Disaster Impact (11-M) in a Blood Bank.
Authors: de Leon Natalia Hernandez , Anguita Javier , Falero Carmen , Llorente Almudena , Cros Tomas Pintado , Gomez-Pineda Alfonso 
Published: April 2020

Objective: To describe the main problems posed to a hospital’s blood bank (BB) by a major disaster situation (the11-M terrorist attack in Madrid, Spain).

Report of the events: In the terrorist attack of Madrid in March 11, 2004, there were a total of 192 casualties and 1432 individuals who suffered various, usually complex, injuries. At the Gregorio Marañon Hospital 232 victims of the attack were admitted and 32 of them required surgical procedures. On this day there were 122 requests for blood products for 23 patient.

Transfusion issues: Patient identification: initially most of transfusion requests arrived without patient’s demographic data nor blood sample; a numeric code was assigned to each case. Blood group testing: only ABO-type and Rh-D antigen were determined. Transfusion policy: patients were transfused with same specific ABO group whenever possible, otherwise with ABO compatible uncrossmatched red blood cells (RBC); for this purpose, retyped group A and O RBC were stored separately. Rh-D negative units were reserved for young D-negative females.

Blood donation issues: There was a massive arrival of volunteers to donate blood in a very short period of time, which completely collapsed the BB facilities. It was necessary to improvise for additional space as well as technical staff and paramedical personal to attend to the massive flux of overanxious volunteers. Regular blood donors were rejected in order to guarantee blood supply after the catastrophe. Many volunteers could not donate at the time and a telephone number and address were obtained for recall at a later time if needed. Table I shows the results of HbsAg and HVC testing of blood donated on the day of the catastrophe (group B) compared with donors before the 11-M (group A).

Conclusions: At a major public disaster such as the 11-M terrorist attack, donation greatly exceeds the actual needs generated by the catastrophe. Furthermore, this donation is of no use for the immediate needs. Ideally, civil authorities should not encourage blood donation indiscriminately but alert the general population to do so only after an evaluation of available resources and estimated needs. A center’s contingency plan should include: coordination with local authorities and regional blood center; hospital heads and directors should cancel all programmed activities, in particular surgical procedures and divert human effort resources to emergency care of the injured; the BB should reorganize its activities, initially focusing in patient identification and testing, redistribution and retyping of available blood products in order to deliver quickly type specific RBC; after above goals have been met, staff resources should be redistributed for blood collection and processing.

Table I: Blood testing results an donation data.

Total donors First-time donors Repeat donors Number HBsAg+ / VHC+ Number HBsAg+ / VHC+ Number HBsAg+ / VHC+ Between March 11 and March 14, 633 donations were made, 398 on March 11; this represent a 1,658% increment from the usual mean. There was a higher % of HCV positivity in group B compared to regular donors and no difference in HBV and HIV testing between both groups. A 662 2 / 2 323 1 / 2 339 1 / 0 B 633 1 / 5 543 1 / 5 90 0 / 0

Table II:Transfusion data.

Available RCC Hospitalized Deceased Surgery Previous stock Received the 11-M Transfused 1st 4h Total transfused the 11-M During the first 4 hours 82% of the transfused patients (19) were registered at the blood bank and 63% of the RBC used that day (90 units) were transfused. 71,72% of RBC were specific ABO-group. 232 4 36 149 265 90 (62%) 143