Tag Archives: blood transfusions

Crisis Developing in Blood Supply

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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).

Some background:

  • 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

Business of Blood in Decline

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With refinements in surgery, including minimally invasive techniques, and studies showing that transfusions are not needed in many conditions until patients have bigger drops in their hemoglobin, there has been a big drop in the need for blood transfusions.  I was unaware of how much of a drop until I read this article from the NY Times: Blood Industry Shrinks

An excerpt:

Changes in medicine have eliminated the need for millions of blood transfusions, which is good news for patients getting procedures like coronary bypasses and other procedures that once required a lot of blood.

But the trend is wreaking havoc in the blood bank business, forcing a wave of mergers and job cutbacks unlike anything the industry, which became large scale after World War II, has ever seen.

Transfusions are down almost one-third over the last five years, to about 11 million units last year from about 15 million units, according to the American Red Cross, which has about 40 percent of the market. With “minimally invasive” techniques like laparoscopic surgery and other shifts in medicine, demand for blood continues to drop despite population growth and a soaring number of people over 65, who have the most surgeries requiring blood.

Blood bank revenue is falling, and the decline may reach $1.5 billion a year this year from a high of $5 billion in 2008.

Other useful points included the following:

  • The decline in demand is opportune given the growing list of exclusions
  • Red blood cells have a shelf life of 42 days; platelets 5 days
  • While blood is donated, hospitals pay $225-240 per unit and patient may be charged ~$1000 per unit.  Hospitals have been trying to lower their costs given the changes in supply and demand.

Related blog post:

Transfusion strategy in acute GI bleeding | gutsandgrowth