Regional
65 years of a philanthropic Brazilian blood bank: achievements and challenges
Afonso José Pereira Cortez
Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
Flavia Roche Moreira Latini
Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
Carine Prisco Arnoni
Associação Beneficente de Coleta de Sangue, São Paulo, Brazil
Established on August 15th, 1959, by the engineer Othon Barcello and his friends, Colsan – Beneficent Association of Blood Collection was inspired by German Red Cross model. During this almost completed 65 years-old, Colsan as a philanthropic association, plays an important role in hemotherapy, mainly within public Brazilian healthcare system.
From the beginning, with a blood collection site in São Paulo downtown and a blood collection bus (Figure 1) that daily moved to industries and commercial streets, until today, with 10 blood collection sites that receive approximately 15,000 blood donors monthly, Colsan is maintaining the purpose of contributing to solve blood shortages in São Paulo state. Focusing on reliable and secure processes, Colsan currently supplies more than 100 hospitals in the state of São Paulo, including, São Paulo city and surrounding cities, countryside cities and beachside cities, attending an area of 18 million population.
Depending almost exclusively of public resources is a dare scenario in Brazil, since adjustment of reimbursement rates does not keep pace with the increases in suppliers’ costs and human resources. The difficult equation to adjust growing expenses to a stationary incoming pushes us to be more efficient in our processes, to be creative in our solutions, and to consolidate partnerships with suppliers and service providers. Over the years, in the face of difficulties and through adaptability, Colsan constructed a solid history marked by both accomplishments and challenges.
Figure 1: Colsan blood collection bus
Regarding achievements, certainly the most important is the sufficiency of blood collection resulting in enough blood components to partner hospitals. Strategic located blood collection sites, campaigns focused on specific populations, a continuous monitoring of efficiency and a high production of platelets result in an enough supply to attend transfusion needs. This capacity was put to the test during the pandemic, when, in association with other practices, we managed to meet expectations [1]. Currently, Colsan collects around 165,000 blood units per year. During 2023, Colsan was responsible for suppling blood components for 203,014 transfusions. Considering that Colsan attend a net of hospitals with a wide range of complexity responsible for 10,877 beds, total annual rate of transfusions/bed is 18.66.
With a continuous focus on quality and security, strategies to improve monitoring increased during past 4 years, specially using Google Workspace. Aiming at improving rational blood usage avoiding unnecessary transfusions, restrictive protocols are adopted in hospitals served by Colsan. We developed a dynamic panel to monitor medical interventions on 57 transfusion sites managed by Colsan hosted in partner hospitals. Random clinical evaluation of transfusion requirements during a 13-month period between January, 2022 and May, 2023, avoided 10,371 transfusions which were requested in disagreement with good practice or institutional protocol. Although there are a high number of unnecessary requests by client hospitals, we proved to be effective on detecting these solicitations. Also, we are able to fight against it by training and orienting clinical staff about rational use of blood and importance of stablishing a partnership with the specialist doctor.
Another important achievement involves both molecular and serologic immunohematology. Since 2011, Colsan is investing on development and implementation of molecular immunohematology, resulting in 27 published articles in scientific journals until 2023.
Predominantly, these articles include publication of adopted strategies to enable certain genotyping flows with limited resources [2, 3], of novel alleles [4, 5] and of prevalence of some characteristics in Brazilian population [6, 7]. Importantly, with a partnership with a reference laboratory in Paris, France, and Unicamp (São Paulo, Brazil) investigation of a patient attended by Colsan resulted on discovery of the first Brazilian blood group system that was named ABCC1. Besides, the immunohematology molecular together with serologic laboratories drive rare donor screening, as today we maintain an updated registration of these donors that are requested to donate according to specific patients need. Our reference immunohematology laboratory receives around 450 patient’s samples per month from network of hospitals served by Colsan and works as a reference laboratory for other services and immunohematology reagents suppliers.
Complementing achievements, challenges significantly contribute to Colsan growth and development as an important player in São Paulo state hemotherapy. Considering Colsan capillarity, besides taking collected blood units and donor samples to blood producing and infectious disease/immunohematology laboratories, respectively, blood components are daily delivered to network of hospitals and patient’s samples are often taken to central immunohematology laboratory. As distances can reach 250km (155 miles) and, monthly, transport fleet circulate around 40,000km (24,855 miles), logistics is a huge challenge to the decentralized structure of Colsan. In addition, platelets supply complicates the logistic challenge due to its short shelf life. To attend this rising demand, different models are adopted. Logistic routine comprises either motorcycles and cars, and both own and outsourced fleets. To overcome difficulties, we are constantly working on strategies to improve providers and searching for new partners. Thus, logistic net must comprise routes to achieve required hospitals, considering optimization of itineraries, distances from blood components distributions centers, complexity of services and components shelf life.
Other important challenges are recruitment of Rh negative blood donors and blood components inventory management. As patient’s need of Rh negative red blood cells (RBC) units is proportionally higher than availability of Rh negative blood donors, recruitment of these specific donors is often a preoccupation. Monitoring the availability and usage, avoiding unnecessary use of Rh negative RBC units, is fundamental to dribble Rh negative RBC units shortage. Concerning blood components inventory management, Colsan strategically have 4 regional blood components distribution centers. Development of tools and flows to manage the inventory is on constant change to fulfill needs to orchestrate collection, local inventories, logistics and waste.
Along last 65 years Colsan successfully merged the history with hemotherapy in the São Paulo state. Adapting through difficulties and overcoming challenges, Colsan grew as an important partner of public health system. Nowadays, Colsan is proud to deliver blood components with quality and security to network of attendance, always improving and developing its processes.
References
- Costa CB, Cortez AJP, Adao DD, de Almeida CM, Taguchi EM, de Oliveira I, et al. Optimization of red blood cell unit storage during SARS-COV-2 Pandemic: adopting new strategies to ensure supply in a decentralized blood bank in Brazil. Hematol Transfus Cell Ther. 2021; 43: 229-35.
- Arnoni CP, Latini FR, Muniz JG, Gazito D, Person Rde M, de Paula Vendrame TA, et al. How do we identify RHD variants using a practical molecular approach? Transfusion. 2014; 54: 962-9.
- Arnoni CP, Latini FR, Muniz JG, Person RD, Vendrame TA, Gazito D, et al. A simple approach to screen rare donors in Brazil. Immunohematology. 2015; 31: 20-3.
- Aparecida de Paula Vendrame T, Latini FRM, de Medeiros Person R, Cortez AJP, Castilho L, Arnoni CP. Molecular characterization of three novel RHD alleles in Brazilians. Transfusion. 2018; 58: 1814-5.
- Arnoni CP, Gazito D, Muniz JG, Person Rde M, Brandao F, Marques MG, et al. Two novel KEL alleles encoding K0 phenotypes in Brazilians. Transfusion. 2014; 54: 2128-9.
- Arnoni CP, Vendrame T, Muniz J, Cortez A, Latini F, Castilho L. RHCE diversity among Brazilian patients with sickle cell disease (SCD) and selected groups of blood donors. Transfusion. 2021
- Arnoni CP, Silva NM, Silva FS, Parreira RM, Vendrame T, Miola MP, et al. Genetic diversity of Gerbich alleles in Brazilians reveals an unexpected prevalence of the GE:-2,-3,4 phenotype. Vox Sang. 2023; 118: 873-80.
