Blood Collection and Transfusion in the United States in 1999

Article

Blood Collection and Transfusion in the United States in 1999
Friday, February 4th, 2005
Author: SABM Staff

Blood Collection and Transfusion in the United States in 1999

In the February issue of Transfusion, Marian T. Sullivan and Edward L. Wallace report the results of Nationwide Blood Collection and Utilization Survey (NBCUS), a survey of blood services activities in the US conducted in 2000 by the National Blood Data Resource Center. The survey and analytic methods were designed to provide national estimates for key blood services activities in 1999 and to allow for comparison with previous measurements, the authors explain. Such information provides a better understanding of the trends over time in blood donation, processing, and utilization and informs resource planning and policy-making decisions.

A single survey instrument consisting of five sections and 54 questions was sent to three types of establishments: regional blood centers, transfusing hospitals, and other specialty facilities. The survey sample was based on the American Association of Blood Banks (AABB) institutional membership list and the American Hospital Association (AHA) list of US hospitals. The final sample included 145 blood centers and 1583 hospitals from the AABB membership list and 3488 hospitals that provided general medical and surgical services or children's medical and surgical services and were not known as members of AABB.

Response rates differed among the institutional types and surgical volume categories and ranged from 98.6% for blood centers to 62.1% for the lowest surgical volume class of non-AABB hospitals. Among the non-AABB hospitals, the response rates were 70.3%, 64.5%, and 62.7%, respectively, for the three highest surgical volume classes, which were the predominant users of blood and blood components. Statistical procedures were used to verify the representativeness of the sample and to estimate national totals.

In 1999, the authors report, the total US blood supply was 13,876,000 units, of which blood centers collected or imported 12,851,000 units (92.6%) and hospitals 1,025,000 units (7.4%), an increase of 10.1 percent over 1997. A total of 12,389,000 red blood cell (RBC) units were transfused, namely 90.8% of the available supply, consisting of 11,804,000 allogeneic units (95.3%), 367,000 autologous units (3%), and 103,000 directed units (0.8%). Approximately 1,260,000 units, i.e. 9.2% of the available supply, were not transfused. Of the 651,000 autologous units collected, 284,000 (43.6%) were discarded.

An estimated 4.5 million recipients were transfused with whole blood and/or RBCs, 3.8 million of whom received allogeneic units. Allogeneic blood recipients were reported to have received a mean of 2.8 units per transfusion episode. Of 1709 responding hospitals, 112 hospitals (6.6%) reported cancellations of elective surgeries on one or more days during 1999 because of blood shortages. The median number of days of cancellations among these 112 hospitals was 2 (range, 1-150).

With regard to non-RBC components, 1,203,000 units of platelets (PLT) from pheresis, 4,693,000 PLT concentrate units, 3,810,000 fresh frozen plasma (FFP) and single-donor plasma units, and 1,972,000 units of cryoprecipitate were produced. A total of 1,003,000 units of single-donor PLTs (an increase of 6.7% over 1997) and 3,036,000 units of PLT concentrate (a decrease of 10.6% from 1997) were administered. Transfusions of FFP and single-donor plasma units amounted to 3,319,000 units, virtually the same number as transfused in 1997. As a consequence, the marked increase of 15.1% in FFP and single-donor plasma unit collections in 1999 resulted in the waste of 491,000 units. Cryoprecipitate transfusions amounted to 860,000 units, a 5.4% increase over 1997.

As the authors point out, the 2000 NBCUS reveals that a number of important changes occurred in the US between 1997 and 1999. These changes, the authors state, include a significant increase in allogeneic blood collections, a significant increase in whole blood and/or RBC transfusions, a substantial increase in prestorage leukoreduction of blood components, a leveling of the rate of laboratory testing losses, and continuation of the trend toward greater utilization of single-donor apheresis PLTs.

Between 1994 and 1999, RBC transfusions increased by 1,282,000 units (11.5%), due primarily to greater transplantation demands and an aging population. “Given an ever-growing demand driven by greater transplantation and oncologic needs, coupled with an aging pool of US donors and the likelihood of new deferral criteria, blood collecting establishments face a major challenge in the future to maintain an adequate margin of available supply over increasing demand,� the authors note.