Declining blood collection and utilization in the United States.

Chung KW, Basavaraju SV, Mu Y, et al.
Transfusion 2016;56:2184-2192.
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Review by : L. T. Goodnough
NATA Review

The authors report an analysis of the 2013 Blood Collection and Utilization Survey results by the US Department of Health and Human Services. They found significant changes in demand for blood components compared to the 2011 survey: transfusions of RBCs, platelets and plasma changed by –4.3%, +8.5%, and –6.6%, respectively. The volumes of blood components distributed from blood centres (and purchased by hospitals) changed even more profoundly: RBC, platelet and plasma units decreased by 9.4%, 10.6% and 26.8%, respectively.

Blood inventory was better managed by both blood centres and hospitals, as evidenced by declines in unit outdates by 31.9% and 24.2%, respectively. The decline in hospital demand was attributed to patient blood management initiatives and a reduction in inappropriate blood transfusions, and these trends are expected to continue.

The authors’ conclusion that these trends constitute threats to blood safety and the blood supply (such as public health emergency preparedness) seem to be misguided. Noone should be able to argue that reducing demand for blood and reducing inappropriate blood transfusions is bad for the blood supply, since both phenomena help preserve the national blood inventory for those patients who truly need it: trauma, postpartum hemorrhage, non-elective surgery and malignant haematology are categories that come to mind. And it has been well documented that natural disasters leading to emergent blood needs result, on balance, in net blood surpluses thanks to the generosity of community donors in response to such disasters.

– Lawrence Tim Goodnough

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