Slowing decline in blood collection and transfusion in the United States – 2017

Abstract

INTRODUCTION The National Blood Collection and Utilization Survey (NBCUS) has demonstrated declines in blood collection and transfusion in the United States since 2008, including declines of 11.6% in red blood cell (RBC) collections and 13.9% in RBC transfusions during 2013‐2015. This study described the 2017 NBCUS results. METHODS The 2017 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated. RESULTS Response rates for the 2017 NBCUS were 88% for blood collection centers and 86% for transfusing hospitals. Compared with 2015, the number of RBC units collected during 2017 (12,211,000; 95% confidence interval [CI], 11,680,000‐12,742,000) declined by 3.0%, and transfused RBC units (10,654,000, 95% CI, 10,314,000‐10,995,000) declined by 6.1%. Distributed platelet (PLT) units (2,560,000; 95% CI, 2,391,000‐2,730,000 units) increased by 5.1%, and transfused PLT units (1,937,000, 95% CI, 1,794,000‐2,079,000) declined by 2.3%. Distributed plasma units (3,209,000; 95% CI, 2,879,000‐3,539,000) declined by 13.6%, and transfused plasma units (2,374,000; 95% CI, 2,262,000‐2,487,000) declined by 12.9%. CONCLUSION The 2017 NBCUS suggests a continued but slowing decline in demand for RBCs. The decline in blood collection and use will likely continue. Despite decreasing demand and increasing manufacturing costs of blood products, the US blood industry has met the regular and emergent needs of the country.

Supplemental findings of the 2017 National Blood Collection and Utilization Survey

“…This article supplements the findings reported by Jones et al 2 on collection, use, and cost of whole blood, red blood cells (RBCs), platelets (PLTs), and plasma, and by Savinkina et al 3 on topics related to implementation of safety measures in the blood industry, including transfusion-associated adverse reactions. The remaining results from the 2017 NBCUS are presented herein with comparison to the 2015 findings.…”

“…This decline appears to be a response to decreased demand for blood from transfusion hospitals. 2 However, the decline in the number of donations from 2015 to 2017 was only seen among donations by donors aged <65 years and the number of donations by donors aged ≥65 years increased. The greatest decline was seen among donors aged 16-18 years followed by donors aged 19-24 years.…”

“…7,10,43,44 The decrease in price paid per unit coupled with increased production costs and decreased demand for blood products 2 likely continues to place a strain on the finances of blood collection facilities and may be a factor contributing to mergers of blood collection centers. 2 This financial strain and negative margins might have prompted many hospitals to cease blood collection operations. 2…”

Transfusion‐associated adverse events and implementation of blood safety measures ‐ findings from the 2017 National Blood Collection and Utilization Survey

“…General limitations of the NBCUS are described elsewhere. 25 These findings describe the implementation of a number of transfusion safety measures at both blood collection centers and hospitals in the United States. Continued monitoring of implementation of these safety measures is important to assess efforts in improving the safety of the blood supply.…”

“…25 National estimates of the rates of adverse reactions were calculated using the total number of units (including red blood cells, PLTs, plasma, and cryoprecipitate) transfused as the denominator. 25 Survey respondents determined whether a transfusion-related adverse event was life threatening; the NBCUS recommended definition of life-threatening adverse events was adverse events requiring major medical intervention following transfusion, including vasopressors, intubation, or transfer to the intensive care unit.…”