Highlights
- •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.
Abstract
Background
Better understanding of blood usage rates could identify trends in transfusion practices
over time and inform more efficient management.
Methods
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).
Results
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.
Conclusions
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Transfusion and Apheresis ScienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Red blood cell transfusion: a clinical practice guideline from the AABB*.Ann Intern Med. 2012; 157: 49
- A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group.N Engl J Med. 1999; 340: 409-417
- Transfusion Requirements in Critical Care. The TRICC trial: a focus on the sub-group analysis.Vox Sang. 2002; 83: 387-396
- Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease.Am Heart J. 2013; 165 (e1): 964-971
- Liberal versus restrictive blood transfusion strategy: 3-year survival and cause of death results from the FOCUS randomised controlled trial.Lancet. 2015; 385: 1183-1189
- Association of blood transfusion with increased mortality in myocardial infarction: a meta-analysis and diversity-adjusted study sequential analysis.JAMA Intern Med. 2013; 173: 132-139
- Trends in red blood cell, plasma, and platelet transfusions in the United States, 1993-2014.JAMA. 2018; 319: 825
- Trends in hospitalizations with a red blood cell transfusion, 2000-2013.Agency for Healthcare Research and Quality, Rockvill, MD2016 (Dec. (HCUP Statistical Brief))
- Internet]. Swiss transfusion SRC; [cited 2019 oct 23].(Available from:)2018
Annual Report 2018/19 [Internet]. New Zealand Blood Service; [cited 2019 Oct 23]. Available from: https://www.nzblood.co.nz/assets/Uploads/New-Zealand-Blood-Service-2018-19-Annual-Report.pdf.
- Demographic and epidemiologic characterization of transfusion recipients from four US regions: evidence from the REDS-III recipient database.Transfusion. 2017; 57: 2903-2913
- Predicting red blood cell transfusion in hospitalized patients: role of hemoglobin level, comorbidities, and illness severity.BMC Health Serv Res. 2014 May; 10: 213
- A multicenter study of plasma use in the United States.Transfusion. 2015; 55 (1313–9; quiz 1312)
- Factors associated with red blood cell, platelet, and plasma transfusions among inpatient hospitalizations: a nationally representative study in the United States.Transfusion. 2019; 59: 500-507
- Slowing decline in blood collection and transfusion in the United States – 2017.Transfusion. 2020; (Mar [cited 2020 Sep 28];60(S2). Available from:)https://doi.org/10.1111/trf.15604
- Continued decline in blood collection and transfusion in the united States-2015: DECLINING BLOOD COLLECTION AND USE-2015.Transfusion. 2017; 57: 1588-1598
- Trends in United States blood collection and transfusion: results from the 2013 AABB blood collection, utilization, and patient blood management survey.Transfusion. 2016; 56: 2173-2183
- HCUP nationwide inpatient sample (NIS). Healthcare cost and utilization project (HCUP).Agency for Healthcare Research and Quality, Rockville, MD2011 ([Note: this format is used for all NIS databases prior to 2012 data.])www.hcup-us.ahrq.gov/nisoverview.jsp
HCUP State Inpatient Databases (SID). Healthcare Cost and Utilization Project (HCUP). 2005-2009. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/sidoverview.jsp.
- Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018; 392: 1789-1858
- Analysis of complex survey samples.J Stat Softw [Internet]. 2004; 9 ([cited 2018 Nov 25], Available from:)
- R: a language and environment for statistical computing.(URL) R Foundation for Statistical Computing, Vienna, Austria2018
- Declining blood collection and utilization in the United States: US BLOOD COLLECTION AND UTILIZATION SURVEY.Transfusion. 2016; 56: 2184-2192
- Changes in massive transfusion over time: an early shift in the right direction?.J Trauma Acute Care Surg. 2012; 72: 106-111
- Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis.BMJ. 2012; 344 (e3054–e3054)
- Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial.Anesthesiology. 2011; 114: 862-871
- Recent trends in blood utilization after primary hip and knee arthroplasty.J Arthroplasty. 2017; 32: 724-727
- The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia.N Engl J Med. 1997; 337: 1870-1875
- Trends in the cost and use of targeted Cancer therapies for the privately insured nonelderly: 2001 to 2011.J Clin Oncol. 2015; 33: 2190-2196
- Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial.JAMA. 2010; 304: 1559-1567
- Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage.JAMA. 2016; 316: 2025-2035
- Restrictive compared with liberal red cell transfusion strategies in cardiac surgery: a meta-analysis.Eur Heart J. 2019; 40: 1081-1088
- Indications contributing to the increasing cesarean delivery rate.Obstet Gynecol. 2011; 118: 29-38
- HIV viral suppression trends over time among HIV-Infected patients receiving care in the United States, 1997 to 2015: a cohort study.Ann Intern Med. 2018; 169: 376
- Improvement of Anemia Among HIV-Infected injection drug users receiving highly active antiretroviral therapy: JAIDS.J Acquir Immune Defic Syndr. 2001; 26: 315-319
- The national blood collection and utilization survey report.2011
- Population-based trends in volumes and rates of ambulatory lumbar spine surgery.Spine. 2006; 31 (discussion 1964): 1957-1963
- Reimbursement for blood products and related services in 2018 [Internet].Covance Market Access Services Inc, 2018 ([cited 2018 Dec 23]. Available from:)
- Comparison of ICD-9-based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting.J Neurosurg Spine. 2011; 14: 16-22
- Accuracy of ICD-9 codes in identifying ischemic stroke in the General Hospital of Lugo di Romagna (Italy).Neurol Sci Off J Ital Neurol Soc Ital Soc Clin Neurophysiol. 2003; 24: 65-69
- Administrative database concerns: accuracy of International Classification of Diseases, Ninth Revision coding is poor for preoperative anemia in patients undergoing spinal fusion.Spine. 2014; 39: 2019-2023
- Effects of the COVID-19 pandemic on supply and use of blood for transfusion.Lancet Haematol. 2020; 7: e756-64
- Validating billing data for RBC transfusions: a brief report.Transfusion. 2001; 41: 530-533
- Evaluation of clinical coding data to determine causes of critical bleeding in patients receiving massive transfusion: a bi-national, multicentre, cross-sectional study.Transfus Med Oxf Engl. 2017; 27: 114-121
- The AABB recommendations for the choosing wisely campaign of the american board of internal medicine: AABB CHOOSING WISELY CAMPAIGN.Transfusion. 2014; 54: 2344-2352
Article info
Publication history
Published online: November 21, 2020
Accepted:
November 11,
2020
Received in revised form:
November 9,
2020
Received:
April 8,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
