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The 2009 NBCUS: Where we were then
andWhere we were then and
where we are going
Barbee I. Whitaker, Ph.D.Director, Center for Data
& Special ProgramsAABBAABB
www.aabb.orgwww.aabb.org
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Background
•
Office of the Assistant Secretary of Health, HHS / AABB
•
Critical data for transfusion medicine community–
Data year 2008
• Continuity allows trending:–
2004, 2006, 2008– 1997, 1999, 2001
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Design and ReviewDesign and Review
• AABB NBCUS Committee–
Bill Coenen, ABC – Nina Salomon, BCA–
Roger Dodd, PhD (ARC)Roger Dodd, PhD (ARC)–
Jim AuBuchon, MD (Dartmouth/PSBC)–
Alyssa Ziman, MD (UCLA/ASH)– Scott Brubaker
(AATB)Scott Brubaker (AATB)–
Alan Williams, PhD (FDA)–
Matthew Kuehnert, MD (CDC)– George Schreiber, ScD
(Westate)George Schreiber, ScD (Westate)
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Survey InstrumentSurvey Instrument
• Bi‐modal Survey Instrument sent to 3 161•
Bi‐modal Survey Instrument sent to 3,161 hospitals and 135 blood centers nationwide–
20 page paper questionnairep g p p q
•
Separate 6 page paper secondary (CT) questionnaire
– Web survey – imbedded logic•
78% (hospitals) –
87% (blood centers) used the web survey
• Online response incentive
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2009 Survey Population2009 Survey Population
• Blood Centers–
126/135 (93.3% response rate)
• Hospitals (AHA/AABB databases)–
1,529/2,970 (51.5% response rate), / , ( p )
• CT Questionnaire Response– 88/201 (43 8% response
rate) + 77
online88/201 (43.8% response rate) + 77 online responses = 165 CT surveys
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Respondent CharacteristicsRespondent Characteristics
17% f di bl d t id•
17% of responding blood centers consider themselves centralized transfusion services
•
12.4% of responding hospitals collect blood
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2009 New (or better)
Questions2009 New (or better) Questions•
Blood Collection and donation
• Apheresis collection• Mobile collections•
Deferrals/Discards• Deferrals/Discards• Donors
• UtilizationUtilization• Pediatric•
Use by Hospital Service/Department
• Adverse reactions
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Total Whole Blood and Red Blood Cell Collections: 1989 -
2008Collections: 1989 2008
18
20
12
14
16
s
8
10
12
ons
of U
nits
Total
Allogeneic
4
6Mill
i g
Autologous
0
2
1989 1992 1994 1997 1999 2001 2004 2006 2008
Survey Year
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Survey Year
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Autologous and Directed Whole Blood and R
d Bl d C ll C ll i 1989
2008Red Blood Cell Collections: 1989‐20082000
1400
1600
1800
ands
800
1000
1200
ts in
Tho
usa
Autologous
Directed
200
400
600Unit Directed
0
1989 1992 1994 1997 1999 2001 2004 2006 2008
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RBC Apheresis18000
15000
18000
1.9% 5.6%10.2%
11.3%
12000
Units
0.9%
6000
9000
Thou
sand
s of
3000
6000T
0
1999 2001 2004 2006 2008
www.aabb.orgTraditional Allogeneic Collections
RBC Apheresis Collections
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Whole Blood and Red Blood Cell Apheresis
CollectionsRed Blood Cell Apheresis Collections
Type of RBC
Collection
2008 2006 PercentChange
(Δ)Blood Center
Hospital Total Total( )
WB Allogeneic
14,120,000 927,000 15,047,000 14,151,000 6.3%
WB 172,000 81,000 253,000* 335,000 -24.5%WB Autologous
172,000 81,000 253,000 335,000 24.5%
WB Directed 35,000 26,000 61,000* 70,000 -12.8%RBC 1 884 000 41
000 1 926 000 1 619 000 18 9%RBC
Apheresis1,884,000 41,000 1,926,000 1,619,000 18.9%
Total 16,212,000 1,074,000 17,286,000 16,174,000 6.9%
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Whole Blood and d l d ll h
llRed Blood Cell Apheresis Collections
Type of RBC
Collection
2008 2006 Per Cent Change
(Δ) Blood Center
Hospital Total TotalCenter
Total 16,212,000 1,074,000 17,286,000 16,174,000 6.9%
Rejected on 116 000 11 000 127 000 151 000 -15 9%Rejected on
Testing
116,000 11,000 127,000 151,000 -15.9%
Available 17 159 000 16 023 000 7 1%Available Supply
17,159,000 16,023,000 7.1%
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Red Blood Cell
TransfusionsRed Blood Cell Transfusions
Estimated Transfusions by Blood Centers and Hospitalsy pType of
RBC Transfusion
2008 2006 Per Cent Change
(Δ)Blood C t
Hospital Total Total(Δ)Center
Allogeneicnot directed)
654,000 14,127,000 14,782,000 †* 13,978.000 5.8%
Autologous 5,000 154,000 159,000 189,000 -15.8%
Directed 0 73,000 73,000* 126,000 - 41.7%Total 15 014 000 14 650
000† 2 5%Total 15,014,000 14,650,000† 2.5%
† Total includes pediatric transfusions
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Allogeneic Whole Blood and Red Blood Cell Collections
and TransfusionsCollections and Transfusions
17.0
18.0
15.0
16.0
12.0
13.0
14.0
s of
Uni
ts
10.0
11.0
12.0
Mill
ions Collections
Transfusions
Available Collections:
8.0
9.0
1989 1992 1994 1997 1999 2001 2004 2006 2008
1997-2008
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1989 1992 1994 1997 1999 2001 2004 2006 2008
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Daily Supply Type O Units
10
12
8
ply
4
6
Days Supp
2
4
0
Jan Feb Mar April May June July August Sept Oct Nov Dec
O + (2008) O ‐ (2008) O + (2009)
O ‐ (2009) O + (2010) O ‐ (2010)
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Key Findings: Blood
ManagementKey Findings: Blood Management
• 18.2% of surveyed hospitals have
established18.2% of surveyed hospitals have established ‘bloodless’ surgery programs–
Ranging from 5% of hospitals with 100‐999 surgeries through 27.8% of hospitals with greater than 8,000 surgeries per year
78 8% i t ti t l•
78.8% use intra‐operative autologous recovery therapies–
92% of large hospitals compared with only 38% of the–
92% of large hospitals compared with only 38% of the smallest hospitals offering these services
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2008 Donors2008 Donors
• 19,339,000 donors presented•
10,877,000 successful allogeneic donors
– 3,165,000 first‐time donors (29.0%)–
7,640,000 repeat donors (70.2%)72 000 directed
donors (0 7%)– 72,000 directed donors (0.7%)
• 11,461,000 donations from repeat donors• 1
5 donations / repeat donor•
1.5 donations / repeat donor
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Deferrals by Reason
DeferredDeferrals by Reason DeferredHigh Risk Behavior
Deferrals
Travel Deferrals7.9%
2.9%
Low Hemoglobin59.3%
Other Medical Deferrals29 9%29.9%
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Donor HemovigilanceDonor Hemovigilance
• Severe adverse donor reactions: 16
000Severe adverse donor reactions: 16,000 reported –
0 09% collections– 0.09% collections –
0.09% collection proceduresH it l h d i ifi tl f ti•
Hospitals had significantly fewer reactions with automated collections (0.04%) than with
l ll ti d (0 10%
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Key Findings: Other
ComponentsKey Findings: Other Components
• Whole blood derived platelets transfused in pools
ofWhole blood derived platelets transfused in pools of five
•
Platelets reported in apheresis platelet equivalentsp
p p q•
23,669,000 components transfused (+5% than 2006)
– 1,300,000 WBD platelets (NS), , p ( )–
1,761,000 Apheresis platelets (+16%*)–
4,484,000 units plasma (+12%*)–
1,109,000 units cryoprecipitate (+12% NS)
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Platelet Concentrate Dosage Reported by H
i l 2008Hospitals 2008
60
40
50
ospitals
30
ntage of ho
2001 2004 2006 2008
10
20
Perce
0
≤ 5 6 7 8 9 10 > 10
l l d (i i )
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Platelet concentrate dosage (in units)
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Platelet Components
PreparedPlatelet Components Prepared
Estimated Collections by Blood Centers and Hospitalsy pType
of
Collection & Other
2008 2006 Per Cent Difference
(Δ)Blood C t
Hospital Total Total& Other Product
Processed
(Δ) Center
WB Derived 358 000 35 000 393,000 399,000 -1.6%WB Derived
Platelets
358,000 35,000 393,000(1,964,000)
399,000 1.6%
Apheresis Platelets
1,906,000 119,000 2,024,000 1,823,000 11.0%PlateletsTotal
2,263,000 154,000 2,417,000 2,222,000 8.8%
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Platelets TransfusedPlatelets Transfused
Estimated Transfusions by Blood Centers and Hospitalsy pType of
Product
Transfused
2008 2006 Per Cent Difference
(Δ)Blood C t
Hospital Total TotalTransfused (Δ) CenterWB Derived
Platelets 38,000 222,000 260,000
(1,300,000)216,000
(1,296,000)20.3%
Apheresis Platelets
60,000 1,701,000 1,761,000* 1,515,000 16.2%
Total 98,000 1,923,000 2,021,000* 1,731,000 16.7%
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Platelet Transfusions
2500
Whole-blood-derived platelet concentrates* Apheresis
platelets
436 256216
260
1500
2000
thou
sand
s)
1 3911,515
1,761
566 506
1000
nsfu
sed
(in t
940 1,0031,264
1,391
0
500
Uni
ts T
ran
01997 1999 2001 2004 2006 2008
*expressed as apheresis doses
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Other Components PreparedOther Components Prepared
Estimated Collections by Blood Centers and HospitalsType of
Non-
RBC2008 2006 Per Cent
DiffRBC Collection
Difference (Δ)
Blood Center
Hospital Total Total
Plasma for 5,305,000 395,000 5,700,000 5,684,000
0.3%Transfusion
, , , , , , , %
Cryoprecipitate 1,425,000 37,000 1,462,000 1,197,000 22.2%
Granulocytes 2,258 5,766 61%
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Transfusion of Non‐Red Blood Cell Components
Estimated Transfusion by Blood Centers and HospitalsEstimated
Transfusion by Blood Centers and HospitalsType of Non-
RBC T f i
2008 2006 Per Cent Difference
(Δ)Blood Hospital Total Total
Transfusion (Δ) Centerp
Plasma for Transfusion
222,000 4,263,000 4,484,000* 4,010,000 11.8%
Cryoprecipitate 42,000 1,068,000 1,109,000 993,000 11.7%
Granulocytes 1,013* 1,652 38%y , ,
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Total Number of Irradiated and Leukoreduced R
d C ll U i T f d i
2008Red Cell Units Transfused in 2008
Units
Modification 2008 2006 % Change
Irradiated Red Cells 1,502 1,153 30.3Total Leukocyte-reducedred
cells 10,294 8,076 27.5red cells
Pre-Bedside 10,115 7,886 28.3
At the Bedside 179 190 -5 8At the Bedside 179 190 -5.8
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Red Cell Modification Trends
14000
16000
10000
12000
ds
8000
10000
ts in
Tho
usan
Red Cell Components Modified by LR
4000
6000
Uni
Red Cell Units LR Pre‐Storage Transfused
Red Cells at Bed‐side Leuko‐Filtered Transfused
Irraditated Red Cell Units Transfused
0
2000
1999 2001 2004 2006 2008
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1999 2001 2004 2006 2008
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2008 RBC Use by Hospital ServiceGeneral Surgery
11%
Orthopedic Surgery6%
Other6%
Cardiac Surgery7%
General Medicine28% 7%28%
Trauma/ER9%
Hem/Onc15%
ICU11%
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15%
Transplant1%OB/GYN
2%Ped/Neonates
2%
Neph/Dialysis2%
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General Surgery
2008 Platelet Use by Hospital ServiceGeneral Surgery
7%Orthopedic Surgery
1%
Cardiac SurgeryGeneral Medicine15%
Other4%
12%15%
Trauma/ER3%
ICU11%
Neph/Dialysis0%
Hem/Onc32%OB/GYN
1%
Ped/Neonates8%
www.aabb.orgTransplant
6%
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Component Age at Transfusion
•
Red Cells: Mean Unit Age at Transfusion: 18 days•
Estimated mean age was 18.2
daysEstimated mean age was 18.2 days•
Calculated mean age was 17.9 days•
Only 13% of hospitals were able to calculate age at transfusion
• Platelets• Platelets•
Only 11.2% of hospitals were able to calculate age at transfusion
– Whole Blood Derived:E i d 3 2 d•
Estimated mean age was 3.2 days
• Calculated mean age was 2.9 days–
Apheresis:
• Estimated mean age was 3.2 days•
Calculated mean age was 3.1 days
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HemovigilanceHemovigilance•
60,000 transfusion related adverse eventsR i f
d 0 25%•
Reaction rate per components transfused 0.25% or 2.5 per 1,000 transfused (2.6/1,000 in 2006)
• TRALI: 460 reported ‐ 1:51,000
componentsTRALI: 460 reported
1:51,000 components transfused
•
Most commonly reported category was febrile non
hemolytic reactionsnon‐hemolytic reactions–
29,000 reports (1:816 components transfused)
•
Severe adverse donor reactions: 16,000 reported ,
p(0.09% collections and 0.09% collection procedures)
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Adverse Transfusion Reactions
6000
7000*
4000
5000
action
s
3000
4000
umbe
rs of R
e
2006 2008
1000
2000N
*
*
*
0
Life Threat Reaction
TRALI Reaction
TACO Reaction
Acute Hemolytic
Delayed Hemolytic
Allergic Reaction
Sepsis Reaction
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Acknowledgements
• AABB– Malika Cook– Nina Hutchinson
• HHS– Jerry Holmberg– Richard
HenryNina Hutchinson
– Diane Killion– Steve Kleinman– Aaron Lyss
Richard Henry– Renee Wilson
• George Schreiber• Westat, Inc.
– Erin Looney– Kathy Loper– Pam Lubel– Jackie
Malasky
– Stan Legum– Jim Greene– Patrick High
K S hl fJackie Malasky– Tamara Manning–
Laurie Munk– Maria Shay
– Karen Schlumpf– Jane Schulman
• Fei, Inc.– Z Cui
– Phil Schiff– Theresa Wiegmann–
Alanna Williamson
– Z. Cui– J. Gu
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2009 NBCUS2009 NBCUS
HHS • www.hhs.gov/bloodsafety•
[email protected]• 240‐453‐8803AABB
bb• www.aabb.org• [email protected]• 301 215 6574•
301‐215‐6574
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Hospital Cost SummaryHospital Cost Summary•
Average hospital cost of a unit of RBCs (8%), 24 hour
l f f i (23%) h i l l (5%)
dplasma for transfusion (23%), apheresis platelets (5%) and cryo (76%) increased significantly between 2006‐2008.
•
Red Cell Costs were significantly higher in North East and Northwest USPHS Regions (I, II and IX).
•
Overall costs lower in Southeast and South Central USPHS Regions
(IV and VII).Regions (IV and VII).
•
Costs were significantly lower in the largest hospitals for all components surveyed.H
it l b t 1 400 2 399 id i ifi tl f•
Hospitals between 1,400‐2,399 paid significantly more for cryo.
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