A few days ago, the e-Network was informed that California blood banks are seriously concerned about rolling blackouts that have been affecting our state. The reason for this concern is that although the main blood collection centers have emergency power for their storage facilities, several collection sites (including blood drives at businesses) do not have emergency power, and some sites (usually not at business blood drives) collect apheresis products using apheresis collection devices that require electricity to run. If an apheresis collection device is stopped by a black out, units drawn by that process could be lost, and if components cannot be returned to the donor, the donor will need to be deferred for a number of future draws resulting in present and future units of blood being lost. If temporary storage facilities are shut down, units of blood might also be lost. The combination of these and other factors could potentially result in the loss of numerous units with each rolling blackout at a time when the state is facing a blood shortage. Many of the problems associated with rolling blackouts can be corrected by an exemption. However, if an exemption cannot be obtained by a blood center, advance warning that a specific power grid will go 'brown' might help alleviate loss of blood. The basic question is: "What can be done if there is a power outage at blood drawing site where automated apheresis equipment is used to collect blood donations, but where there is no access to back-up power". The answers to this question (see below) have been shared with the California Dept. of Health Services, Laboratory Field Services, the Blood Centers of California and the leadership of the CBBS.

1. One blood center indicated that if apheresis equipment is shut down during a power outage, that they have procedures for reinfusing platelets, plasma and RBCs to the donor, but none for salvaging the components. A second blood center indicated that they operate a Gambro Spectra device, which can be manually adjusted to return red cells and plasma to the donor, so that even if the collected product cannot be used, the donor can get back his/her red cells, but like the first donor center, the second donor center did not indicate that they could salvage the product.

2. One blood center indicated that in regard to storage issues associated with platelet apheresis products during power outages, they move the product into boxes almost immediately due to the rotator going off and the temp increasing in concert. A second donor center reported that all components have to meet storage requirements. They pack platelets into validated coolers on Sebra coolants which are kept in a temperature monitored storage area. If the power went down in a site with no generator, they would pack the platelets immediately and send to the main center (where there is a generator).

3. Regarding if blood centers know what their grid locations are for their main centers and for all of their donor collection facilities, one center suggested that this information should be on the utility bill. If not, the blood center can contact the power supplier and ask A second donor center replied that Southern California Edison is going to be including grid locations on all consumer bills with this next cycle. Also, SCE will be publishing which grids will go out effective June1st, so that blood centers who use SCE can be checking each mornings and scheduling automated procedures and generators as required.

4. With regard to the impact on product availability if a donor collection facility was not on an exempt grid, and that donor collection facility decided to forego collecting apheresis products during the late afternoon hours when outages are most likely to occur, one donor center indicates that such a situation would complicate matters somewhat, but they would be able to schedule around it. However, a second center is less optimistic and says that they would lose collection capability at their satellite center, at which they collect roughly 20% of their apheresis platelets. This center will probably look into activating on-call donors for morning hours, contingency plans for changing center hours, and shifting apheresis collections to early mornings this summer.

5. Regarding if apheresis equipment can be safely operated with a 20 minute uninterruptible power supply, one donor center says that the manufacturer's device that they use can be so used, to their knowledge. A second donor center indicated that their Gambro Rep told them they thought so, but would be checking with engineers to confirm.

6. Regarding the possibilities for donor collection facilities to acquire back-up power supplies like the main centers have, one donor center indicated that this was NOT possibility for them, since their satellite center is leased and they wouldn't be able to house a generator of sufficient size in their leased area. There's also the cost issue.

7. Regarding if refrigerators, freezers and platelet environmental chambers can store blood and blood components at appropriate temperatures for the normal duration of a power outage, one center reported that as long as the refrigerators, freezers and platelet chambers have been validated and proven to hold their temperature, they should perform as they have been validated to perform. This center commented that there's also the issue of getting the components to a processing facility with power so that components can be separated and appropriately stored after manufacture. However, a second donor center replied that depending on the temperature of the storage device when the power goes out, some refrigerators, etc., might not hold their temperature. If, for example, the storage environment has been 'open' because a refrigerator had just been subject to stocking, the temperature in the device might be higher than is desirable, if an outage were to occur at that exact moment. This donor center's last experience showed them that some refrigerators can and some cannot hold their temperature.

Editor's Note: This observation raises the question of how best to validate the performance of storage devices (such as refrigerators, etc.), to hold their temperature when the power is suddenly cut. Perhaps the device performance should be tested under 'stress conditions', simulating power failure within minutes of having had the door opened and loading the storage device with lots of blood products? Just a thought!

8. Finally, regarding how much warning lead time of an impending outage would be needed for donor collection facilities to adequately prepare for such an outage, one center stated 4 hours minimum. With the SCE web site, supposedly 5 - 7 hours would be given. A second donor center also stated that two to three hours lead time would be nice, so that all just started procedures could be finished and additional fill-in procedures started.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator