Zimrin Ann B, Hess John R
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Transfusion. 2007 Jun;47(6):1071-9. doi: 10.1111/j.1537-2995.2007.01225.x.
Influenza causes episodic pandemics when viral antigens shift in ways that elude herd immunity. Avian influenza A H5N1, currently epizootic in bird populations in Asia and Europe, appears to have pandemic potential.
The virology of influenza, the history of the 1918 pandemic, and the structure of the health care and the blood transfusion systems are briefly reviewed. Morbidity and mortality experience from the 1918 pandemic are projected onto the current health care structure to predict points of failure that are likely in a modern pandemic.
Blood donor centers are likely to experience loss of donors, workers, and reliable transport of specimens to national testing laboratories and degradation of response times from national testing labs. Transfusion services are likely to experience critical losses of workers and of reagent red cells (RBCs) that will make their automated procedures unworkable. Loss of medical directors, supervisors, and lead technicians may make alternative procedures unworkable as well.
Lower blood collection capacity and transfusion service support capability will reduce the availability of RBCs and especially of platelets. Plans for rationing medical care need to take the vulnerability of the blood transfusion system into account.
当病毒抗原发生变异从而避开群体免疫时，流感会引发周期性大流行。目前在亚洲和欧洲禽类中流行的甲型H5N1禽流感似乎具有大流行的潜力。
简要回顾了流感病毒学、1918年大流行的历史以及医疗保健和输血系统的结构。将1918年大流行的发病率和死亡率情况推算到当前的医疗保健结构上，以预测现代大流行中可能出现的故障点。
献血中心可能会面临献血者流失、工作人员流失、标本向国家检测实验室的可靠运输出现问题以及国家检测实验室响应时间延长的情况。输血服务可能会出现工作人员严重短缺以及试剂红细胞（RBC）短缺的问题，这将导致其自动化程序无法运行。医疗主任、主管和首席技术人员的流失也可能使替代程序无法实施。
较低的采血能力和输血服务支持能力将减少红细胞尤其是血小板的供应。医疗护理配给计划需要考虑到输血系统的脆弱性。
