Research Article| Volume 60, ISSUE 1, 103012, February 2021

Blood transfusion trends by disease category in the United States, 2000 to 2014

  • Nicholas Roberts
    Corresponding author at: Institute for Health Metrics and Evaluation, 2301 5th Avenue, Seattle, WA, 98121, United States.
    Department of Health Metric Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
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  • Spencer L James
    Department of Health Metric Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
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  • Meghan Delaney
    Division of Pathology & Laboratory Medicine, Children’s National Medical Center, Washington, DC, United States

    Departments of Pathology & Pediatrics, George Washington University Medical School, Washington DC, United States
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  • Christina Fitzmaurice
    Department of Health Metric Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States

    Department of Medicine, Division of Hematology, University of Washington, Seattle, WA, United States
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Published:November 21, 2020DOI:


      • From 2000–2014, blood transfusion frequency peaked in 2011.
      • Blood practices broken down by disease show decreasing trends in most specialties.
      • More restrictive blood transfusion practices saved over three million units of blood in 2014.



      Better understanding of blood usage rates could identify trends in transfusion practices over time and inform more efficient management.


      Inpatient admissions from the Healthcare Cost and Utilization Project National Inpatient Sample and State Inpatient Databases were analyzed for packed red blood cell (PRBC), plasma, platelet, and whole blood (WB) transfusions. The transfusion rates per admission and per prevalent case were calculated. Prevalence estimates were from the Global Burden of Disease 2017 study (GBD).


      From 2000 to 2014, blood usage rates for most causes peaked around 2010. Across all causes, PRBC were the most commonly transfused component, followed by plasma, platelets, and WB. However, the relative use of each type varied by cause. Nutritional deficiencies (1.75 blood product units across all components per admission; 95 % uncertainty interval (UI) 1.62–1.87), neoplasms (0.95; 0.87–1.04), and injuries (0.92; 0.86 – 0.98) had the greatest blood use per admission. Cardiovascular diseases (96.9 units per 1000 prevalent cases; 89.3–105.0) and neoplasms (92.7 units per 1000 prevalent cases; 84.3–101.5) had the greatest blood use per prevalent case. Across all admissions, over three million blood units were saved in 2014 compared to 2011 due to transfusing at a reduced rate.


      Blood transfusion rates decreased from 2011 to 2014 in the United States. This decline occurred in most disease categories, which points towards broad strategies like patient blood management systems and disease specific improvements like changes in surgical techniques being effective.


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