Supplemental findings of the 2021 National Blood Collection and Utilization Survey

Abstract

BackgroundThe Department of Health and Human Services' National Blood Collection and Utilization Survey (NBCUS) has been conducted biennially since 1997. Data are used to estimate national blood collection and use. Supplemental data from the 2021 NBCUS not presented elsewhere are presented here.MethodsData on survey participation, donor characteristics, blood component cost, transfusion‐associated adverse reactions, and implementation of blood safety measures, including pathogen‐reduction of platelets, during 2021, were analyzed. Comparisons are made to 2019 survey data where available (2013–2019 for survey participation).ResultsDuring 2021, there were 11,507,000 successful blood donations in the United States, a 4.8% increase from 2019. Persons aged 45–64 years accounted for 42% of all successful blood donations. Donations by persons aged 65 years and older increased by 40.7%, while donations among minorities and donors aged <25 years decreased. From 2019 to 2021, the median price hospitals paid per unit of leukoreduced red blood cells, leukoreduced and pathogen‐reduced apheresis platelets, and fresh frozen plasma increased. The largest increase in price per unit of blood component in 2021 was for leukoreduced apheresis platelets, which increased by ~$51. Between 2019 and 2021, the proportion of transfusing facilities reporting use of pathogen‐reduced platelets increased, from 13% to 60%. Transfusion‐related adverse reactions declined slightly between 2019 and 2021, although the rate of transfusion‐transmitted bacterial infections remained unchanged.ConclusionDuring 2021, blood donations increased nationally, although donations from those aged <25 years and minorities declined. The prices hospitals paid for most blood products increased, as did the use of pathogen‐reduced platelets.

Bacterial Contamination of Platelet Products

“…However, the following generalizations can be made about these measures: All these strategies have reduced, but not eliminated, transfusion transmitted bacterial sepsis. Secondary testing on day 3 or day 4 has been very effective in preventing transfusion of contamination missed by primary culture, but is unfortunately hardly used due to logistic and cost issues [ 44 , 58 ]. The predominant bacterial mitigation methods now used are LVDS and pathogen reduction, with high incremental costs for both these strategies (over $200 million per year in the US) [ 44 ].…”

“… Secondary testing on day 3 or day 4 has been very effective in preventing transfusion of contamination missed by primary culture, but is unfortunately hardly used due to logistic and cost issues [ 44 , 58 ]. The predominant bacterial mitigation methods now used are LVDS and pathogen reduction, with high incremental costs for both these strategies (over $200 million per year in the US) [ 44 ]. Pathogen reduction was considered to be a highly effective strategy, but four recent cases of severe septic reactions, two fatal, have challenged this view [ 14 ], and no systematic culture studies on pathogen reduced units at time of use or outdate have been performed.…”

“…Secondary testing on day 3 or day 4 has been very effective in preventing transfusion of contamination missed by primary culture, but is unfortunately hardly used due to logistic and cost issues [ 44 , 58 ].…”

“…Meta-analysis of five studies using the PGD rapid test as a secondary testing method, with 114,697 primary culture negative components tested, showed a mean positivity rate of 90 (95% CI, 10–250) per million components, with a wide range of mean rates (0–710 per million) [ 34 ]. Six of 14,764 (406 per million) rapid bacterial tests performed in the US in 2021 were positive in a 2021 national survey [ 44 ].…”

“…The US Department of Health and Human Services’ National Blood Collection and Utilization Survey (NBCUS) has been conducted biennially since 1997, with findings for 2021 published in 2023 [ 44 , 58 ]. These reports document that 2,327,000 platelet units were distributed in 2021, with 2,175,000 units transfused, indicating that 152,000 units (6.5%) were not used.…”