Blood Management
 
No single medical function is more often misunderstood—by both line and medical officers—than that of blood and blood product management. Yet, the system is relatively simple. The ASBPO has the ultimate technical responsibility for managing the military’s blood supply. Each service has its own blood management system to manage its own peacetime blood supply and mobilization requirements. 

Operational Blood Management

Wartime, conflict, and joint operational blood management, however, are the responsibility of the unified CINC who is conducting operations. Generally, the Unified Command Surgeon establishes a JBPO to control the process. If needed to support multiple operations or regions, the surgeon also creates one or more AJBPOs. As part of the planning process, the surgeon’s staff decides where the JBPO/AJBPOs will locate. Additionally, the surgeon’s staff determines how many Blood Transshipment Centers (BTC) and Blood Supply Units (BSU) will be needed to ensure adequate stocks in theater. The command’s Air Force component controls BTC operations, while BSUs may be provided by any service. The Unified Command Surgeon may direct one service’s BSU(s) to provide theater or area support on a joint basis. This is especially likely when an established BSU is already within the JOA.

Blood requests generally originate at using activities. Although each service may handle the requests differently, the general rules of thumb are as follows:

  • No blood is available at echelon I units or facilities.
  • Only type O blood is available at echelon II units or facilities.
  • Multiple blood types are available at echelon III, IV, and V facilities.
Medical units that use blood, submit requests for replenishment to their supporting BSU. The BSU then issues the blood and, in turn, consolidates resupply requirements and forwards them to the JBPO/AJBPO. The JBPO relays these requirements to the ASBPO, and the ASBPO directs one of two of the Armed Services Whole Blood Processing Laboratories (ASWBPL) to ship the blood. Blood is transported by the most immediate means available—usually strategic aircraft—into theater. There, the blood is off-loaded at the theater BTC (TBTC), re-iced, and loaded on theater aircraft or other transport vehicles for shipment to the ordering BSU. 


Blood Planning Factors and Formulas

Product Availability and Storage. The guidelines in Table 5 are based on Joint Pub 4-02, Doctrine for Health Service Support in Joint Operations.

Table 5. Product Availability and Storage 
 
Echelon
Products
ABO & Rh
Storage
Resupply From
I
None
--
--
--
II
Red Blood Cells (RBC)
O+/-
50 units/reefer
Theater BSU
III
RBC liquid
RBC frozen
Frozen Plasma
Platelets
O,A,B +/-
O,A,B +/-
A,B,AB +/-
O,A +/-
480 units
475 units
20 units
NA
Theater BSU
IV
Same as above
Same as above
Same as above
External BSU
 
Transportation capacities and planning factors
  • Insulated blood shipping container (NSN 8115-00-935-9761)
    • Empty weight: 9 lb.
    • Cubic feet: 3.5
    • Exterior dimensions: 19"x18"x16"
    • Capacity
      • Non-frozen (weights include 14 lb. of ice)
        • 20 units whole blood: 44 lb.
        • 30 units packed cells: 41 lb.
        • 12 units whole blood + 12 delivery sets: 38 lb.
        • 20 units packed cells + 24 delivery sets: 40 lb.
      • 24 units fresh frozen plasma + 20 lb. of dry ice: 39 lb.
      • 56 recipient sets: 24 lb.
  • 463L pallet (air pallet)
    • Size: 108"x88"x4"
    • Maximum loaded height: 96"
    • Maximum loaded weight: 8,000 lb.
    • Maximum blood shipment: 120 boxes (4’ wide x 5’ long x 6’ high)
      • Whole blood: 2,400 units: 5,634 lb.
      • Packed cells: 3,600 units: 5,394 lb.
      • Frozen plasma: 2,880 units: 4,680 lb.
  • Intratheater aircraft delivery capacities
    • UH-1 helicopter
      • Sling load: 1,200 blood units
      • Internal: 900 blood units
    • UH-60 helicopter
      • Sling load: 4,800 blood units
      • Internal: 1,500 blood units
    • Parachute
      • Low-Altitude Parachute Extraction System (LAPES): 4,800 blood units
      • Cargo Delivery System (CDS): 1,440 blood units
      • Naval Emergency Airdrop CDS (NEACDS): 1,440 blood units
Consumption. Expect that 4 units of packed red blood cells, 0.08 units of fresh frozen plasma, and 0.04 units of platelets will be required for each WIA or DNBI hospital admission. For planning purposes, count each WIA/DNBI only once, not each time an individual would be seen as he/she moves through the medical echelons. 
 
As Table 6 shows, blood types are not distributed equally throughout the population;

Table 6. Expected Blood Type Distribution in a Random U.S. Force Distribution
 
Blood Type
% of Population
O+
37
A+
36
B+
8
AB+
3
O-
7
A-
6
B-
2
AB-
1
 
Therefore, if in planning an operation you project 100 patients will be admitted to JTF hospitals (echelon III) facilities, whole-blood requirements would be as shown in Table 7.

Table 7. Estimation of Whole-Blood Requirements per 100 admissions
 
Patients
x
Type Occurance
x
Units
=
Total Units
100
x
0.37 (O+)
x
4
=
148 O+
100
x
0.36 (A+)
x
4
=
144 A+
100
x
0.08 (B+)
x
4
=
32 B+
100
x
0.03 (AB+)
x
4
=
12 AB+
100
x
0.07 (O-)
x
4
=
28 O-
100
x
0.06 (A-)
x
4
=
24 A-
100
x
0.02 (B-)
x
4
=
8 B-
100
x
0.01 (AB-)
x
4
=
4 AB-
100
x
1.00 (All Types)
s
4
=
400 Total Units
 
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