national blood collection and utilization in the united ... · total supply 11,713 502 12,215...

Jefferson Jones, MD MPH

Office of Blood, Organ, and Other Tissue SafetyDivision of Healthcare Quality Promotion

National Center for Emerging and Zoonotic Infectious DiseasesCenters for Disease Control and Prevention

2018 AABB Annual Meeting

Boston, MA

10/15/2018

National Blood Collection and Utilization in the United States, 2017

National Center for Emerging and Zoonotic Infectious Diseases

Division of Healthcare Quality Promotion

Presentation Objectives

Overview National Blood Collection and Utilization Survey

(NBCUS)

Survey design and analytic methods

Preliminary findings

Conclusion and discussion

2017 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY

Background

NBCUS Objectives

Quantify blood and blood component collection,

distribution, and transfusion nationally

Develop reliable national estimates of collection and

utilization used to:

estimate blood demand

project future blood needs

inform policy decisions

NBCUS Background

NBCUS is a biennial, cross-sectional survey:

All US blood collection centers

Sample of US hospitals that transfuse blood and blood

components

Key information collected:

Units of blood and components collected and transfused

Units rejected and outdated

Costs, practices, and policies

NBCUS Background

Intermittent national surveys of US blood collection

centers and transfusing facilities since 1971

1979 – 1994: Nine surveys conducted with NIH support

In 1997, the Office of the Assistant Secretary for Health (OASH)

launched the standardized and biennial NBCUS

1999 – 2011: Six surveys conducted by AABB with Department of

Health and Human Services (DHHS) support

2013 - present: CDC/OASH administered the survey

NBCUS Background

Trends in estimated rates of WB/RBC collection and transfusion,

1992–2015

Population data from US Census Bureau (http://www.census.gov/popest/data/index.html)


Survey Design

2017 Survey Design

Web-based

Facility sampling

Letter sent to facility administrator via US mail

Unique web links were emailed to facilities

Phone follow-up with non-respondents/missing data

2017 Survey Design

The link directed participants to the 2017 NBCUS Portal

Page which included:

2017 National Blood Collection and Utilization Survey

Portal Page

2017 Survey Design

2017 Survey contained three sections:

Section A – General Information

• Facility type

• Contact information

Section B – Blood Collection, Processing, and Testing

• 20 questions

• Quantity of blood and blood components collected, processed, tested,

and distributed

Section C – Blood Transfusion

• 28 questions

• Quantity of blood and blood components transfused, cost paid per

unit, and hospital-specific practices related to transfusion

2015 vs 2017 Survey Differences


FDA Blood Establishment Registration definitions






Whole blood for distribution as whole blood

Group O+/O- whole blood

AB plasma

Single, double, triple apheresis platelet collections

Hematopoietic growth factor for granulocyte collections





Gender-specific donor deferrals

Adolescent donors by year of age

First time donors

Severe adverse events by age (adult vs adolescent)

Pathogen reduction technology

Babesia screening






Neonatal transfusions

Method of irradiation

Before storage vs. after storage leukoreduction


Methods

Sampling Frame — Blood Centers

Data sources: FDA Blood Establishment Registration database

America’s Blood Center’s contact list

Survey sample included all blood collection centers

Sampling Frame — Acute care hospitals

Data source: 2015 American Hospital Association (AHA) annual survey database

Excluded:

Hospitals performing <100 inpatient surgeries annually

Hospitals located in U.S. territories

Military, Department of Justice, rehabilitation, acute long-term

care, and psychiatric hospitals

Hospitals performing 100-999 inpatient surgeries were

randomly sampled at a rate of 40%

Hospitals performing ≥ 1000 inpatient surgeries were

completely sampled

Survey Timeline

2017 2018 2019

Facility contacts

confirmed

Survey Timeline

2017 2018 2019

Facility contacts

confirmed

Survey

launched

Survey Timeline

2017 2018 2019

Facility contacts

confirmed

Survey

launched

Nonrespondents

contacted

Survey Timeline

2017 2018 2019

Facility contacts

confirmed

Survey

launched

Nonrespondents

contacted

Follow up on

incomplete

responses

Survey Timeline

2017 2018 2019

Facility contacts

confirmed

Survey

launched

Nonrespondents

contacted

Follow up on

incomplete

responses

Publish

findings

Stratification

Blood collections centers (non-hospital based)

stratified on anticipated volume of RBCs collected

Expected volume of WB and RBC collections % sampled N

Fewer than 50,000 100% 31

50,000 to 199,999 100% 26

200,000 to 399,000 100% 6

400,000 or more units 100% 3

Total 66

Stratification

Hospital-based blood collection centers

Annual surgical volume % sampled n

Fewer than 1000 100% 19

1000 to 7999 100% 44

8000 or more surgeries 100% 44

Total 107

Stratification

Acute care hospitals

Surgical volume Sampled Population

100 to 999 surgeries per year 633* 1564

1000 to 1399 surgeries per year 404 404




8000 or more surgeries per year 219 219

Total 2847 3783

* Sampled at 40%; all other groups sampled at 100%


Analytic Methods

Analytic Methods

Sampling Weights

BCC and hospital respondents were weighted by strata to adjust

for non-respondents and sampling (transfusion data only)

Data Imputation

Multiple imputation was used to estimate missing data for

respondents

Point estimates with 95% confidence intervals (CI)

Point estimates, with 95% CIs, were calculated for collection and

utilization

Median cost per unit

Median cost per unit calculated by component type


Preliminary Findings

Response Rates: Blood Collection Centers

Type of Blood

collection center

Total number

sampled

Total number of

respondents

BCC response

rate

Non-hospital 66 62 94%

Hospital-based 107 91 85%

Total 173 153 88%

Non-hospital blood collection centerresponses by RBC collection volume

Volume of WB and

RBC collections

Total number

sampled

Total number

of respondents

Non-hospital

BCC response

rate

< 50,000 31 28 90%

50,000 to 199,999 26 25 96%

200,000 to 399,000 6 6 100%

≥ 400,000 3 3 100%

Total 62 66 94%

Hospital-based blood collection centerresponses by annual inpatient surgical volume

Annual inpatient

surgical volume

Total number

sampled

Total number

of respondents

Hospital-

based BCC

response rate

<1000 19 18 95%

1000 to 7999 44 38 86%

≥ 8000 44 35 80%

Total 107 91 85%

Hospital responsesby annual surgical volume

Annual surgical

volume

Total number

of surveys sent

Total number

of respondents

Hospital-

based BCC

response rate

100 to 999 633 525 83%

1000 to 1399 404 352 87%

1400 to 2399 588 504 86%

2400 to 4999 721 611 85%

5000 to 7999 282 251 89%

≥ 8000 219 192 88%

Total 2847 2435 86%

Decrease in number of non-hospital blood collection centers

Volume of WB and

RBC collections2015 2017

< 50,000 40 31

50,000 to 199,999 31 26

200,000 to 399,000 4 6

≥ 400,000 5 3

Total 80 66

Decrease in number of hospital-based blood collection centers

Annual inpatient

surgical volume2015 2017

<1000 12 19

1000 to 7999 83 44

≥ 8000 47 44

Total 142 107

Estimated numbers of whole blood and RBC units collected, transfused, and

outdated in 2017 (expressed in thousands)

Blood Centers

HospitalsCombined

Totals95% CI

2015 Totals

% Change 2017–2015

Collections

Whole Blood units

Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%

Autologous 7 2 10 (7-12) 25 -61.9%

Directed 6 10 16 (7-24) 21 -25.7%

Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%

Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%

Rejected on testing 74 4 78 (70-87) 53 47.8%

Rejected for other reasons 571 19 590 (537-643) 510 15.7%

Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%

Transfusions

Allogeneic, nondirected 10,491 (10,152-10,831) 11,264 -6.9%

Autologous 27 (11-43) 20 35.5%

Directed 56 (32-80) 66 -14.6%

Total Transfusions 10,575 (10,233-10,917) 11,349 -6.8%

Outdated whole blood or RBCs 269 175 444 (417-472) 600 -26.0%

Estimated numbers of whole blood and RBC units collected in 2017 (expressed in

thousands)

Blood Centers

Hospitals

Combined Totals 95% CI 2015

Totals% Change 2017–2015

Whole Blood units

Allogeneic, nondirected 9,918 479 10,397 (9,892-10,902) 10,748 -3.3%

Autologous 7 2 10 (7-12) 25 -61.9%

Directed 6 10 16 (7-24) 21 -25.7%

Apheresis RBC units 1,782 11 1,794 (1,631-1,956) 1,797 -0.2%

Total Supply 11,713 502 12,215 (11,680-12,751) 12,591 -3.0%

Rejected on testing 74 4 78 (70-87) 53 47.8%

Rejected for other reasons 571 19 590 (537-643) 510 15.7%

Total Available Supply 11,068 478 11,547 (11,032-12,061) 12,028 -4.0%

Estimated numbers of whole blood and RBC units transfused and outdated in

2017 (expressed in thousands)

Blood Centers Hospitals Combined

Totals 95% CI 2015 Totals

% Change 2017–2015

Allogeneic, nondirected 10,491 (10,152-10,831) 11,264 -6.9%

Autologous 27 (11-43) 20 35.5%

Directed 56 (32-80) 66 -14.6%

Total Transfusions 10,575 (10,233-10,917) 11,349 -6.8%

Outdated whole blood or RBCs 269 175 444 (417-472) 600 -26.0%

Trends in RBC collections and transfusion

per 1000 population, 1992–2017

Population data from US Census Bureau (http://www.census.gov/popest/data/index.html)

Trends in RBC distribution and transfusion , 1992–2017

Trends in RBC outdates, 1997–2017

Estimated number of platelets, plasma, and cryoprecipitate units distributed,

transfused, and outdated in 2017 (expressed in thousands)

Blood Centers

HospitalsCombined

Totals95% CI

2015

Totals

% Change 2017-2015

Distributed

Apheresis platelets 2,181 157 2,338 (2,188-2,487) 2,234 4.6%

Whole-blood-derived PLTs* 171 50 221 (141-302) 202 9.6%

Total platelets 2,352 207 2,559 (2,392-2,726) 2,436 5.1%

Total plasma 2,986 224 3,210 (2,877-3,542) 3,714 -13.6%

Cryoprecipitate‡ 1,979 177 2,156 (1,906-2,407) 1,857 16.1%

Blood center outdates§ 273 38 311 (268-354) 242 28.6%

Transfused

Apheresis platelets 1,847 (1,714-1,979) 1,807 2.2%

Whole-blood-derived PLTs* 82 (30-135) 171 -51.9%

Total platelets (includes directed units) 1,936 (1,793-2,080) 1,983 -2.3%

Total plasma 2,318 (2,205-2,431) 2,727 -15.0%

Cryoprecipitate‡ 1,068 (945-1,190) 1,167 -8.5%

Hospital outdates‖ 446 (415-477) 426 4.7%

* Whole-blood-derived platelets are expressed as apheresis equivalents.

‡ Cryoprecipitates are expressed as individual unit equivalents.

§ Blood center outdates are units that were outdated at non-hospital and hospital-based blood centers.

‖ Hospital outdates are units that were outdated at transfusing hospitals.

Estimated number of platelets, plasma, and cryoprecipitate units distributed

in 2017 (expressed in thousands)


Totals 95% CI 2015

Totals

% Change 2017-2015

Apheresis platelets 2,181 157 2,338 (2,188-2,487) 2,234 4.6%

Whole-blood-derived PLTs 171 50 221 (141-302) 202 9.6%

Total platelets 2,352 207 2,559 (2,392-2,726) 2,436 5.1%

Total plasma 2,986 224 3,210 (2,877-3,542) 3,714 -13.6%

Cryoprecipitate 1,979 177 2,156 (1,906-2,407) 1,857 16.1%

Estimated number of platelets, plasma, and cryoprecipitate units transfused

and outdated in 2017 (expressed in thousands)


Totals 95% CI 2015

Totals

% Change 2017-2015


Whole-blood-derived PLTs 82 (30-135) 171 -51.9%


Total plasma 2,318 (2,205-2,431) 2,727 -15.0%

Cryoprecipitate 1,068 (945-1,190) 1,167 -8.5%

Hospital outdates 446 (415-477) 426 4.7%

Estimated number of platelets, plasma, and cryoprecipitate units transfused

and outdated in 2017 (expressed in thousands)


Totals 95% CI 2015

Totals

% Change 2017-2015


Whole-blood-derived PLTs 82 (30-135) 171 -51.9%


Total plasma 2,318 (2,205-2,431) 2,727 -15.0%

Cryoprecipitate 1,068 (945-1,190) 1,167 -8.5%

Hospital outdates 446 (415-477) 426 4.7%

Blood center outdates 273 38 311 (268-354) 242 28.6%

Dis

trib

ute

d, tr

ansfu

sed

0

1,000

2,000

3,000

4,000

5,000

6,000

1989 1992 1994 1997 1999 2001 2004 2006 2008 2011 2013 2015 2017

Apheresis PLT distributedWhole blood PLT distributedPlasma distributedCryoprecipitate distributed

Apheresis PLT transfusedWhole blood PLT transfusedPlasma transfusedCryoprecipitate transfused

Trends in platelets, plasma, and cryoprecipitate

distribution and transfusion, 1989–2017

Median cost of components ($) as reported by hospitals

Median price paid per unit

Component 2017 IQR 2015 IQR

Median

Difference

2017-2015$

Leukoreduced RBCs $207 $196-$224 $211 $197-$228 -$4

Apheresis platelets $517 $490-$550 $524 $495-$560 -$7

Fresh frozen plasma $51 $43-$60 $54 $45-$64 - $3

Plasma, frozen within

24 hours (PF24)$50 $43-$60 $52 $45-$60 -$2

Limitations

As with previous NBCUS, imputation and weighting had to be employed to generate final estimates

• Effect of missing data and non-response smaller in 2017

Volume of inpatient surgical procedures may not reflect transfusion volume

Outpatient facilities and certain hospitals not included, possibly underestimating utilization

Summary

Slowing decline in blood collection and transfusion

• RBC collections decreased 3% and transfusions decreased 7% since 2015

• Total platelet distributions and transfusion with no significant changes since 2015 but decrease in whole-blood-derived platelet transfusion

• Plasma collections decreased 14% and transfusions decreased 15% since 2015

Decline in median price per unit and decline in distributed blood

Consolidation of blood centers

• Non-hospital based blood centers decreased from 80 to 66

• Hospital based blood centers decreased from 142 to 107

Discussion

Declining demand likely a result of changing practices

• Evidence-based guidance to standardize thresholds for transfusion and dosing

• Increasing oversight of transfusion practices and clinician decision support

• Proliferation of patient blood management to reduce need for transfusion

Issues for policy maker and industry consideration

• Increasing demands for safety interventions

• Trend of declining collection and utilization might results in diminished surplus

• How to maintain adequate supply for routine and emergent transfusion needs?

Acknowledgements

CDC

Sridhar Basavaraju

Kathryn Haass

Misha Baker

Alexandra Savinkina

Matt Sapiano

Tuyen Do

Karen Chung

Julie Smith

Jasmine Charter-Harris

Jacqueline Hensley

Kelsey Coy

OASH/HHS

Jim Berger

Richard Henry

FDA

Richard McBride

Judy Ciaraldi

Alan Williams

Orieji Illoh

Veterans Administration

Nora Ratcliff

ABC

Lou Katz

Martin Grable

And many others

For more information please contact Centers for Disease Control and Prevention

1600 Clifton Road NE, Atlanta, GA 30333

Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348

E-mail: [email protected] Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official

position of the Centers for Disease Control and Prevention.

Thank you

National Center for Emerging and Zoonotic Infectious Diseases

Division of Healthcare Quality Promotion

922,668

892,765 (-3.24%)

868,381 (-2.73%)

860,793 (-0.87%)

859,324 (-0.17%)

837,847 (-2.5%)

838,510 (0.08%)

841,939 (0.41%)

852,513 (1.26%) 831,257

(-2.49%)

809,567 (-2.61%)

819,684 (1.25%)

820,132 (0.05%)

792,452 (-3.38%)

783,668 (-1.11%)

783,479 (-0.02%)

803,248 (2.52%)

788,841 (-1.79%)

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

14Q1 14Q2 14Q3 14Q4 15Q1 15Q2 15Q3 15Q4 16Q1 16Q2 16Q3 16Q4 17Q1 17Q2 17Q3 17Q4 18Q1 18Q2

2014-2018Q2 BCA Red Cell Quarterly Demand Tracking with % Change Quarter to Quarter

130,000

135,000

140,000

145,000

150,000

155,000

2014-2018Q2 Quarterly Total Platelets Equivalent Doses Demand1SDP = 5RDPs =1Pool RDP

Total Platelets

Total Platelet Q2 % changeto prior year Q2

2015 1.3%2016 1.7%2017 -1.8%2018 -0.4%

50,000

70,000

90,000

110,000

130,000

150,000

170,000

190,000

210,000

230,000

250,000

14Q1 14Q2 14Q3 14Q4 15Q1 15Q2 15Q3 15Q4 16Q1 16Q2 16Q3 16Q4 17Q1 17Q2 17Q3 17Q4 18Q1 18Q2 18Q3 18Q4

2014-2018Q2 Quarterly Plasma Demand Tracking

PLasma Actual Demand Plasma Linear Estimates Plasma Linear Projection

Preliminary Results: 2016 AABB Blood

SurveySrijana Rajbhandary, BDS, MPH

Research and Data Analyst

AABB

10/15/2018

Faculty Disclosure

• I have no conflicts of interest to disclose.

www.aabb.org 2

Objectives

• Learn the preliminary results from the 2016 AABB

Blood Survey

• Learn the new AABB membership survey plan

www.aabb.org 3

Methods

www.aabb.org 4

• Past Formal Surveys AABB conducted independently: 1997,1999, 2001, 2013, 2014-2015

• Data collection : August 2017- November 2017• Data cleaning, QC and analysis : December 2017- October 2018• AABB institutional members surveyed • Members allowed to report for other hospitals (including non-AABB

members)• Estimates were weighted• Weights were calculated as the inverse of the probability of response

Weights: Blood Centers

www.aabb.org 5

Weights : Hospitals

Annual Inpatient Surgical Volume Non-Respondents

Respondents Total Weight Response Rate

<= 99 surgeries per year 83 45 128 2.844 35.2%

100 - 999 surgeries per year 126 59 185 3.136 31.9%

1,000 - 1,399 surgeries per year 62 23 85 3.696 27.1%




=> 8,000 surgeries per year 100 52 152 2.923 34.2%

Unknown surgical volume 23 7 30 4.286 23.3%

Total 787 394 1181 33.4%

www.aabb.org 6

Blood Centers and Centralized Transfusion

Services

Blood Collector Size 2013 2014 2015 2016

RBC Collection 250,000+ 7 5 5 13RBC Collection 50,000 to 249,999 36 35 33 36RBC Collection <50,000 36 33 33 17

www.aabb.org 7

2013N

2015N

2016N

Reporting Centralized Transfusion Services 18 15 11

Estimated AABB US Member 2016 Collection: WB/RBC

(expressed in thousands of Units)

www.aabb.org 8

Activity Blood Centers

Hospitals 2016 Combined Total

% of Total Collections/Transfusions

2015 Total % Change 2015-2016

Collection

WB Allogeneic (including directed) 10,219 464 10,683 86.9 10,957 -2.5%

Total Supply ( RBCs from WB /Apheresis Collection) 11,822 472 12,294 100.0 12,806 -4.0%

Rejected on Testing 45 3 48 0.4 72 -33.3% *

Rejected for Other Reasons 502 13 515 4.2 599 -14.0%

Available Supply 11,276 455 11,731 95.4 12,136 -3.3%

www.aabb.org 9

-4.0 %

0

2

4

6

8

10

12

14

16

18

2011 2013 2015 2016

Mill

ion

s o

f U

nit

s

Allogeneic whole blood and red cell collections, 2011- 2016*AABB estimate

AABB Allogeneic

Total Available Supply *

www.aabb.org 10

-4.0 %

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

1989 1992 1994 1997 1999 2001 2004 2006 2008 2011 2013 2015 2016

Mill

ion

s o

f U

nit

s

Allogeneic whole blood and red cell collections, 1989 – 2016*AABB estimateSources: National Blood Collection and Utilization Survey (NBCUS) reports . For years 2011 through 2015, new trend lines show collections from AABB members

Allogeneic

AABB Allogeneic

Total Available Supply *

Estimated AABB US Member 2016 Transfusion: WB/RBC

(expressed in thousands of Units)

www.aabb.org 11

2 CTS that reported transfusion data didn’t provide information regarding the hospitals they served.


Hospitals 2016 Combined

Total

% of Total Collections/Transfusions

2015 Total

% Change 2015-2016

Transfusions

Allogeneic WB/RBC ( including directed)

9 5,582 5,591 100.0 5,776 -3.2%

Allogeneic WB − 1 1 0.0 2 -50.0%

Allogeneic RBC 9 5,580 5,589 100.0 5,774 -3.2%

Group 0+ve 4 1,571 1,575 28.2 1,211 30.1%*

Group 0-ve 1 423 424 7.6 304 39.5%*

US allogeneic WB/RBC collections and transfusions, 1989-2016

www.aabb.org 12

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

1989 1992 1994 1997 1999 2001 2004 2006 2008 2011 2013 2015 2016

Mil

lio

ns o

f U

nit

s

Survey Year

.

Allogeneic Collections* Allogeneic Transfusions†

* Source: For years 1989-2011, National Blood Collection and Utilization Survey (NBCUS). Years 2013 ,2015 and 2016 AABB Blood Survey.† Source: For years 1989-2015, National Blood Collection and Utilization Survey (NBCUS). Year 2016, AABB transfusion data extrapolated based on proportion of AABB membership transfusion to national estimate in 2015.

Allogenic WB/RBCs

www.aabb.org 13

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

2011 2013 2015 2016

Survey Year

Available Supply Transfused

Tho

usa

nd

sO

f U

nit

s

-3.3%

-3.2%

RBC Transfusion

www.aabb.org 14

44.3%

11.3%

95.0%

24.4%

55.7%

88.7%

5.0%

75.6%

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0%

O+ve Transfusion (Total =3,556;N=258)

O-ve Transfusion (Total =3,746;N=266)

LR RBC Tranfusion (Total =5,549;N=378)

IRR RBC Tranfusion (Total =5,094;N=347)

2016 RBC Transfusion: Group O Type and Modification

2015: 21.3%

2015: 92.4%

2015: 10.3%

2015: 40.4%

Estimated 2016 Collection by AABB US Member Institutions for Non-

Red Blood Cell Components (expressed in thousands of units)


Hospitals 2016 Combined Total

2015 Total % Change 2013-2015

Collection/Production

Apheresis Platelets Collected 2,261 122 2,383 2,314 2.9%

Apheresis Platelets Distributed 2,164 121 2,285 2,112 7.6%

WB-Derived Platelet Produced (individual concentrates)

1,340 40 1,380 1,190 13.8%

WB-Derived Platelet Distributed as individual concentrates or pools†

210 9 218 (1,091) 172 (869) 21.1% *

Total Platelets Distributed 2,374 130 2,503 2,284 8.7%

Plasma Collected or Produced 2,832 237 3,069 3,787 -23.4% *

Plasma Distributed for Transfusion 2,745 131 2,876 3,302 -14.8%

Cryoprecipitate produced 2,105 100 2,205 1,565 29.0% *

Cryoprecipitate distributed 1,850 93 1,943 1,523 21.6% *

www.aabb.org 15

†Apheresis Equivalent units; numbers in parenthesis represent individual platelet concentrates produced from whole blood donations

Estimated 2016 Transfusion by AABB US Member Institutions for Non-

Red Blood Cell Components (expressed in thousands of units)


Hospitals 2016 Combined

Total

2015 Total % Change 2013-2015

TransfusionsApheresis Platelets 3 1,252 1,255 1,094 12.8%

WB-Derived Platelet Concentrates

0 135 135(674) 145 (774) -7.4%

Total Platelets 3 1,387 1,390 1,239 10.9%Plasma 1 1,436 1,438 1,591 -10.6%Cryoprecipitate 1 1,070 1,071 877 18.1%*

www.aabb.org 16

Apheresis Platelet

www.aabb.org 17

0

500

1000

1500

2000

2500

3000

2011 2013 2015 2016

Tho

usa

nd

s o

f U

nit

s

Survey Year

Transfused Collected/Produced Distributed

+12.8%

+7.6%

+2.9%

WBD Platelet

www.aabb.org 18

0

50

100

150

200

250

2011 2013 2015 2016

Ap

he

resi

s Eq

uiv

ale

nt

Un

its

Survey Year

Distributed Transfused

-7.4%

+21.2%

Plasma

www.aabb.org 19

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

2011 2013 2015 2016

Tho

usa

nd

s o

f U

nit

s

Survey Year

Transfused Collected/Produced Distributed

-10.6%

-23.4%

-14.8%

Cryoprecipitate AHF

www.aabb.org 20

+21.6%

+18.1%

0

500

1,000

1,500

2,000

2,500

3,000

3,500

2011 2013 2015 2016

Tho

usa

nd

s o

f U

nit

s

Survey Year

Distribution Transfusion

Summary• Overall trend of decline in collection and transfusion continued

in 2016 for WB/RBCs and Plasma

• The margin between allogeneic WB/RBC supply and demand suggests that the supply is fragile

• Overall platelet and Cryo collection as well as transfusion showed upward trends

• Continued study and surveys required to quantify the supply and demand of blood components and to identify the reasons behind observed changes.

www.aabb.org 21

Limitations

• Survey limited to AABB membership

• Transfusion estimates limited to AABB membership

• Poor hospital response rate

• Non-response increases the uncertainty in the

estimates and introduces bias to the estimates

www.aabb.org 22

Future Survey

www.aabb.org 23

Future Survey

www.aabb.org 24

www.aabb.org 25

Thank you!!

For questions

[email protected]

Independent Blood

Centers – Financial

Health TrendsJohn E. Murphy

1

October 15, 2018

Many Centers Now Operating at Breakeven

2

2012 2013 2014 2015 2016

All 2.0% 0.8% 0.2% -0.7% 0.2%

Small 2.5% 1.5% 0.6% -0.6% 0.0%

Medium 3.5% 2.1% -0.7% -1.7% 0.4%

Large -0.7% 0.1% 0.5% -1.6% 0.4%

2.0%

0.8%0.2%

-0.7%0.2%

-3.0%

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Median Operating Margin (Operating Income Percent)

Source: ABC member survey, fall 2017

Average of All Centers is Slightly Negative

3

2012 2013 2014 2015 2016

All 1.5% 0.9% 0.0% -1.5% -0.2%

Small 2.0% 1.0% 0.7% -0.8% 0.3%

Medium 2.4% 1.5% -0.5% -1.4% 0.3%

Large 0.0% 0.1% -0.3% -2.3% -1.1%

1.5%

0.9%

0.0%

-1.5%

-0.2%

-3.0%

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

Average Operating Margins


Aggregated Basis - Our Industry Has Run In The Red

4

-3.0%

-2.5%

-2.0%

-1.5%

-1.0%

-0.5%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

2012 2013 2014 2015 2016

Median 2.0% 0.8% 0.2% -0.7% 0.2%

Average 1.5% 0.9% 0.0% -1.5% -0.2%

Aggregate -0.5% -0.7% -1.9% -2.9% -2.2%

America's Blood CentersOperating Margins


Our Customers Are Profitable

5

2012 2013 2014 2015 2016

ABC -0.5% -0.7% -1.9% -2.9% -2.2%

Hospitals * 2.9% 2.2% 2.9% 3.6% 2.4%

-0.5% -0.7%

-1.9%

-2.9%

-2.2%

2.9%

2.2%

2.9%

3.6%

2.4%

-4.0%

-3.0%

-2.0%

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

Operating Margins* S&P Ratings - US Not for Profit Healthcare System Median; ABC Centers Financial Ratios –

Aggregate Operating Margin


Fees Continue To Fall And Operating Margins

Hover Around Breakeven

6

$214$215

$213 $210

$2002.0%

0.8%

0.2%

-0.7%

0.2%

-2.0%

-1.5%

-1.0%

-0.5%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

$100

$120

$140

$160

$180

$200

$220

2012 2013 2014 2015 2016

Median Operating Margin & Median Price, Leukoreduced Red Cells (All Centers)

LRBC Price Operating Margin %


Business Issues Raised by the American Red

Cross*

• Red cell demand has dropped by nearly a third in the past decade – could reach 40%

• Industry has shed $1.3 billion in expenses since 2009

• Most blood products are shipped below cost

• ARC red cell fees decreased 11% (2010-17) while the MCPI increased by 26%

• Critical responses are innovation and fee increases

7

*Source: ARC open letter to the U.S. health care community, August 2018

8

Thank You

Blood Collection and Use in the United

States: Findings of the 2017 CDC

National Blood Collection and

Utilization Survey and the 2016 AABB

Blood Survey

10/15/2018

Faculty Disclosures

The following faculty have no

relevant financial relationships

to disclose:

– Jefferson Jones MD, MPH

– Srijana Rajbhandary BDS,

MPH

– John Murphy

The following faculty have a

relevant financial relationship:

– Jay Menitove MD

Accumen: Consultant

CSL Plasma: Consultant

Mediware Analytics:

Consultant

www.aabb.org 2

Learning Objectives

• Describe the trend of blood collection and use in the

United States

• Discuss the implications of the trend of blood collection

and use on the implementation of blood safety

interventions

• Discuss the implications of the findings of the survey(s)

on the sustainability of the U.S. blood supply

www.aabb.org 3

national blood collection and utilization in the united ... · total supply 11,713 502 12,215...

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