The Production and Supply Chain Management of Kuwait Central Blood Bank against Disastrous

Times

Dr. Raed Al-HusainDepartment of Quantitative Methods and

Information SystemsKuwait University

Facts

• According to World Health Organization (WHO) (2011), while the need for secure supply of blood continues to grow, more than 70 countries lack the necessary rate of blood donation in order to meet their required demand, and many patients die due to shortages in blood supply.

Facts

• News Medical (2010) reported that a study conducted on hospitals in the U.S. and Europe, that annual expenditures on blood and transfusion for surgical patients costs $1.6 to $6.0 million per hospital, 37% higher than estimated by prior studies.

Facts

• Nationwide Blood Collection and Utilization Survey Report (2007) stated that 4.5 million Americans will need blood transfusion each year, yet only 37 percent of the U.S. population is eligible to donate blood and less than 10% do annually.

Facts

• A study by Cant (2006) stated that in 2001, 7% of U.S. hospitals had to postpone surgeries due to shortages in blood inventories.

• A survey study conducted by Toner (2011)in the U.S., states that the cost of acquisition, screening, and transfusion of blood had increased over the past 5 years due to blood shortages.

Facts

• In order to cope with its increasing cost and instability of supply, effective and efficient supply chain practices of blood is essential to ensure blood transfusion procedures for those in need.

Blood Basics

• Blood banks fractionate the whole blood in to different components:– Cryoprecipitate (Cryo):• prepared from Plasma and be kept Frozen and has a

shelf life of up to one year.

– White blood cells (leukocytes):• Transfusion is rare and can last from 18 – 36 hours.

– Red blood cells (RBC):• Most common in the blood and has a shelf life of about

35 days.

Blood Basics

– Platelets:• They cannot be refrigerated or frozen as they will be

destroyed, which make them very valuable product and require extra care when dealt• Platelets have a shelf life of 5 days only.

– Plasma:• It has shelf life of up to 2 years and can be frozen.

– Fresh frozen plasma (FFP):• very similar to plasma's content except that it is

prepared and frozen at -18 C○ or colder within 8 hours from donation time, whereas plasma is frozen within 24 hours of donation time.

Blood Basics

• Blood types are divided into different groups referred to as the ABO groups.

• There are 8 different ABO group types

Blood Basics

• The most common blood types are O+ and A+, but they are also the types that cause the most concern.

• Many potential donors with these types of blood are reluctant to donate thinking that their blood is not needed much, where in reality their blood type is really used more than twice as much as any other types.

Blood Basics

• The rarest type is AB-. • It has been estimated that only about 1 in 170

people have this type. • Next most rare blood type is the B-, About 1 in

every 70 people has this type.

Blood Supply Chain

Blood Supply Chain

• Donation Process:– It starts with a volunteer

donor who gives a unit of 417ml of blood cells.

– The blood donation process could take place either at a local blood bank, or at a different blood donation sites.

– The donated blood is then transferred to the nearest processing center, or any alternative center in case of overflow or emergency demand.

Blood Supply Chain

• Blood Processing:– At the processing center a

blood unit is tested and processed into different components.

– After the testing is being completed and the blood cell unit is being approved, it is then transferred to a hospital in need, either based on a schedule or an emergency requisition.

Blood Supply Chain• Blood Transfusion at Hospitals:

– A blood bank within the hospital then makes that blood available to a patient and eventually transfused.

– A blood unit that is crossmatched for transfusion and labeled as assigned inventory but not used, is returned to the hospital's unassigned inventory.

– An excess in blood inventory at a local hospital could be returned to a processing center where it is reallocated again to different hospitals.

Major Issues of Blood SC• Wastage of blood

components:– For RBCs, wastage can be

caused due to time expiry and out of temperature control due to refrigerator failure.

– For platelets, over 95% of wastage is due to time expiry either within the blood processing center or the hospital as well, in which they are ordered for surgical purposes but then fail to be transfused; hence unable to be returned to the blood processing center or allocated for another patient.

Major Issues of Blood SC

• Transfusion mismatch:– Caused from patients

receiving the wrong blood type.

– Although it is rare, it remains an important cause of mortality.

Major Issues of Blood SC

• Blood shortages:– Blood shortages

normally occur in areas where disasters strike.

– Another reason for the blood shortage include increased use of blood for more advanced procedures than blood transfusion.

Major Issues of Blood SC

• Collaboration between all various elements of the supply chain: – Caused by the lack of data

sharing of supply chain players (donation centers, processing centers, and hospitals).

– Lack of horizontal visibility at the end of the supply chain.

– Hospitals are usually individually responsible for the fate of the blood.

Literature Review

• The interest in the management of blood banks services dates back to the early 1960s.

• However, only most recent work will be discussed here.

• Angelis et al. (2001) developed a goal programming model with multi-product and multi-period to determine the best assignment of blood resources to demand.

• The objective of their model is to minimize the quantity of blood imported from outside the system and stabilize the quantities assigned daily.

Literature Review

• Kozan (2001) developed a stochastic model that simulates the blood bank inventory system of a hospital over a finite number of days.

• The study examined the influence of mean and variation of daily transfusion, the remaining shelf life of blood units shipped from the blood supplier, and the number of days between consecutive shipments on blood outdates and shortages.

Literature Review

• Blake et al. (2003) developed a dynamic programming model to determine local inventory ordering policies for platelet suppliers.

• Bosnes et al. (2005) used regression analysis in order to predict the daily number of blood donors arrival in peruse to minimize the waiting time in blood donation centers.

Literature Review

• Katsaliaki and Brailsford (2007) conducted a case study on a UK hospital blood inventory system.

• A simulation model was used to monitor the entire supply chain of blood, from donor to recipient.

• Their objective was to determine an ordering policy that will lead to the reduction in blood shortages and wastages, increased service levels, improved safety procedures, and reduced costs.

Literature Review

• A similar study was conducted by Jennings (2009), where a detailed inventory model of a hospital blood bank was developed using simulation.

• The main objective was to study the effect of the hospital's inventory policies on blood shortages and blood outdates.

Literature Review

Kuwait Central Blood Bank (KCBB)

• KCBB is the major blood provider in Kuwait for both governmental and privet hospitals.

• The blood supply chain network of KCBB is very similar to the general network shown earlier.

• However, the unused blood units at hospitals are kept in their local blood bank inventory and not returned back to KCBB.

• KCBB produces 6 types of blood components:1. Leukocyte reduced RBCs (LR-RBCs)2. Leukocyte reduced FFP (LR-FFP)3. Cryo-depleted plasma (Plasma)4. Cryoprecipitate (Cryo)5. Apheresis FFP (APH-FFP)6. Platelet Apheresis (PC-APH)

Kuwait Central Blood Bank (KCBB)

Kuwait Central Blood Bank (KCBB)

• The production process at KCBB includes the following stages:– Registration and donation– Testing and processing– Storing and delivery – Delivery to hospitals.

• A detailed description of the production process is shown in the following diagram.

Kuwait Central Blood Bank (KCBB)

When Disaster strikes

• During al Jahra Fire accident in 2009, KCBB was faced with huge blood shortage and needed 400 donations of blood daily to maintain its emergency supply.

• More recently, during Eid Al-Adha holiday in 2011 the number of donors dropped to 40 donors only.

• There were many casualties across Kuwaiti hospitals which have led to an acute shortage of blood supplies as a result of road accidents and illnesses.

When Disaster strikes

• Accordingly, disasters may affect supply, demand, or even both.

• A quantitative models of how blood banks, KCBB in specific, should react to disasters are very limited.

Research Methodology

Research Methodology

• This research aims to analyze the production process and supply chain management of KCBB via simulation modeling.

• The objective of the simulation model is to identify:– Problems of the current

KCBB production system.– Problems of KCBB’s Supply

Chain.

• Moreover, simulation will aid to conduct sensitivity analysis that will enable to test the current KCBB system against:– The surge of unexpected demand during time of

crises– The issue of donation shortages during scarcity

time, such as holidays.

Research Methodology

Performance Measures

• Production cycle time:– Enables to distinguish the production time for all blood

components from the point of donation until they are ready for delivery.

• Blood wastage:– in order to be minimized, its important to know its

causes through out the production and supply chain system.

• Blood shortage:– Simulation will enable to determine how much, how

often, and of what components blood shortages occur in KCBB system.

Thank You