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PLASTIC RECONSTRUCTIVE AND REGENERATIVE SURGERY

Original article

Ahead-of-Print

Implementation of an algorithm for optimized multisite distribution of red blood cell concentrates: an efficacy analysis

Authors

Vincenzo Guarcello ORCID , Mattia Celebrin ORCID , Adelio Cangemi ORCID , Marco D'Agostino ORCID , Mariateresa Pugliano ORCID , Alessandra Livraghi , Roberto Crocchiolo ORCID , Paola Bergamaschi

Key words: blood, algorithms, transfusion medicine, decision support, blood banks, blood supply management
Doi: 10.2450/BloodTransfus.1463
Organization and quality systems in transfusion medicine
Publication Date: 2026-11-10

Abstract

Background - Managing red blood cell (RBC) inventory across multi-site transfusion networks is challenging, often resulting in expiry wastage or costly external compensation. We report the development and evaluation of a spreadsheet-based decision-support tool implemented in the Pavia Transfusion Medicine and Hematology Department (DMTE), Lombardy, Italy.

Materials and methods - A Microsoft Excel workbook with visual basic for applications (VBA) macros implemented tiered inventory thresholds (safety stock, critical level, and maximum stock) derived from 2022-2024 transfusion data. Automated algorithms redistributed RBC units according to shortages and surpluses, with dedicated rules for Rh-negative units with C/E/Kell antigens and AB-group units. Expiry-wastage rates before (January-June 2025) and after implementation (July-December 2025) were compared using Fisher’s exact test, multivariable logistic regression, Mantel-Haenszel analysis, and difference-in-differences (DiD) analysis against 2024.

Results - Over 100,000 RBC unit movements were analyzed. Expiry wastage decreased from 1.30% to 1.00% (RR 0.77, 95% CI 0.65-0.90; p=0.002), corresponding to a relative reduction of 23.3%. Multivariable analysis confirmed the protective effect (OR 0.72,
95% CI 0.61-0.86; p<0.001). However, benefits were confined to Rh(D)-positive units; wastage among Rh(D)-negative groups increased from 1.59% to 2.27% (RR 1.43,
95% CI 1.03-1.99; p=0.034). DiD analysis showed a net reduction of 0.50 percentage points. Improvements were greater in lower-complexity facilities, whereas
high-complexity centers showed nonsignificant increases, consistent with their inherently rapid RBC turnover and their role as recipients of last-resort redistribution.

Discussion - This low-cost digital tool reduced overall RBC expiry wastage while maintaining departmental self-sufficiency in a multi-site Italian transfusion network. However, its effectiveness was not uniform across blood groups. Rh(D)-negative inventory requires dedicated safety-stock calibration and mandatory recirculation of near-expiry units. Algorithm-driven inventory management may improve transfusion network efficiency, provided that rare phenotypes are governed by tailored rules. Future developments should incorporate predictive analytics and integration with transfusion management systems.

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Authors

Vincenzo Guarcello Immunohematology and Transfusion Medicine Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy ORCID

Mattia Celebrin Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy ORCID

Adelio Cangemi Immunohematology and Transfusion Medicine Service, ASST Sette Laghi, Varese, Italy ORCID

Marco D'Agostino Immunohematology and Transfusion Medicine Service, ASST Lodi, Lodi, Italy ORCID

Mariateresa Pugliano Immunohematology and Transfusion Medicine Service, ASST Santi Paolo e Carlo, Milan, Italy ORCID

Alessandra Livraghi Immunohematology and Transfusion Medicine Service, ASST Pavia, Pavia, Italy

Roberto Crocchiolo Immunohematology and Transfusion Medicine Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy ORCID

Paola Bergamaschi Immunohematology and Transfusion Medicine Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

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