Collection and transfusion of blood and blood components in the United States, 1989

Abstract

To probe recent trends in transfusion practice and their effect on the adequacy of the national blood resource, transfusions and collections in the United States in 1989 were studied, by using data shared by the American Association of Blood Banks, the American Red Cross, and the Council of Community Blood Centers, together with results from a sample survey of the 3600 hospitals that were not members of the national organizations. Statistical methods were used to estimate national activities. The total US supply of blood in 1989 was 14,229,000 units, an increase of 1.2 percent over the supply in 1987. Red cell transfusions were 12,059,000 units. A total of 3,159,000 patients underwent transfusion with whole blood and/or red cells (mean, 3.8 units/patient). Preoperative autologous deposits of 655,000 units by 310,000 patients represented an increase of 65 percent over the level in 1987. However, only 356,000 units (54%) were transfused to the patients who preoperatively deposited them; of the remainder, 13,000 units were crossed over for transfusion to other patients, while 286,000 units were never used. Directed donations, 350,000 units, were provided for 130,000 intended recipients, but only 97,000 units (28%) were transfused to their intended recipients; of the balance, 59,000 units (17%) were crossed over and 194,000 units (55%) were never transfused. Total platelet transfusions were equivalent to 7,258,000 units in 1989, for an increase of 13.7 percent over totals in 1987.

Historical review: megakaryopoiesis and thrombopoiesis

“…The magnitude of the problem can be gauged by considering that in the United States approximately 1.5 million platelet transfusions (representing the equivalent of the platelets from 9 million units of blood) are administered yearly to patients to reduce their risk of severe bleeding. 9 Unfortunately, platelet transfusion therapy is less than ideal. At least 30% are associated with one or more complications, 10 usually by immune or cytokine-mediated febrile reactions, but occasionally by bacteremia, graft-versus-host disease, or acute pulmonary injury.…”

Prospective comparison of packed red blood cell–to–fresh frozen plasma transfusion ratio of 4

“…1 A restrictive transfusion policy is supported by randomized prospective trials in many diseases, including burns. 2Y4 However, none of the restrictive transfusion strategy studies has included patients with major acute blood loss.…”

Blood Product Transfusion: Does Location Make a Difference?

“…1 Although a restrictive transfusion policy in nonbleeding intensive care unit (ICU) patients has been supported by randomized prospective trials, the appropriate use of blood products, such as fresh frozen plasma (FFP), platelets, and cryoprecipitate, is less clear. 2 Recent trauma literature has reported improved mortality and decreased transfusion requirements in patients receiving an FFP: packed red blood cell (PRBC) ratio of 1:1 during massive transfusion.…”