National Blood Collection and Utilization in the United ... · Total Supply 11,713 502 12,215...
Transcript of National Blood Collection and Utilization in the United ... · Total Supply 11,713 502 12,215...
Jefferson Jones, MD MPH
Office of Blood, Organ, and Other Tissue SafetyDivision of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious DiseasesCenters for Disease Control and Prevention
2018 AABB Annual Meeting
Boston, MA
10/15/2018
National Blood Collection and Utilization in the United States, 2017
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
Presentation Objectives
Overview National Blood Collection and Utilization Survey
(NBCUS)
Survey design and analytic methods
Preliminary findings
Conclusion and discussion
NBCUS Objectives
Quantify blood and blood component collection,
distribution, and transfusion nationally
Develop reliable national estimates of collection and
utilization used to:
estimate blood demand
project future blood needs
inform policy decisions
NBCUS Background
NBCUS is a biennial, cross-sectional survey:
All US blood collection centers
Sample of US hospitals that transfuse blood and blood
components
Key information collected:
Units of blood and components collected and transfused
Units rejected and outdated
Costs, practices, and policies
NBCUS Background
Intermittent national surveys of US blood collection
centers and transfusing facilities since 1971
1979 – 1994: Nine surveys conducted with NIH support
In 1997, the Office of the Assistant Secretary for Health (OASH)
launched the standardized and biennial NBCUS
1999 – 2011: Six surveys conducted by AABB with Department of
Health and Human Services (DHHS) support
2013 - present: CDC/OASH administered the survey
NBCUS Background
Trends in estimated rates of WB/RBC collection and transfusion,
1992–2015
Population data from US Census Bureau (http://www.census.gov/popest/data/index.html)
2017 Survey Design
Web-based
Facility sampling
Letter sent to facility administrator via US mail
Unique web links were emailed to facilities
Phone follow-up with non-respondents/missing data
2017 Survey Design
The link directed participants to the 2017 NBCUS Portal
Page which included:
2017 National Blood Collection and Utilization Survey
Portal Page
2017 Survey Design
2017 Survey contained three sections:
Section A – General Information
• Facility type
• Contact information
Section B – Blood Collection, Processing, and Testing
• 20 questions
• Quantity of blood and blood components collected, processed, tested,
and distributed
Section C – Blood Transfusion
• 28 questions
• Quantity of blood and blood components transfused, cost paid per
unit, and hospital-specific practices related to transfusion
2015 vs 2017 Survey Differences
Section A – General Information
FDA Blood Establishment Registration definitions
Section B – Blood Collection, Processing, and Testing
Section C – Blood Transfusion
2015 vs 2017 Survey Differences
Section A – General Information
Section B – Blood Collection, Processing, and Testing
Whole blood for distribution as whole blood
Group O+/O- whole blood
AB plasma
Single, double, triple apheresis platelet collections
Hematopoietic growth factor for granulocyte collections
Section C – Blood Transfusion
2015 vs 2017 Survey Differences
Section A – General Information
Section B – Blood Collection, Processing, and Testing
Gender-specific donor deferrals
Adolescent donors by year of age
First time donors
Severe adverse events by age (adult vs adolescent)
Pathogen reduction technology
Babesia screening
Section C – Blood Transfusion
2015 vs 2017 Survey Differences
Section A – General Information
Section B – Blood Collection, Processing, and Testing
Section C – Blood Transfusion
Neonatal transfusions
Method of irradiation
Before storage vs. after storage leukoreduction
Sampling Frame — Blood Centers
Data sources: FDA Blood Establishment Registration database
America’s Blood Center’s contact list
Survey sample included all blood collection centers
Sampling Frame — Acute care hospitals
Data source: 2015 American Hospital Association (AHA) annual survey database
Excluded:
Hospitals performing <100 inpatient surgeries annually
Hospitals located in U.S. territories
Military, Department of Justice, rehabilitation, acute long-term
care, and psychiatric hospitals
Hospitals performing 100-999 inpatient surgeries were
randomly sampled at a rate of 40%
Hospitals performing ≥ 1000 inpatient surgeries were
completely sampled
Survey Timeline
2017 2018 2019
Facility contacts
confirmed
Survey
launched
Nonrespondents
contacted
Follow up on
incomplete
responses
Survey Timeline
2017 2018 2019
Facility contacts
confirmed
Survey
launched
Nonrespondents
contacted
Follow up on
incomplete
responses
Publish
findings
Stratification
Blood collections centers (non-hospital based)
stratified on anticipated volume of RBCs collected
Expected volume of WB and RBC collections % sampled N
Fewer than 50,000 100% 31
50,000 to 199,999 100% 26
200,000 to 399,000 100% 6
400,000 or more units 100% 3
Total 66
Stratification
Hospital-based blood collection centers
Annual surgical volume % sampled n
Fewer than 1000 100% 19
1000 to 7999 100% 44
8000 or more surgeries 100% 44
Total 107
Stratification
Acute care hospitals
Surgical volume Sampled Population
100 to 999 surgeries per year 633* 1564
1000 to 1399 surgeries per year 404 404
1400 to 2399 surgeries per year 588 588
2400 to 4999 surgeries per year 721 721
5000 to 7999 surgeries per year 282 282
8000 or more surgeries per year 219 219
Total 2847 3783
* Sampled at 40%; all other groups sampled at 100%
Analytic Methods
Sampling Weights
BCC and hospital respondents were weighted by strata to adjust
for non-respondents and sampling (transfusion data only)
Data Imputation
Multiple imputation was used to estimate missing data for
respondents
Point estimates with 95% confidence intervals (CI)
Point estimates, with 95% CIs, were calculated for collection and
utilization
Median cost per unit
Median cost per unit calculated by component type
Response Rates: Blood Collection Centers
Type of Blood
collection center
Total number
sampled
Total number of
respondents
BCC response
rate
Non-hospital 66 62 94%
Hospital-based 107 91 85%
Total 173 153 88%
Non-hospital blood collection centerresponses by RBC collection volume
Volume of WB and
RBC collections
Total number
sampled
Total number
of respondents
Non-hospital
BCC response
rate
< 50,000 31 28 90%
50,000 to 199,999 26 25 96%
200,000 to 399,000 6 6 100%
≥ 400,000 3 3 100%
Total 62 66 94%
Hospital-based blood collection centerresponses by annual inpatient surgical volume
Annual inpatient
surgical volume
Total number
sampled
Total number
of respondents
Hospital-
based BCC
response rate
<1000 19 18 95%
1000 to 7999 44 38 86%
≥ 8000 44 35 80%
Total 107 91 85%
Hospital responsesby annual surgical volume
Annual surgical
volume
Total number
of surveys sent
Total number
of respondents
Hospital-
based BCC
response rate
100 to 999 633 525 83%
1000 to 1399 404 352 87%
1400 to 2399 588 504 86%
2400 to 4999 721 611 85%
5000 to 7999 282 251 89%
≥ 8000 219 192 88%
Total 2847 2435 86%
Decrease in number of non-hospital blood collection centers
Volume of WB and
RBC collections2015 2017
< 50,000 40 31
50,000 to 199,999 31 26
200,000 to 399,000 4 6
≥ 400,000 5 3
Total 80 66
Decrease in number of hospital-based blood collection centers
Annual inpatient
surgical volume2015 2017
<1000 12 19
1000 to 7999 83 44
≥ 8000 47 44
Total 142 107
Estimated numbers of whole blood and RBC units collected, transfused, and
outdated in 2017 (expressed in thousands)
Blood Centers
HospitalsCombined
Totals95% CI
2015 Totals
% Change 2017–2015
Collections
Whole Blood units
Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%
Autologous 7 2 10 (7-12) 25 -61.9%
Directed 6 10 16 (7-24) 21 -25.7%
Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%
Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%
Rejected on testing 74 4 78 (70-87) 53 47.8%
Rejected for other reasons 571 19 590 (537-643) 510 15.7%
Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%
Transfusions
Allogeneic, nondirected 10,491 (10,152-10,831) 11,264 -6.9%
Autologous 27 (11-43) 20 35.5%
Directed 56 (32-80) 66 -14.6%
Total Transfusions 10,575 (10,233-10,917) 11,349 -6.8%
Outdated whole blood or RBCs 269 175 444 (417-472) 600 -26.0%
Estimated numbers of whole blood and RBC units collected in 2017 (expressed in
thousands)
Blood Centers
Hospitals
Combined Totals 95% CI 2015
Totals% Change 2017–2015
Whole Blood units
Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%
Autologous 7 2 10 (7-12) 25 -61.9%
Directed 6 10 16 (7-24) 21 -25.7%
Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%
Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%
Rejected on testing 74 4 78 (70-87) 53 47.8%
Rejected for other reasons 571 19 590 (537-643) 510 15.7%
Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%
Estimated numbers of whole blood and RBC units collected in 2017 (expressed in
thousands)
Blood Centers
Hospitals
Combined Totals 95% CI 2015
Totals% Change 2017–2015
Whole Blood units
Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%
Autologous 7 2 10 (7-12) 25 -61.9%
Directed 6 10 16 (7-24) 21 -25.7%
Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%
Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%
Rejected on testing 74 4 78 (70-87) 53 47.8%
Rejected for other reasons 571 19 590 (537-643) 510 15.7%
Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%
Estimated numbers of whole blood and RBC units collected in 2017 (expressed in
thousands)
Blood Centers
Hospitals
Combined Totals 95% CI 2015
Totals% Change 2017–2015
Whole Blood units
Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%
Autologous 7 2 10 (7-12) 25 -61.9%
Directed 6 10 16 (7-24) 21 -25.7%
Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%
Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%
Rejected on testing 74 4 78 (70-87) 53 47.8%
Rejected for other reasons 571 19 590 (537-643) 510 15.7%
Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%
Estimated numbers of whole blood and RBC units collected in 2017 (expressed in
thousands)
Blood Centers
Hospitals
Combined Totals 95% CI 2015
Totals% Change 2017–2015
Whole Blood units
Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%
Autologous 7 2 10 (7-12) 25 -61.9%
Directed 6 10 16 (7-24) 21 -25.7%
Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%
Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%
Rejected on testing 74 4 78 (70-87) 53 47.8%
Rejected for other reasons 571 19 590 (537-643) 510 15.7%
Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%
Estimated numbers of whole blood and RBC units collected in 2017 (expressed in
thousands)
Blood Centers
Hospitals
Combined Totals 95% CI 2015
Totals% Change 2017–2015
Whole Blood units
Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%
Autologous 7 2 10 (7-12) 25 -61.9%
Directed 6 10 16 (7-24) 21 -25.7%
Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%
Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%
Rejected on testing 74 4 78 (70-87) 53 47.8%
Rejected for other reasons 571 19 590 (537-643) 510 15.7%
Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%
Estimated numbers of whole blood and RBC units collected in 2017 (expressed in
thousands)
Blood Centers
Hospitals
Combined Totals 95% CI 2015
Totals% Change 2017–2015
Whole Blood units
Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%
Autologous 7 2 10 (7-12) 25 -61.9%
Directed 6 10 16 (7-24) 21 -25.7%
Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%
Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%
Rejected on testing 74 4 78 (70-87) 53 47.8%
Rejected for other reasons 571 19 590 (537-643) 510 15.7%
Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%
Estimated numbers of whole blood and RBC units transfused and outdated in
2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015 Totals
% Change 2017–2015
Allogeneic, nondirected 10,491 (10,152-10,831) 11,264 -6.9%
Autologous 27 (11-43) 20 35.5%
Directed 56 (32-80) 66 -14.6%
Total Transfusions 10,575 (10,233-10,917) 11,349 -6.8%
Outdated whole blood or RBCs 269 175 444 (417-472) 600 -26.0%
Estimated numbers of whole blood and RBC units transfused and outdated in
2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015 Totals
% Change 2017–2015
Allogeneic, nondirected 10,491 (10,152-10,831) 11,264 -6.9%
Autologous 27 (11-43) 20 35.5%
Directed 56 (32-80) 66 -14.6%
Total Transfusions 10,575 (10,233-10,917) 11,349 -6.8%
Outdated whole blood or RBCs 269 175 444 (417-472) 600 -26.0%
Estimated numbers of whole blood and RBC units transfused and outdated in
2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015 Totals
% Change 2017–2015
Allogeneic, nondirected 10,491 (10,152-10,831) 11,264 -6.9%
Autologous 27 (11-43) 20 35.5%
Directed 56 (32-80) 66 -14.6%
Total Transfusions 10,575 (10,233-10,917) 11,349 -6.8%
Outdated whole blood or RBCs 269 175 444 (417-472) 600 -26.0%
Estimated numbers of whole blood and RBC units transfused and outdated in
2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015 Totals
% Change 2017–2015
Allogeneic, nondirected 10,491 (10,152-10,831) 11,264 -6.9%
Autologous 27 (11-43) 20 35.5%
Directed 56 (32-80) 66 -14.6%
Total Transfusions 10,575 (10,233-10,917) 11,349 -6.8%
Outdated whole blood or RBCs 269 175 444 (417-472) 600 -26.0%
Trends in RBC collections and transfusion
per 1000 population, 1992–2017
Population data from US Census Bureau (http://www.census.gov/popest/data/index.html)
Estimated number of platelets, plasma, and cryoprecipitate units distributed,
transfused, and outdated in 2017 (expressed in thousands)
Blood Centers
HospitalsCombined
Totals95% CI
2015
Totals
% Change 2017-2015
Distributed
Apheresis platelets 2,181 157 2,338 (2,188-2,487) 2,234 4.6%
Whole-blood-derived PLTs* 171 50 221 (141-302) 202 9.6%
Total platelets 2,352 207 2,559 (2,392-2,726) 2,436 5.1%
Total plasma 2,986 224 3,210 (2,877-3,542) 3,714 -13.6%
Cryoprecipitate‡ 1,979 177 2,156 (1,906-2,407) 1,857 16.1%
Blood center outdates§ 273 38 311 (268-354) 242 28.6%
Transfused
Apheresis platelets 1,847 (1,714-1,979) 1,807 2.2%
Whole-blood-derived PLTs* 82 (30-135) 171 -51.9%
Total platelets (includes directed units) 1,936 (1,793-2,080) 1,983 -2.3%
Total plasma 2,318 (2,205-2,431) 2,727 -15.0%
Cryoprecipitate‡ 1,068 (945-1,190) 1,167 -8.5%
Hospital outdates‖ 446 (415-477) 426 4.7%
* Whole-blood-derived platelets are expressed as apheresis equivalents.
‡ Cryoprecipitates are expressed as individual unit equivalents.
§ Blood center outdates are units that were outdated at non-hospital and hospital-based blood centers.
‖ Hospital outdates are units that were outdated at transfusing hospitals.
Estimated number of platelets, plasma, and cryoprecipitate units distributed
in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 2,181 157 2,338 (2,188-2,487) 2,234 4.6%
Whole-blood-derived PLTs 171 50 221 (141-302) 202 9.6%
Total platelets 2,352 207 2,559 (2,392-2,726) 2,436 5.1%
Total plasma 2,986 224 3,210 (2,877-3,542) 3,714 -13.6%
Cryoprecipitate 1,979 177 2,156 (1,906-2,407) 1,857 16.1%
Estimated number of platelets, plasma, and cryoprecipitate units distributed
in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 2,181 157 2,338 (2,188-2,487) 2,234 4.6%
Whole-blood-derived PLTs 171 50 221 (141-302) 202 9.6%
Total platelets 2,352 207 2,559 (2,392-2,726) 2,436 5.1%
Total plasma 2,986 224 3,210 (2,877-3,542) 3,714 -13.6%
Cryoprecipitate 1,979 177 2,156 (1,906-2,407) 1,857 16.1%
Estimated number of platelets, plasma, and cryoprecipitate units distributed
in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 2,181 157 2,338 (2,188-2,487) 2,234 4.6%
Whole-blood-derived PLTs 171 50 221 (141-302) 202 9.6%
Total platelets 2,352 207 2,559 (2,392-2,726) 2,436 5.1%
Total plasma 2,986 224 3,210 (2,877-3,542) 3,714 -13.6%
Cryoprecipitate 1,979 177 2,156 (1,906-2,407) 1,857 16.1%
Estimated number of platelets, plasma, and cryoprecipitate units distributed
in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 2,181 157 2,338 (2,188-2,487) 2,234 4.6%
Whole-blood-derived PLTs 171 50 221 (141-302) 202 9.6%
Total platelets 2,352 207 2,559 (2,392-2,726) 2,436 5.1%
Total plasma 2,986 224 3,210 (2,877-3,542) 3,714 -13.6%
Cryoprecipitate 1,979 177 2,156 (1,906-2,407) 1,857 16.1%
Estimated number of platelets, plasma, and cryoprecipitate units transfused
and outdated in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 1,847 (1,714-1,979) 1,807 2.2%
Whole-blood-derived PLTs 82 (30-135) 171 -51.9%
Total platelets (includes directed units) 1,936 (1,793-2,080) 1,983 -2.3%
Total plasma 2,318 (2,205-2,431) 2,727 -15.0%
Cryoprecipitate 1,068 (945-1,190) 1,167 -8.5%
Hospital outdates 446 (415-477) 426 4.7%
Estimated number of platelets, plasma, and cryoprecipitate units transfused
and outdated in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 1,847 (1,714-1,979) 1,807 2.2%
Whole-blood-derived PLTs 82 (30-135) 171 -51.9%
Total platelets (includes directed units) 1,936 (1,793-2,080) 1,983 -2.3%
Total plasma 2,318 (2,205-2,431) 2,727 -15.0%
Cryoprecipitate 1,068 (945-1,190) 1,167 -8.5%
Hospital outdates 446 (415-477) 426 4.7%
Estimated number of platelets, plasma, and cryoprecipitate units transfused
and outdated in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 1,847 (1,714-1,979) 1,807 2.2%
Whole-blood-derived PLTs 82 (30-135) 171 -51.9%
Total platelets (includes directed units) 1,936 (1,793-2,080) 1,983 -2.3%
Total plasma 2,318 (2,205-2,431) 2,727 -15.0%
Cryoprecipitate 1,068 (945-1,190) 1,167 -8.5%
Hospital outdates 446 (415-477) 426 4.7%
Estimated number of platelets, plasma, and cryoprecipitate units transfused
and outdated in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 1,847 (1,714-1,979) 1,807 2.2%
Whole-blood-derived PLTs 82 (30-135) 171 -51.9%
Total platelets (includes directed units) 1,936 (1,793-2,080) 1,983 -2.3%
Total plasma 2,318 (2,205-2,431) 2,727 -15.0%
Cryoprecipitate 1,068 (945-1,190) 1,167 -8.5%
Hospital outdates 446 (415-477) 426 4.7%
Estimated number of platelets, plasma, and cryoprecipitate units transfused
and outdated in 2017 (expressed in thousands)
Blood Centers Hospitals Combined
Totals 95% CI 2015
Totals
% Change 2017-2015
Apheresis platelets 1,847 (1,714-1,979) 1,807 2.2%
Whole-blood-derived PLTs 82 (30-135) 171 -51.9%
Total platelets (includes directed units) 1,936 (1,793-2,080) 1,983 -2.3%
Total plasma 2,318 (2,205-2,431) 2,727 -15.0%
Cryoprecipitate 1,068 (945-1,190) 1,167 -8.5%
Hospital outdates 446 (415-477) 426 4.7%
Blood center outdates 273 38 311 (268-354) 242 28.6%
Dis
trib
ute
d, tr
ansfu
sed
0
1,000
2,000
3,000
4,000
5,000
6,000
1989 1992 1994 1997 1999 2001 2004 2006 2008 2011 2013 2015 2017
Apheresis PLT distributedWhole blood PLT distributedPlasma distributedCryoprecipitate distributed
Apheresis PLT transfusedWhole blood PLT transfusedPlasma transfusedCryoprecipitate transfused
Trends in platelets, plasma, and cryoprecipitate
distribution and transfusion, 1989–2017
Median cost of components ($) as reported by hospitals
Median price paid per unit
Component 2017 IQR 2015 IQR
Median
Difference
2017-2015$
Leukoreduced RBCs $207 $196-$224 $211 $197-$228 -$4
Apheresis platelets $517 $490-$550 $524 $495-$560 -$7
Fresh frozen plasma $51 $43-$60 $54 $45-$64 - $3
Plasma, frozen within
24 hours (PF24)$50 $43-$60 $52 $45-$60 -$2
Limitations
As with previous NBCUS, imputation and weighting had to be employed to generate final estimates
• Effect of missing data and non-response smaller in 2017
Volume of inpatient surgical procedures may not reflect transfusion volume
Outpatient facilities and certain hospitals not included, possibly underestimating utilization
Summary
Slowing decline in blood collection and transfusion
• RBC collections decreased 3% and transfusions decreased 7% since 2015
• Total platelet distributions and transfusion with no significant changes since 2015 but decrease in whole-blood-derived platelet transfusion
• Plasma collections decreased 14% and transfusions decreased 15% since 2015
Decline in median price per unit and decline in distributed blood
Consolidation of blood centers
• Non-hospital based blood centers decreased from 80 to 66
• Hospital based blood centers decreased from 142 to 107
Discussion
Declining demand likely a result of changing practices
• Evidence-based guidance to standardize thresholds for transfusion and dosing
• Increasing oversight of transfusion practices and clinician decision support
• Proliferation of patient blood management to reduce need for transfusion
Issues for policy maker and industry consideration
• Increasing demands for safety interventions
• Trend of declining collection and utilization might results in diminished surplus
• How to maintain adequate supply for routine and emergent transfusion needs?
Acknowledgements
CDC
Sridhar Basavaraju
Kathryn Haass
Misha Baker
Alexandra Savinkina
Matt Sapiano
Tuyen Do
Karen Chung
Julie Smith
Jasmine Charter-Harris
Jacqueline Hensley
Kelsey Coy
OASH/HHS
Jim Berger
Richard Henry
FDA
Richard McBride
Judy Ciaraldi
Alan Williams
Orieji Illoh
Veterans Administration
Nora Ratcliff
ABC
Lou Katz
Martin Grable
And many others
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected] Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Thank you
National Center for Emerging and Zoonotic Infectious Diseases
Division of Healthcare Quality Promotion
922,668
892,765 (-3.24%)
868,381 (-2.73%)
860,793 (-0.87%)
859,324 (-0.17%)
837,847 (-2.5%)
838,510 (0.08%)
841,939 (0.41%)
852,513 (1.26%) 831,257
(-2.49%)
809,567 (-2.61%)
819,684 (1.25%)
820,132 (0.05%)
792,452 (-3.38%)
783,668 (-1.11%)
783,479 (-0.02%)
803,248 (2.52%)
788,841 (-1.79%)
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
14Q1 14Q2 14Q3 14Q4 15Q1 15Q2 15Q3 15Q4 16Q1 16Q2 16Q3 16Q4 17Q1 17Q2 17Q3 17Q4 18Q1 18Q2
2014-2018Q2 BCA Red Cell Quarterly Demand Tracking with % Change Quarter to Quarter
130,000
135,000
140,000
145,000
150,000
155,000
2014-2018Q2 Quarterly Total Platelets Equivalent Doses Demand1SDP = 5RDPs =1Pool RDP
Total Platelets
Total Platelet Q2 % changeto prior year Q2
2015 1.3%2016 1.7%2017 -1.8%2018 -0.4%
50,000
70,000
90,000
110,000
130,000
150,000
170,000
190,000
210,000
230,000
250,000
14Q1 14Q2 14Q3 14Q4 15Q1 15Q2 15Q3 15Q4 16Q1 16Q2 16Q3 16Q4 17Q1 17Q2 17Q3 17Q4 18Q1 18Q2 18Q3 18Q4
2014-2018Q2 Quarterly Plasma Demand Tracking
PLasma Actual Demand Plasma Linear Estimates Plasma Linear Projection
Preliminary Results: 2016 AABB Blood
SurveySrijana Rajbhandary, BDS, MPH
Research and Data Analyst
AABB
10/15/2018
Objectives
• Learn the preliminary results from the 2016 AABB
Blood Survey
• Learn the new AABB membership survey plan
www.aabb.org 3
Methods
www.aabb.org 4
• Past Formal Surveys AABB conducted independently: 1997,1999, 2001, 2013, 2014-2015
• Data collection : August 2017- November 2017• Data cleaning, QC and analysis : December 2017- October 2018• AABB institutional members surveyed • Members allowed to report for other hospitals (including non-AABB
members)• Estimates were weighted• Weights were calculated as the inverse of the probability of response
Weights : Hospitals
Annual Inpatient Surgical Volume Non-Respondents
Respondents Total Weight Response Rate
<= 99 surgeries per year 83 45 128 2.844 35.2%
100 - 999 surgeries per year 126 59 185 3.136 31.9%
1,000 - 1,399 surgeries per year 62 23 85 3.696 27.1%
1,400 - 2,399 surgeries per year 93 60 153 2.550 39.2%
2,400 - 4,999 surgeries per year 193 94 287 3.053 32.8%
5,000 - 7,999 surgeries per year 107 54 161 2.981 33.5%
=> 8,000 surgeries per year 100 52 152 2.923 34.2%
Unknown surgical volume 23 7 30 4.286 23.3%
Total 787 394 1181 33.4%
www.aabb.org 6
Blood Centers and Centralized Transfusion
Services
Blood Collector Size 2013 2014 2015 2016
RBC Collection 250,000+ 7 5 5 13RBC Collection 50,000 to 249,999 36 35 33 36RBC Collection <50,000 36 33 33 17
www.aabb.org 7
2013N
2015N
2016N
Reporting Centralized Transfusion Services 18 15 11
Estimated AABB US Member 2016 Collection: WB/RBC
(expressed in thousands of Units)
www.aabb.org 8
Activity Blood Centers
Hospitals 2016 Combined Total
% of Total Collections/Transfusions
2015 Total % Change 2015-2016
Collection
WB Allogeneic (including directed) 10,219 464 10,683 86.9 10,957 -2.5%
Total Supply ( RBCs from WB /Apheresis Collection) 11,822 472 12,294 100.0 12,806 -4.0%
Rejected on Testing 45 3 48 0.4 72 -33.3% *
Rejected for Other Reasons 502 13 515 4.2 599 -14.0%
Available Supply 11,276 455 11,731 95.4 12,136 -3.3%
www.aabb.org 9
-4.0 %
0
2
4
6
8
10
12
14
16
18
2011 2013 2015 2016
Mill
ion
s o
f U
nit
s
Allogeneic whole blood and red cell collections, 2011- 2016*AABB estimate
AABB Allogeneic
Total Available Supply *
www.aabb.org 10
-4.0 %
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
1989 1992 1994 1997 1999 2001 2004 2006 2008 2011 2013 2015 2016
Mill
ion
s o
f U
nit
s
Allogeneic whole blood and red cell collections, 1989 – 2016*AABB estimateSources: National Blood Collection and Utilization Survey (NBCUS) reports . For years 2011 through 2015, new trend lines show collections from AABB members
Allogeneic
AABB Allogeneic
Total Available Supply *
Estimated AABB US Member 2016 Transfusion: WB/RBC
(expressed in thousands of Units)
www.aabb.org 11
2 CTS that reported transfusion data didn’t provide information regarding the hospitals they served.
Activity Blood Centers
Hospitals 2016 Combined
Total
% of Total Collections/Transfusions
2015 Total
% Change 2015-2016
Transfusions
Allogeneic WB/RBC ( including directed)
9 5,582 5,591 100.0 5,776 -3.2%
Allogeneic WB − 1 1 0.0 2 -50.0%
Allogeneic RBC 9 5,580 5,589 100.0 5,774 -3.2%
Group 0+ve 4 1,571 1,575 28.2 1,211 30.1%*
Group 0-ve 1 423 424 7.6 304 39.5%*
US allogeneic WB/RBC collections and transfusions, 1989-2016
www.aabb.org 12
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
1989 1992 1994 1997 1999 2001 2004 2006 2008 2011 2013 2015 2016
Mil
lio
ns o
f U
nit
s
Survey Year
.
Allogeneic Collections* Allogeneic Transfusions†
* Source: For years 1989-2011, National Blood Collection and Utilization Survey (NBCUS). Years 2013 ,2015 and 2016 AABB Blood Survey.† Source: For years 1989-2015, National Blood Collection and Utilization Survey (NBCUS). Year 2016, AABB transfusion data extrapolated based on proportion of AABB membership transfusion to national estimate in 2015.
Allogenic WB/RBCs
www.aabb.org 13
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2011 2013 2015 2016
Survey Year
Available Supply Transfused
Tho
usa
nd
sO
f U
nit
s
-3.3%
-3.2%
RBC Transfusion
www.aabb.org 14
44.3%
11.3%
95.0%
24.4%
55.7%
88.7%
5.0%
75.6%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%
O+ve Transfusion (Total =3,556;N=258)
O-ve Transfusion (Total =3,746;N=266)
LR RBC Tranfusion (Total =5,549;N=378)
IRR RBC Tranfusion (Total =5,094;N=347)
2016 RBC Transfusion: Group O Type and Modification
2015: 21.3%
2015: 92.4%
2015: 10.3%
2015: 40.4%
Estimated 2016 Collection by AABB US Member Institutions for Non-
Red Blood Cell Components (expressed in thousands of units)
Activity Blood Centers
Hospitals 2016 Combined Total
2015 Total % Change 2013-2015
Collection/Production
Apheresis Platelets Collected 2,261 122 2,383 2,314 2.9%
Apheresis Platelets Distributed 2,164 121 2,285 2,112 7.6%
WB-Derived Platelet Produced (individual concentrates)
1,340 40 1,380 1,190 13.8%
WB-Derived Platelet Distributed as individual concentrates or pools†
210 9 218 (1,091) 172 (869) 21.1% *
Total Platelets Distributed 2,374 130 2,503 2,284 8.7%
Plasma Collected or Produced 2,832 237 3,069 3,787 -23.4% *
Plasma Distributed for Transfusion 2,745 131 2,876 3,302 -14.8%
Cryoprecipitate produced 2,105 100 2,205 1,565 29.0% *
Cryoprecipitate distributed 1,850 93 1,943 1,523 21.6% *
www.aabb.org 15
†Apheresis Equivalent units; numbers in parenthesis represent individual platelet concentrates produced from whole blood donations
Estimated 2016 Transfusion by AABB US Member Institutions for Non-
Red Blood Cell Components (expressed in thousands of units)
Activity Blood Centers
Hospitals 2016 Combined
Total
2015 Total % Change 2013-2015
TransfusionsApheresis Platelets 3 1,252 1,255 1,094 12.8%
WB-Derived Platelet Concentrates
0 135 135(674) 145 (774) -7.4%
Total Platelets 3 1,387 1,390 1,239 10.9%Plasma 1 1,436 1,438 1,591 -10.6%Cryoprecipitate 1 1,070 1,071 877 18.1%*
www.aabb.org 16
Apheresis Platelet
www.aabb.org 17
0
500
1000
1500
2000
2500
3000
2011 2013 2015 2016
Tho
usa
nd
s o
f U
nit
s
Survey Year
Transfused Collected/Produced Distributed
+12.8%
+7.6%
+2.9%
WBD Platelet
www.aabb.org 18
0
50
100
150
200
250
2011 2013 2015 2016
Ap
he
resi
s Eq
uiv
ale
nt
Un
its
Survey Year
Distributed Transfused
-7.4%
+21.2%
Plasma
www.aabb.org 19
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2011 2013 2015 2016
Tho
usa
nd
s o
f U
nit
s
Survey Year
Transfused Collected/Produced Distributed
-10.6%
-23.4%
-14.8%
Cryoprecipitate AHF
www.aabb.org 20
+21.6%
+18.1%
0
500
1,000
1,500
2,000
2,500
3,000
3,500
2011 2013 2015 2016
Tho
usa
nd
s o
f U
nit
s
Survey Year
Distribution Transfusion
Summary• Overall trend of decline in collection and transfusion continued
in 2016 for WB/RBCs and Plasma
• The margin between allogeneic WB/RBC supply and demand suggests that the supply is fragile
• Overall platelet and Cryo collection as well as transfusion showed upward trends
• Continued study and surveys required to quantify the supply and demand of blood components and to identify the reasons behind observed changes.
www.aabb.org 21
Limitations
• Survey limited to AABB membership
• Transfusion estimates limited to AABB membership
• Poor hospital response rate
• Non-response increases the uncertainty in the
estimates and introduces bias to the estimates
www.aabb.org 22
Many Centers Now Operating at Breakeven
2
2012 2013 2014 2015 2016
All 2.0% 0.8% 0.2% -0.7% 0.2%
Small 2.5% 1.5% 0.6% -0.6% 0.0%
Medium 3.5% 2.1% -0.7% -1.7% 0.4%
Large -0.7% 0.1% 0.5% -1.6% 0.4%
2.0%
0.8%0.2%
-0.7%0.2%
-3.0%
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
Median Operating Margin (Operating Income Percent)
Source: ABC member survey, fall 2017
Average of All Centers is Slightly Negative
3
2012 2013 2014 2015 2016
All 1.5% 0.9% 0.0% -1.5% -0.2%
Small 2.0% 1.0% 0.7% -0.8% 0.3%
Medium 2.4% 1.5% -0.5% -1.4% 0.3%
Large 0.0% 0.1% -0.3% -2.3% -1.1%
1.5%
0.9%
0.0%
-1.5%
-0.2%
-3.0%
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
Average Operating Margins
Source: ABC member survey, fall 2017
Aggregated Basis - Our Industry Has Run In The Red
4
-3.0%
-2.5%
-2.0%
-1.5%
-1.0%
-0.5%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
2012 2013 2014 2015 2016
Median 2.0% 0.8% 0.2% -0.7% 0.2%
Average 1.5% 0.9% 0.0% -1.5% -0.2%
Aggregate -0.5% -0.7% -1.9% -2.9% -2.2%
America's Blood CentersOperating Margins
Source: ABC member survey, fall 2017
Our Customers Are Profitable
5
2012 2013 2014 2015 2016
ABC -0.5% -0.7% -1.9% -2.9% -2.2%
Hospitals * 2.9% 2.2% 2.9% 3.6% 2.4%
-0.5% -0.7%
-1.9%
-2.9%
-2.2%
2.9%
2.2%
2.9%
3.6%
2.4%
-4.0%
-3.0%
-2.0%
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
Operating Margins* S&P Ratings - US Not for Profit Healthcare System Median; ABC Centers Financial Ratios –
Aggregate Operating Margin
Source: ABC member survey, fall 2017
Fees Continue To Fall And Operating Margins
Hover Around Breakeven
6
$214$215
$213 $210
$2002.0%
0.8%
0.2%
-0.7%
0.2%
-2.0%
-1.5%
-1.0%
-0.5%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
$100
$120
$140
$160
$180
$200
$220
2012 2013 2014 2015 2016
Median Operating Margin & Median Price, Leukoreduced Red Cells (All Centers)
LRBC Price Operating Margin %
Source: ABC member survey, fall 2017
Business Issues Raised by the American Red
Cross*
• Red cell demand has dropped by nearly a third in the past decade – could reach 40%
• Industry has shed $1.3 billion in expenses since 2009
• Most blood products are shipped below cost
• ARC red cell fees decreased 11% (2010-17) while the MCPI increased by 26%
• Critical responses are innovation and fee increases
7
*Source: ARC open letter to the U.S. health care community, August 2018
Blood Collection and Use in the United
States: Findings of the 2017 CDC
National Blood Collection and
Utilization Survey and the 2016 AABB
Blood Survey
10/15/2018
Faculty Disclosures
The following faculty have no
relevant financial relationships
to disclose:
– Jefferson Jones MD, MPH
– Srijana Rajbhandary BDS,
MPH
– John Murphy
The following faculty have a
relevant financial relationship:
– Jay Menitove MD
Accumen: Consultant
CSL Plasma: Consultant
Mediware Analytics:
Consultant
www.aabb.org 2
Learning Objectives
• Describe the trend of blood collection and use in the
United States
• Discuss the implications of the trend of blood collection
and use on the implementation of blood safety
interventions
• Discuss the implications of the findings of the survey(s)
on the sustainability of the U.S. blood supply
www.aabb.org 3