In Focus
Remote Site Blood Management (RSBM)
Shaping the future of remote blood management
Many blood transfusion medicine programs distribute small numbers of blood units, and occasionally other blood products, to blood fridges that are remote from the central transfusion laboratory.
Background
Examples of remote blood fridges include departments within hospitals such as obstetrics, emergency departments and theatres, small hospitals that are some distance away from the central transfusion laboratories, remote clinics or hospices and emergency stations supporting ambulance or air ambulance rescue.
These remote fridges would typically hold emergency use only units, predominately O Rh(D) negative and small units of crossmatched blood where the recipient may not be able to travel to a larger hospital.
Remote site blood management requires processes and systems in place to ensure the safe and efficient handling of blood and blood products at locations distant from a central blood bank or laboratory. These involve managing the storage, handling, transportation, and issuance of blood and blood products while adhering to strict safety, quality and traceability standards.1,2
Remote sites, often with limited resources, struggle to accurately monitor the out-of-fridge time of blood components, a key factor in ensuring cold chain compliance and patient safety. In addition, blood replenishment frequently relies on manual inventory processes or fixed-schedule stock rotations, leading to inefficiencies such as blood wastage or shortages caused by fluctuating blood donations. Assurance of cold chain compliance and the management of product expiry and rotation back into general inventory for transferring blood and blood products between facilities can help optimize blood utilization and reduce wastage.3,4,5
The issues that the central transfusion laboratory encounter are well known and include poor visibility of current stock and inadequate record keeping at the remote site. By implementing robust systems and processes for remote site blood management, healthcare providers can ensure the safe and efficient delivery of blood and blood products to patients, even in challenging settings.
Figure 1. PJM CAS Antenna
Radiofrequency identification tracking system for Blood Management
Radiofrequency identification tracking system (RFID) is a technology that can provide real-time visibility of all units in storage and real-time visibility of all movements including who actioned them when linked with the storage device access control.
This visibility is completely independent of the user following any proper procedures and enables complete end-to-end traceability with a full audit trail, cold chain record-keeping, compliance and automated compliance enforcement at all times. RFID has the potential to eliminate wastage and avoidable human errors in blood transfusion.
In 2010 the Guidelines for Use of RFID in Transfusion Medicine were published in Vox Sanguinis6. The Guidelines recommend the use of passive HF (13.56 MHz) technology in transfusion medicine when applied to blood bags and storage containers. Passive HF (13.56 MHz) RFID technology is internationally recognised, with globally uniform operational parameters, maintained by the ITU and ISO, for worldwide use on an unlicensed basis and is supported with the global standard ISO 18000-37.
ISO18000-3 defines two MODES suitable for transfusion: MODE 1 and MODE 2. MODE 1 is a rebadged version of the legacy ISO15693 standard, and MODE 2 is a new RFID technology based on Phase Jitter Modulation (PJM), designed for items that are densely packed and/or stacked in random orientations.
Since the publication of the 2010 Guidelines there have been significant advances in the available RFID technology including the development of NFC enabled tags for bedside transfusion, bulk reading with tunnels and equipment integrated RFID readers installed into fridges, freezers, agitators, incubators, cold room shelving and freezer room shelving.
Recently, a Compact Antenna System (CAS) based on PJM, designed for the storage of 4 to 6 RBC units and the direct placement onto any fridge shelf, has been developed. The PJM CAS is ideal for fitment to emergency fridges in remote sites. PJM CAS fitted remote emergency fridges can provide automated remote real time visibility of fridge stocks including blood components and batch products allowing for cold chain monitoring and timely restocking4,5. This ability to automate the real time visibility of remote stocks results in the ability to automate cold chain record keeping, the timestamping of unit placement and removal, the collection of recipient data and the ability to automatically generate alerts when automation rules are breached.
With a suitable software solution, the central laboratory can reduce, if not completely, remove the issues of poor visibility of current stock and inadequate record keeping at the remote site, whilst at the same time reducing the manpower required to control the remote site transfusion processes.
Figure 2. PoC trial machines and materials
Remote Site Blood Management Trial
At the ISBT Blood Supply Management (BSMWP) meeting in June 2024, remote site blood management emerged as the most critical issue facing healthcare providers.
To address this, the BSMWP is launching a Proof of Concept (PoC) trial utilizing PJM CAS to enhance the tracking and management of remote blood inventories across various regions. The trial will include a source tagging solution of blood bags from blood banks, a mobile NFC-enabled reader application, a PJM enabled antenna system, and Blood management system software.
The solution will enable centralized oversight, real-time location tracking, FEFO stock rotation, and automated timestamping of blood bag movements. It will also monitor out-of-storage durations and trigger alerts when thresholds are exceeded.
The PoC trial will run for an estimated period of 10 weeks, focusing on evaluating the effectiveness and efficiency of the proposed solution in enhancing blood management at remote sites. Data will be collected to assess improvements in compliance, traceability, and inventory accuracy compared to existing practices.
The expected trial outcomes include seamless integration into existing workflows, accurate tracking, proper storage, and efficient inventory management. The system’s performance will be tested in resource-limited environments, focusing on its reliability in areas with minimal infrastructure.
Healthcare providers are invited to participate and contribute to shaping the future of remote blood management. Industry partners will supply PJM hardware and integration support with participating software vendors.
Suitable blood establishments with a centralised well-run establishment receptive to operating the trial software package are required. To date trial sites in Australia, India and Africa are being evaluated and invitations for further interested trial sites in all countries are open.
References
- The Royal College of Pathologists of Australia, Australian and New Zealand Society of Blood Transfusion Ltd. Managing Blood and Blood Product Inventory, National Blood Authority Australia February 2014
- Red Blood Cell Management for Sites with No Laboratory Procedure. Government of Western Australia Country Health Service, April 2025
- Tavares da Souza A, Flores J, Meléndez L, Filio M, Delores Y, Jacquot C, Delaney M. Radiofrequency identification tracking system (RFID) significantly improves blood bank inventory management and decreases staff work effort. Transfusion 2024; 64:578 - 584
- Ayyalil F, Irwin G, Ross B, Manolis M, Enjeti A: Zeroing in on red blood cell unit expiry. TRANSFUSION Volume 57, December 2017, pages 2870 – 2877
- Braye S, Irwin G, Pertridge B, Martens V, Seldon M, Barret A, Lechner K: Better Practice Case Study: Hunter Area Pathology Service, National Blood Authority Australia, www.blood.gov.au/case-studies
- Guidelines for the Use of RFID Technology in Transfusion Medicine. Vox Sanguinis, Volume 98, Supplement 2, April 2010
- ISO ⁄ IEC 18000-3: RFID for Item Management: Air Interface. ISO/IEC JTC 1/SC 31
