Continued decline in blood collection and transfusion in the <scp>U</scp>nited <scp>S</scp>tates–2015

Ellingson, Katherine; Sapiano, Mathew R. P.; Haass, Kathryn A.; Savinkina, Alexandra; Baker, Misha L.; Chung, Koo‐Whang; Henry, Ronald J. W.; Berger, James J.; Kuehnert, Matthew J.; Basavaraju, Sridhar V.

doi:10.1111/trf.14165

Cited by 236 publications

(255 citation statements)

References 42 publications

(83 reference statements)

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“…Since 2006, the number of states in the United States allowing donation by 16‐year‐olds has risen from 6 to 37 . Consequently, high school–aged donors now contribute over 10% of the national supply, even as total collections have dropped from 17 to 12 million units of blood annually …”

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confidence: 99%

Elevated risk for iron depletion in high‐school age blood donors

et al. 2019

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BACKGROUND High school students 16 to 18 years‐old contribute 10% of the US blood supply. Mitigating iron depletion in these donors is important because they continue to undergo physical and neurocognitive development. STUDY DESIGN AND METHODS Study objectives were to determine the prevalence of iron depletion in 16‐ to 18‐year‐old donors and whether their risk for iron depletion was greater than adult donors. Successful, age‐eligible donors were enrolled from high school blood drives at two large US blood centers. Plasma ferritin testing was performed with ferritin less than 12 ng/mL as our primary measure of iron depletion and ferritin less than 26 ng/mL a secondary measure. Multivariable repeated‐measures logistic regression models evaluated the role of age and other demographic/donation factors. RESULTS Ferritin was measured from 4265 enrollment donations September to November 2015 and 1954 follow‐up donations through May 2016. At enrollment, prevalence of ferritin less than 12 ng/mL in teenagers was 1% in males and 18% in females making their first blood donation, and 8% in males and 33% in females with prior donations. Adjusted odds for ferritin less than 12 ng/mL were 2.1 to 2.8 times greater in 16‐ to 18‐year‐olds than in 19‐ to 49‐year‐olds, and for ferritin less than 26 ng/mL were 3.3‐ to 4.7‐fold higher in 16‐ to 18‐year‐olds. Progression to hemoglobin deferral was twice as likely in 16‐ to 18‐year‐old versus 19‐ to 49‐year‐old females. CONCLUSION Age 16 to 18 years‐old is an independent risk factor for iron deficiency in blood donors at any donation frequency. Blood centers should implement alternate eligibility criteria or additional safety measures to protect teenage donors from iron depletion.

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confidence: 99%

Elevated risk for iron depletion in high‐school age blood donors

et al. 2019

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“…First, the analysis focuses exclusively on apheresis PLTs, and did not model risks from pooled or whole blood–derived PLTs. However, approximately 92% of the PLTs transfused annually in the United States are apheresis PLTs, rendering this a reasonable simplification . The analysis also focused on bacterial contamination only and did not account for potential effects of these approaches on nonbacterial infections.…”

Section: Discussionmentioning

confidence: 99%

Financial impact of alternative approaches to reduce bacterial contamination of platelet transfusions

et al. 2019

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BACKGROUND Bacterial contamination of platelets remains the leading infectious risk from blood transfusion. Pathogen reduction (PR), point‐of‐release testing (PORt), and secondary bacterial culture (SBC) have been proposed as alternative risk control strategies, but a comprehensive financial comparison has not been conducted. STUDY DESIGN AND METHODS A Markov‐based decision tree was constructed to model the financial and clinical impact of PR, PORt, and SBC, as well as a baseline strategy involving routine testing only. Hospitals were assumed to acquire leukoreduced apheresis platelets on Day 3 after collection, and, in the base case analysis, expiration would occur at the end of Day 5 (PR and SBC) or 7 (PORt). Monte Carlo simulations assessed the direct medical costs for platelet acquisition, testing, transfusion, and possible complications. Input parameters, including test sensitivity and specificity, were drawn from existing literature, and costs (2018 US dollars) were based on a hospital perspective. RESULTS The total costs per unit acquired by the hospital under the baseline strategy, PR, PORt, and SBC were $651.45, $827.82, $686.33, and $668.50, respectively. All risk‐reduction strategies decreased septic transfusion reactions and associated expenses, with the greatest reductions from PR. PR would add $191.09 in per‐unit acquisition costs, whereas PORt and SBC would increase per‐unit testing costs by $31.79 and $17.26, respectively. Financial outcomes were sensitive to platelet dating; allowing 7‐day storage with SBC would lead to a cost savings of $12.41 per transfused unit. Results remained robust in probabilistic sensitivity analyses. CONCLUSIONS All three strategies are viable approaches to reducing bacterially contaminated platelet transfusions, although SBC is likely to be the cheapest overall.

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“…Over the years, the level of platelet counts at which one would give a platelet transfusion to a patient with CIT has decreased, in large part because of little change in the risk of significant hemorrhage [1]. In spite of this decreasing trigger point, the number of transfusions in the United States and other first world counties has steadily increased, so that ~1.9 million platelet units were transfused in the US in 2015 [2]. This demand may outstrip supply, due to the aging of the United States’ population, a rise in hematologic malignancies and the development of new, invasive therapeutic interventions, such as extracorporeal membrane oxygenation and ventricular assistant devices [2,3].…”

Section: Introductionmentioning

confidence: 99%

“…In spite of this decreasing trigger point, the number of transfusions in the United States and other first world counties has steadily increased, so that ~1.9 million platelet units were transfused in the US in 2015 [2]. This demand may outstrip supply, due to the aging of the United States’ population, a rise in hematologic malignancies and the development of new, invasive therapeutic interventions, such as extracorporeal membrane oxygenation and ventricular assistant devices [2,3]. These trends have provided the drive to develop non-donor sources of platelets for transfusions.…”

Section: Introductionmentioning

confidence: 99%

Current status of blood ‘pharming’: megakaryoctye transfusions as a source of platelets

Gollomp

Lambert

Poncz

2017

Current Opinion in Hematology

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Purpose of review Donor-derived platelets have proven to be of hemostatic value in many clinical settings. There is a fear that the need for platelets may outgrow the donor pool in first-world countries. Moreover, there are other challenges with donor platelets that add to the impetus to find an alternative platelet source, especially after the megakaryocyte cytokine thrombopoietin was identified. Megakaryocytes have since been differentiated from numerous cell sources and the observed released platelet-like particles (PLPs) have led to calls to develop such products for clinical use. The development of megakaryocytes from embryonic stem cell also supported the concept of developing non-donor-based platelets. Recent findings Several groups have claimed that non-donor-based platelets derived from in vitro-grown megakaryocytes may soon become available to supplement or replace donor-derived products, but their number and quality has been wanting. A possible alternative of directly infusing megakaryocytes that release platelets in the lungs – similar to that recently shown for endogenous megakaryocytes – has been proposed. Summary This review will describe the present state-of-the-art in generating and delivering non-donor-derived platelets. Progress has been slow, but advances in our ability to generate human megakaryocytes in culture, generate PLPs from these cells, and test the functionality of the resultant platelets in vitro and in vivo have identified important remaining challenges and raised alternative potential solutions.

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Continued decline in blood collection and transfusion in the United States–2015

Cited by 236 publications

References 42 publications

Elevated risk for iron depletion in high‐school age blood donors

Elevated risk for iron depletion in high‐school age blood donors

Financial impact of alternative approaches to reduce bacterial contamination of platelet transfusions

Current status of blood ‘pharming’: megakaryoctye transfusions as a source of platelets

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