Fresh blood product manufacture, issue, and use: A chain of diminishing returns?

The available pool of potential blood donors continues to decrease. There are blood component losses all along the chain of production from the recruitment of the donor, attendance and bleeding of the donor, production process, storage of the inventory in the blood center, storage in the hospital or laboratory, selection, and transfusion of the recipient. There is a requirement and potential to improve product availability by better recruitment strategies, production methods, inventory management, and recipient selection. All of these areas of transfusion medicine have been investigated, and some data and options for improving donor/donation utilization are available in the literature. There are also some developing strategies that have the potential to have a positive influence on the availability of blood components. They include the use of blood components that have often been regarded as expensive. Further studies are required to determine if products such as leukoreduced red cells and platelets, unrefrigerated or fresh whole blood, and some recombinant products can conserve large numbers of other components or reduce hospital costs.