As noted in a previous blog, Business of Blood in Decline, the number of transfusions are declining. While this is good news, there are a number of worrisome trends that indicate a crisis in the sustainability of the U.S. blood system (HG Klein et al. NEJM 2017; 1485-8).
- U.S. blood collectors draw 35,000 units a day
- Blood transfusion is ordered in 10-15% of all hospitalizations
- Less-invasive surgical techniques and other blood-management strategies have reduced demand for blood
So what is the problem?
The U.S. blood supply relies on nonprofit organizations which in turn have relied on blood as a major source of revenue. With reduction in blood demand and increased screening (e.g. for more infections), the cost per unit has increased; yet, due to stiff competition, there has not been a commiserate increase in reimbursement.
- 57.1% of America’s Blood Centers in December 2016 reported operating with negative margins
- 90% of the blood supply is estimated to be provided below cost
- Due to cost constraints, blood suppliers are less likely to adopt additional measures which could improve patient and donor safety
The authors argue that human blood should not be treated as “just another consumer good.” Strict economic principles undervalues the need of having a safe, available blood supply. While there have not been clinical consequences thus far, the current model is not sustainable.
My take: The financial market of the blood supply is precarious. This needs to be addressed to ensure the availability of blood when we need it.
Briefly noted -related study: EA Gehrie et al. J Pediatr 2017; 189: 227-31. In this study, the authors tested 220 red blood cell units. 15 (6.8%) had detectable drugs:. opiates, benzodiazepines, stimulants, and barbituates. While none of these units would have been disallowed under current FDA regulations, it is possible that these levels could cause reactions in vulnerable populations, like neonates. The authors note that allergens, like peanuts and fish, in blood donations can result in anaphylactic transfusion reactions