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 .. 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.

2 21 transfusion Recipients .. 22 Non-RBC Components Transfused .. 22 Outdated Units .. 26 THE 2013 aabb Blood COLLECTION, UTILIZATION, AND PATIENT Blood MANAGEMENT Survey REPORTiv6.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 .. 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. Component Modification .. 63 Leukocyte Reduction .. 63 aabb Member transfusion of Irradiated and LR Components.. 6311. Appendix I: Methods.

3 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) .. 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).

4 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. 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 .. 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 .

5 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. 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.

6 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%).. 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).

7 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 .. 37 Figure 6-7. INR threshold for transfusion of plasma .. 39 Figure 6-8. Reported PTT threshold for bleeding patients (n=174) .. 40 Figure 6-9. Use of prothrombin complex concentrates (4-factor or 3-factor) by hospitals reporting a policy for their use .. 40 Figure 7-1. Donor deferrals 2013 .. 44 Figure 8-1. Trends in estimated rates of WB/RBC collection United States, 1980- 2013 .. 48 Figure 8-2. Trends in estimated rates of WB/RBC transfusion in the United States, 1980- 2013 .. 49 Figure 8-3. US allogeneic WB/RBC collections and transfusions, 1989- 2013 .. 49 Figure 8-4. RBC use by hospital service in 2013 .. 51 Figure 8-5. Platelet use by hospital service in 2013 .. 51 Figure 8-6.

8 Adverse reactions by type, 2011 and 2013 .. 55 Figure 10-1. US transfusion of modified RBC components .. 65 THE 2013 aabb Blood COLLECTION, UTILIZATION, AND PATIENT Blood MANAGEMENT Survey REPORTE xecutive Summary 11. Executive SummaryThe 2013 aabb Blood Col-lection, Utilization, and Patient Blood Management Survey ( Blood Survey ) was sponsored by aabb and conducted with aabb member participation. The objectives of this new sur-vey were to gather Blood collection and transfusion information about aabb members, both within the United States and interna-tionally, make comparisons with previous US surveys where possible, and pro-vide patient Blood manage-ment (PBM) benchmarks for aabb members complet-ing the PBM section. The 2013 Blood Survey find-ings are reported here in total, replacing Part I of the 2013 Blood Survey Report released earlier and includ-ing all results. Survey results from aabb members out-side of the United States are facilities surveyed included all aabb member Blood collectors (both Blood center and hospital-based facilities), hospital transfusion services, and centralized transfusion ser-vices, both in the United States and internationally.

9 There was no sampling all responding aabb institu-tional members were included, regardless of size and overall response rate for the 2013 aabb Blood Survey was (625/1147). The Blood center response rate was (73/79) and there was an additional response from member US military collectors (2/4). The hospi-tal response rate was (552/1068).* Response rates were comparable to the 2009 National Blood Col-lection and Utilization Sur-vey (NBCUS) and slightly higher than responses by aabb member institutions for the 2011 to the high response rate of Blood collectors, estimates and comparisons to previous data can be made for the entire US Blood collection system. However, as aabb institu-tional members administer only a portion of the trans-fusions in the United States, comparisons of Blood trans-fusions are limited to activ-ity at aabb member hospitals reporting in 2011 versus 2013 . The international response was less robust, with (6/17) of non-US Blood centers and (8/35) of non-US hospitals reporting.

10 It is possible that the low response was due to inade-quate communication to all members that the Survey scope included non-US aabb members for the sur-vey year Blood CollectionThe 2013 aabb Blood Sur-vey estimates that mil-lion whole Blood (WB) and red Blood cell (RBC) units *Military hospitals were included in this group as they serve military and non-military populations. Report of the US Department of Health and Human Services. The 2011 national Blood collection and utilization Survey Report . Washington, DC: US Department of Health and Human Services, Office of the Assistant Secretary of Health, 2013 aabb Blood COLLECTION, UTILIZATION, AND PATIENT Blood MANAGEMENT Survey REPORT2 Executive Summarywere collected, a significant decline of (p< ) from 2011. In 2013 , Blood centers were responsible for the collec-tion of million units, or of the supply; the remaining were col-lected by aabb hospitals. Therapeutic collections that were not intended for trans-fusion have not been included in this was a decrease in the total number of RBC apheresis units collected, including both allogeneic and autologous collec-tions, to approximately million units (p= ).