Hospitals need 10,000 half-litre units of blood a day and demand is rising at a time when donors are proving harder to find. Pressure to meet Government waiting list targets combined with declining public confidence in blood because of safety fears has pushed the service to the limit.
In a circular to the NHS on blood issued on Friday, the health department says all hospitals must establish new rules for blood transfusion and seek ways of using patients' own blood to reduce dependence on that given by donors by March 2000.
The latest move to shore up the ailing National Blood Service comes after a year in which it has suffered major blows. In July the Government announced that all donated blood would be screened for CJD, more than doubling the cost of collecting it to pounds 83.50 a unit.
Earlier, in February, the Government ruled that all blood products should be made from plasma imported from abroad, slashing an important source of income for the service. Public confidence had already been damaged by earlier rows about the sale of blood plasma to other countries, a scandal involving leaking blood bags, and an unpopular reorganisation which was the subject of a damning report earlier this year, which led to the sacking of the chairman and the departure of the chief executive.
The blood service was so worried about the effect on donors that it commissioned a report from the Kings Fund on attitudes to altruism published last month. It claimed in the report that there was "no evidence that the donor pool was shrinking dramatically," but admitted that increasing numbers of would- be donors were being rejected because of more stringent checks, for example because they might be at risk of HIV or hepatitis. Demand for blood is rising at 3 to 4 per cent a year as hospitals treat more patients. Ministers have a manifesto pledge to cut waiting lists and have committed hundreds of millions of pounds to the cause. That means more patients to be treated, more operations performed and more blood used.
The circular says there is wide variation among doctors over the amount of blood ordered suggesting some is "used unnecessarily".
It says transfusion committees should be set up to monitor blood use in every hospital and introduce protocols to reduce wastage and improve safety.
Of 169 "serious hazards" reported last year, it says 81 involved patients being given the wrong blood while only eight involved infection.
Alternatives to the use of donated blood include autologous blood transfusion, in which patients give blood several weeks before their operation which is stored and then given back to them during surgery. However, there is no evidence that this method reduces adverse events happening or demand, the circular says.
A second option is cell salvage, in which patients' blood is collected during the operation, washed, and given back to them. The equipment needed is expensive but the circular says the method, already in use in several NHS trusts, will become more affordable as the cost of collecting donor blood rises.
Clare Rayner, chair of the Patients Association which advised on the circular, said: "There is a crisis. Demand for blood is ever increasing and the number of donors being excluded for safety reasons is rising. There is a real problem."
A spokesman for the health department said: "What we are trying to achieve is better use of an invaluable resource which is not in plentiful supply.
"We will continue to appeal for more blood donations as the NHS gets through more work. But we need to explore every single way of making better use of what we have got."Reuse content