Relative impact of a patient blood management program on utilization of all three major blood components

Thakkar, Rajiv N.; Lee, K.H. Ken; Ness, Paul M.; Wintermeyer, Tyler L.; Johnson, Daniel J.; Liu, Emily; Rajprasad, Anjuli; Knight, Amy M.; Wachter, Pat A.; Demski, Renee; Frank, Steven M.

doi:10.1111/trf.13718

Cited by 41 publications

(32 citation statements)

References 30 publications

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“…This might reflect the shorter shelf life of platelet products, which requires blood centers to maintain inventory to ensure availability when clinically needed . Guidelines for platelet transfusion thresholds have been published but reducing plasma and platelet transfusion through blood management programs might be more difficult than reducing RBC transfusions . Platelet trends might also be affected by evidence supporting and guidelines recommending early platelet transfusion and a high ratio of platelets to RBCs during resuscitation of severely injured bleeding patients, potentially requiring hospitals to maintain increased numbers of platelets in inventory …”

Section: Discussionmentioning

confidence: 99%

“…33 Guidelines for platelet transfusion thresholds have been published 8 but reducing plasma and platelet transfusion through blood management programs might be more difficult than reducing RBC transfusions. 34 Platelet trends might also be affected by evidence supporting and guidelines recommending early platelet transfusion and a high ratio of platelets to RBCs during resuscitation of severely injured bleeding patients, potentially requiring hospitals to maintain increased numbers of platelets in inventory. [35][36][37] Projections of RBC use in the United States from 2017 to 2022 suggest a continued 10.0% to 14.3% decline.…”

Section: Discussionmentioning

confidence: 99%

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Slowing decline in blood collection and transfusion in the United States – 2017

et al. 2020

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INTRODUCTION The National Blood Collection and Utilization Survey (NBCUS) has demonstrated declines in blood collection and transfusion in the United States since 2008, including declines of 11.6% in red blood cell (RBC) collections and 13.9% in RBC transfusions during 2013‐2015. This study described the 2017 NBCUS results. METHODS The 2017 NBCUS was distributed to all US blood collection centers, all hospitals performing at least 1000 surgeries annually, and a 40% random sample of hospitals performing 100 to 999 surgeries annually. Weighting and imputation were used to generate national estimates for units of blood and components collected, deferred, distributed, transfused, and outdated. RESULTS Response rates for the 2017 NBCUS were 88% for blood collection centers and 86% for transfusing hospitals. Compared with 2015, the number of RBC units collected during 2017 (12,211,000; 95% confidence interval [CI], 11,680,000‐12,742,000) declined by 3.0%, and transfused RBC units (10,654,000, 95% CI, 10,314,000‐10,995,000) declined by 6.1%. Distributed platelet (PLT) units (2,560,000; 95% CI, 2,391,000‐2,730,000 units) increased by 5.1%, and transfused PLT units (1,937,000, 95% CI, 1,794,000‐2,079,000) declined by 2.3%. Distributed plasma units (3,209,000; 95% CI, 2,879,000‐3,539,000) declined by 13.6%, and transfused plasma units (2,374,000; 95% CI, 2,262,000‐2,487,000) declined by 12.9%. CONCLUSION The 2017 NBCUS suggests a continued but slowing decline in demand for RBCs. The decline in blood collection and use will likely continue. Despite decreasing demand and increasing manufacturing costs of blood products, the US blood industry has met the regular and emergent needs of the country.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Slowing decline in blood collection and transfusion in the United States – 2017

et al. 2020

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“…Appropriate use of blood products is a key component of PBM. However, only few studies compared transfusion rate of platelets and fresh frozen plasma before and after implementation of PBM . Overall, adherence to transfusion guidelines was associated with significant reduction of transfused platelets and plasma .…”

Section: Discussionmentioning

confidence: 99%

Health economics of Patient Blood Management: a cost‐benefit analysis based on a meta‐analysis

et al. 2019

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Background and Objectives Patient Blood Management (PBM) is the timely application of evidence‐based medical and surgical concepts designed to improve haemoglobin concentration, optimize haemostasis and minimize blood loss in an effort to improve patient outcomes. The focus of this cost‐benefit analysis is to analyse the economic benefit of widespread implementation of a multimodal PBM programme. Materials and Methods Based on a recent meta‐analysis including 17 studies (>235 000 patients) comparing PBM with control care and data from the University Hospital Frankfurt, a cost‐benefit analysis was performed. Outcome data were red blood cell (RBC) transfusion rate, number of transfused RBC units, and length of hospital stay (LOS). Costs were considered for the following three PBM interventions as examples: anaemia management including therapy of iron deficiency, use of cell salvage and tranexamic acid. For sensitivity analysis, a Monte Carlo simulation was performed. Results Iron supplementation was applied in 3·1%, cell salvage in 65% and tranexamic acid in 89% of the PBM patients. In total, applying these three PBM interventions costs €129·04 per patient. However, PBM was associated with a reduction in transfusion rate, transfused RBC units per patient, and LOS which yielded to mean savings of €150·64 per patient. Thus, the overall benefit of PBM implementation was €21·60 per patient. In the Monte Carlo simulation, the cost savings on the outcome side exceeded the PBM costs in approximately 2/3 of all repetitions and the total benefit was €1 878 000 in 100·000 simulated patients. Conclusion Resources to implement a multimodal PBM concept optimizing patient care and safety can be cost‐effectively.

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“…26 Transfusion service directors need to discourage poor transfusion practices as part of a PBM program and shift the intrainstitutional culture to transfusion avoidance, where appropriate. 27 This can substantially impact the volume of RBCs transfused, [28][29][30][31] and the safest blood remains the unit that is never transfused.…”

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confidence: 99%