2013 AABB Blood Survey Report

1 THE aabb Blood Survey Report Final The 2013 aabb Blood Collection, Utilization, and Patient Blood Management Survey ReportReport AuthorsBarbee I. Whitaker, PhD Srijana Rajbhandary, BDS, MPH Andrea Harris, MPHC itation aabb , December 18, 2015 iii Table of ContentsList of Tables.. vList of Figures ..vii1. Executive Summary.. 1US Blood Collection .. 1US Blood Utilization .. 2 Patient Blood Management (PBM) .. 32. Key Findings ..53. International Report .. 9 Blood Collected and Produced .. 9 Blood transfusion .. 104. Blood Collected and Produced in aabb Member Facilities: Trends in US Collections.

2 11 Total WB/RBC Collections .. 11 Whole Blood (WB) .. 11 Red Blood Cell (RBC) Apheresis.. 12 RBC Distributions .. 14 Non-RBC Components .. 14 Platelets ..14 Plasma..15 Cryoprecipitate .. 17 Granulocytes .. 18 Blood Center Inventory .. 185. Blood Transfused by US-Based aabb Member Hospitals .. 21WB and RBCs Transfused .. 21 Pediatric Transfusions .. 21 transfusion Recipients .. 22 Non-RBC Components Transfused .. 22 Outdated Units .. 26 THE 2013 aabb Blood COLLECTION, UTILIZATION, AND PATIENT Blood MANAGEMENT Survey REPORTiv6. Patient Blood Management (PBM) in aabb Member Facilities.

3 29 PBM Interventions .. 31 Measure of Intervention Success .. 34 Informed Consent .. 35 Type and Screen before Procedures .. 36 transfusion Thresholds .. 367. Current Issues in Blood Collection and Donor Screening .. 43 Donor Hemovigilance .. 458. Current Issues in Blood transfusion .. 47US Collection Trends .. 47 Blood Availability .. 48 Blood Use.. 50 Crossmatch Procedures .. 52 Red Cell Age.. 52 Platelet Age.. 52 Hemovigilance .. 529. Component Costs .. 57 RBCs .. 57 Plasma .. 57 Apheresis Platelets .. 58 Reimbursement .. 58 Summary .. 6110.

4 Component Modification .. 63 Leukocyte Reduction .. 63 aabb Member transfusion of Irradiated and LR Components.. 6311. Appendix I: Methods .. 69 Survey Population.. 69 Non-US aabb Member Response.. 69US Military Blood Program Response .. 69 aabb US Member Data Analysis .. 69 Response Rates and Weights.. 69 Imputation of Data Items.. 72 Characterization of Respondents.. 72 Comparison with Previous Surveys .. 73 Data Quality Control .. 74 Statistical Analysis.. 74 Limitations .. 7412. Appendix II: Glossary of Terms .. 7513. Acknowledgements .. 77 THE 2013 aabb Blood COLLECTION, UTILIZATION, AND PATIENT Blood MANAGEMENT Survey Report v List of TablesTable 2013 Collection and transfusion by aabb US Member Blood Centers and Hospitals for Whole Blood (WB) and Red Blood Cells (RBCs) (expressed in thousands of units).

5 13 Table 4-2. Estimated 2013 Collection and transfusion by aabb US Member Blood Centers and Hospitals for Non-RBC Components (expressed in thousands of units) .. 16 Table 5-1. Pediatric Transfusions by US Blood Centers and Hospitals in 2013 (expressed in thousands of units) .. 22 Table 5-2. Outdated Components as a Percentage of the Total Number of Units of Each Component Distributed for transfusion in 2013 .. 27 Table 6-1. Reporting Hospitals Policy for Platelet Threshold for transfusion .. 38 Table 7-1. Donor Adverse Reaction Rate by aabb Facility and Procedure Type.. 45 Table 8-1.

6 transfusion -Related Adverse Reactions Reported to the transfusion Service .. 54 Table 9-1. Mean aabb Member Hospital Amount ($) Paid per Selected Component Unit in 2011- 2013 .. 58 Table 9-2. Average aabb Member Hospital Component Cost ($) by Surgical Volume, 2013 .. 59 Table 9-3. CMS Hospital Outpatient Prospective Payment System Rates for Selected Blood Components .. 60 Table 10-1. Blood Components Modified to Achieve Prestorage Leukocyte Reduction in US aabb Facilities .. 64 Table 10-2. Change in Number of Blood Components Modified to Achieve Pre-Storage Leukocyte Reduction by Facility Type from 2011 to 2013 .

7 66 Table 10-3. Estimated Number of Blood Component Units Modified by Irradiation or Leukocyte Reduction and Transfused by US aabb Member Facilities in 2013 .. 67 THE 2013 aabb Blood COLLECTION, UTILIZATION, AND PATIENT Blood MANAGEMENT Survey REPORTviTable 10-4. Total Number of Irradiated and Leukocyte Reduced Red Blood Cell (RBC) Units Transfused by US aabb Member Hospitals in 2013 , compared with RBC Units Transfused by aabb Member Hospitals in 2011 .. 68 Table A-1. aabb Blood Survey 2013 : Survey Population and Response Rates Non-US Members .. 70 Table A-2.

8 aabb Blood Survey 2013 : Survey Population and Response Rates US Military Blood Program .. 70 Table A-3. aabb Blood Survey 2013 : Survey Population and Response Rates .. 70 Table A-4. Response Rate Summary and Comparison with Previous Surveys .. 71 Table A-5. Weights for Blood Centers .. 71 Table A-6. Weights for 2013 Hospitals.. 72 Table A-7. Calibrated Average Final Weight by USPHS Region and Inpatient Surgical Volume 2011 aabb Hospital Respondents.. 73 THE 2013 aabb Blood COLLECTION, UTILIZATION, AND PATIENT Blood MANAGEMENT Survey Report vii List of FiguresFigure 1-1.

9 Growth in use of RBC apheresis technology .. 2 Figure 4-1. Allogeneic and autologous WB and RBC collections, 1989- 2013 .. 12 Figure 4-2. Apheresis procedures by primary component .. 15 Figure 4-3. Apheresis Platelets as Percent of Total Platelets Produced .. 17 Figure 4-4. Sources of plasma for transfusion .. 18 Figure 4-5. Days of Group O Supply 2011 and 2013 .. 19 Figure 5-1. Trends in platelet transfusion , 1997- 2013 .. 23 Figure 5-2. Types of plasma transfused in 2011- 2013 .. 24 Figure 5-3. Percent of plasma transfused as thawed plasma ( 2013 average 53%).

10 25 Figure 5-4. Percentage of Group O Allogeneic RBC Outdates .. 28 Figure 6-1. Use of national transfusion guidelines, 2011- 2013 .. 31 Figure 6-2. Preoperative PBM interventions implemented, 2013 (n=199) .. 32 Figure 6-3. Intra-operative PBM interventions implemented, 2013 (n=226) .. 33 Figure 6-4. Postoperative PBM interventions implemented, 2013 (n=203) .. 34 Figure 6-5. Methods hospitals use to measure the success of implementations to improve PBM.. 35 Figure 6-6. Reporting hospitals policy for a hemoglobin threshold for transfusion for hemodynamically stable non-bleeding patients.