|M.A. Popovsky, MD, American Red Cross Blood Services, Dedham,
Mass, examined transfusion data from 182 hospitals serving 10
million people. Seven years' usage (FY'91 through FY'97) showed
little change in the number of units of autologous (RCA) and
allogeneic (RC) red blood cells used for transfusions.
Plateletpheresis (PH) from single donors seemingly replaced
some units of pooled platelet concentrate (PC). Cryoprecipitate
(CRYO) units fell steadily while administered fresh frozen
plasma units (FFP) increased. The results may help blood
collection and transfusion services plan future allocation of
|Background for survey||In Popovsky's view, many changes took place in transfusion
practice since the 1989 US nation-wide survey of Wallace and
coworkers (Transfusion 1993;33:139-144). Among these changes
were the increase in minimally invasive surgery, pharmacologic
interventions in surgery, managed care and pressures to cut
costs, and use of growth factors to promote the formation of
blood cells. The present survey covers a 7-year period to help
understand recent trends in blood component usage.
|Collection of data||This survey used several sources to cover FY'91 through FY'97. The Mass Department of Public Health provided actual transfusion data for the 7-year period. Mathematical modeling allowed application of market share information. In addition, distribution records of all 182 hospitals in Mass, Maine, Vermont and New Hampshire helped provide a database covering 10 million people.|
|New England trends in transfusion usage||As seen below, the use of PC, PH, FFP and CRYO units changed
appreciably since FY'91.
Intervening years showed some fluctuations in the number of units dispensed.
The 34% decrease in PC units may be associated, in part, with the 69% increase in PH units obtained from single donors. According to Popovsky, two developments help account for the decreased use of PC: (1) the rise in intensive chemotherapy and (2) the new transfusion guidelines recommending the initial use of fewer units of PC.
FFP administrations increased steadily over the 7 years. This trend occurred despite the introduction of guidelines narrowing the indications for use to plasma exchange and thrombocytopenia purpura.
Use of CRYO products (cryoglobulin, antihemophilic factor and other precipitates resulting from cooling) fell 15% since FY'91. Popovsky suggests that approval of Factor VIII for treating von Willebrand's disease may account for the decreased demand for CRYO.
|Conrad comments||At minimum, the Popovsky survey covering 4 of the 6 New England
States merits annual updating and possible expansion to include
the entire US. The increased use of more costly units of PH
requires further study to identify the added benefit(s).
For professional correspondence, please contact Dr. Popovsky by Fax at: (781) 461-2020 or E-mail at: Popovsky@Crossnet.org
Presented at The American Society of Hematology (ASH) Meeting, December 5-9, 1997
Copyright © 1998 Conrad Group, Inc. All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078-2230 / February 1998
Send comments to: ConradNote@aol.com