, not a revenue driver
Emerging markets
• Want adequate supplies– Help in collecting
enough blood– Access to
economical quality blood collection equipment
– Access to quality systems
• Software supportable by local staff and able to run on simple IT systems
• Want safe blood– Western model of >$1
million/QUALY not sustainable– But: Is pathogen inactivation
cheaper than broad scale screening?
– Pre-donation rapid tests can add a layer of safety but not adequate alone
Rwanda Blood Transfusion
CNTS collects 38,000 volunteer units fully tested for HIV, Hepatitis B & C
Afghanistan Maternity Hospital (Rabia Balkhi) transfusion service
ABO/Rh typing but no Antibody screen
Whole blood is collected from family Replacement donors
Malalai maternity hospital
• Malalai hospital had exactly one O negative unit and only 3 O+ units on the shelf. They have over 120 deliveries daily!
Market opportunities
• Honduras Red Cross• Dr. Elizabeth Vinelli
– CEO received donation of older model Hemocue devices but couldn’t obtain cuvettes in local market
– I contacted HemoCue North America to facilitate access to needed supplies
Market opportunities: Kazakhstan
• National blood program has access to• NAT testing• Pathogen inactivation• Blood irradiation• Automated collections
AIHA Central Asia Project
• Kazakhstan is almost as large as US but has 18 million people– GDP/capita ~12K
• Kyrgyzstan has ~6 million people– GDP/capita ~1K
• US has ~350 million people and GDP/capita ~58K
AABB poster 132
• A Voluntary non-remunerated blood program in the Kyrgyz republic– Over the last 20 years, the # of active blood donors in
Kyrgyzstan has declined almost 6 fold from Soviet times with current rate ~5/1,000 pop.
– Majority of current donors are family/replacement donors– Program aims to increase VNRD from 23 to 50% by 2018
and reduce TTI discards from 18% to 10 % .
• 2013 results: 34 K donations– 75% FRD, 23% VNRD, 2% paid – Increase to ~6/1,000
Kyrgyz Prikaz (Order)
AIHA Goal:Work with local KyrgyzStaff to update PrikazThis is the main orderthat sets all rules and requirements for blood transfusionDr. Chursin, director of Anesthesia at the largest hospital in Almaty had done similar work in Kazakhstan
KYR Blood donor center collections
Blood typing and hemoglobin screening
Donor testing tubes- no vacutainers were available, so diversion pouches were not used
KYRGYZSTAN:Whole blood platelets are made upon order for a specific patient
Market Opportunity: China
• Active competition to provide technology for:– Automated
collections• Apheresis platelets,
double red cells
– Advanced testing• NAT testing• Pathogen inactivation
Qingdao blood center
Motivation for staff