When whole blood arrives, it is checked into the
centre electronically through the scanning of bar codes.
The sample tubes are sent for testing, and the whole
blood to processing. The blood is put through a
centrifuge, which separates it into three components:
RBC, a buffy coat and plasma.
Mandatory tests are performed on the blood for
blood group, microbiology screening and quality
monitoring. Once testing is completed, the results are
sent electronically to processing, so that the relevant
units of blood can be labelled with their blood group
ready for issue to hospitals. NHSBT has an ideal stock
level of 40,000�50,000 units of RBCs, which equates to
a national stock of approximately seven days. Each centre
has a first-in, first-out (FIFO) inventory policy, so the
stock level directly affects the remaining shelf life of the
RBCs when they are issued to hospitals. There is a
service level agreement with hospitals for blood not to
be issued to hospitals with less than 12 days to expiry,
which has led to wastage of blood by NHSBT in the past
when stocks have been very high. A small percentage of
blood remains within NHSBT to be used for research.
Transfusion
Hospitals hold their own supply of stock of RBCs and
fresh frozen plasma (FFP), and a few of the larger
hospitals also hold stock for platelets. It is estimated that
within the supply chain around 50% of stock of RBCs is
in NHSBT and 50% is held within hospitals. Hospitals
receive a number of routine deliveries a week, depending
on their size, with the largest receiving several each day.
These deliveries are included in the price of the products
and the same for all hospitals, regardless of location.
The cost of the products is related directly to
NHSBT's costs for processing and transport. A unit of
RBCs is about �140, platelets about �220, and plasma
about �100. If a hospital plans carefully, then these
routine deliveries should provide a sufficient supply of
blood. In case of an emergency, a hospital can request an
ad hoc delivery, which will be sent out immediately for a
charge of approximately �50. If best use is made of the
routine deliveries, then, except for emergencies, hospitals
should not need to use ad hoc deliveries. However, due
to the relatively low cost of an ad hoc delivery, some
hospitals use it as a regular delivery service.
Once blood arrives at a hospital, it is checked into
the main laboratory fridge. Once a clinician requests
a unit of blood for a patient, the blood must first be
cross-matched with a sample of the patient's blood to
ensure that it is compatible.The compatible blood is then
reserved for the patient for a period of 24�72 hours. If
the hospital is large, the blood will be moved to a satellite
fridge closer to the patient during this time. A significant
development within hospitals is the `electronic issue'
fridges, which enable a much quicker, electronic testing to
see if blood is compatible, freeing up stock that was
previously tied to a single patient for 24�72 hours.
In general, each hospital � or hospital trust, usually one
or two hospitals � operate as an independent
organisation. However, a number of smaller hospitals
34
FOCUSNOVEMBER2009
SUPPLY CHAIN
PAPER
The blood supply chain
Figure 1
Red blood cells � medium shelf life
RBCs are fast-moving products for NHSBT, and hence managed in a lean way that focuses on efficiency.They
are split into the eight main blood groups � seeTable 1. A unit of RBCs consists of 270ml, and around 1.8 million
units of RBCs are issued annually to hospitals.Within hospitals, they are used in haematology/oncology, general
medicine, cardiothoracic surgery, casualty and orthopaedics.They have a shelf life of 35 days, and must be stored
between 2�C and 6�C.The longest time that they can be out of a temperature-controlled area is 30 minutes.
Collection targets for RBCs are set weekly to try to keep the national stock level between the desired levels.
Targets are not blood group specific, although collection levels of each group do coincide approximately with
population figures. However, marketing campaigns do treat different blood groups differently. If there is a
shortage in a specific group � usually O- and B-, due to the percentage demand for both being slightly higher
than their natural abundance in the population � registered donors are sent more urgent communications
inviting them to donate. Contrarily, group AB is not desirable for RBC � whole blood � donation, as an AB
patient can receive any blood group, but A's can only be given to other ABs, resulting in high stock levels.To
try and encourage hospitals to take AB stock, they are not charged for wastage.
Percentages of the population
in England that have each type
of blood group
Blood type % of population
O+ 37
O- 7
A+ 35
A- 7
B+ 8
B- 2
AB+ 3
AB- 1
Table 1

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