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• W2029046974 abstract "In this issue of TRANSFUSION, Sullivan and colleagues1 present data on blood product collection and transfusion in the United States in 2001, including the utilization of special product modifications such as leukoreduction and irradiation, and a comprehensive look at the changing nature of cellular therapy. Publication of this article comes on the heels of the 2005 Nationwide Blood Collection and Utilization Survey Report (NBCUS) of data collected by the AABB for the Department of Health and Human Services (DHHS).2 The two reports provide the opportunity to review trends from 1999 to 2004. Sullivan and coworkers1 solicited data in the form of a questionnaire sent to more than 2100 hospitals and 147 blood centers in March 2002, providing a comprehensive snapshot of the blood supply and trends in its use in 2001. What is immediately apparent is that the collection of red blood cells (RBCs) had substantially increased since last measured in 1999, with a parallel increase in the number of RBCs transfused during the same period. As the authors point out, allogeneic collections had begun to decrease starting after 1989, with the nadir in 1997. During the early 1990s, autologous collections were at the height of their popularity, which helped to buoy the overall number of RBC units available for transfusion. As these collections dwindled, so too did the RBC supply margin in spite of a renewed vigor in donor recruitment. Data are presented that indicate that had there not been a surge of donations in the aftermath of the September 2001 terrorist attacks, the RBC supply margin could have been as little as 3 percent, which should serve to remind us about the constant need for blood donations. The NBCUS report reveals that both allogeneic RBC collections and transfusions have remained relatively stable since 2001 (Tables 1 and 2),2 perhaps in part due to the adoption of a lower RBC transfusion threshold, increased use of perioperative blood conservation strategies, and improvements in surgical hemostatic technique. Whether the increased use of recombinant factor VIIa, as judged by the number of adverse reactions reported to the FDA,4 in the most heavily bleeding patients during this time period has helped reduce the need for allogeneic RBCs is unclear. Similarly, both the collection and the transfusion of autologous blood decreased in the period 1999 through 2001 with even further reductions seen by 2004 (Tables 1 and 2). This observation could be explained by the public's satisfaction with the safety of the current blood supply and increased use of perioperative cell salvage techniques. Although the figure of 60 percent utilization of autologous blood cited in the current article1 is higher than the traditionally cited benchmark figure of 50 percent utilization, it is unclear whether the increased number of autologous RBC transfusions were medically indicated or if the blood was retransfused simply because it was available. In any case, 40 percent wastage is still substantial. The collection of directed RBC units continued to decline from 1999 through 2004 (Table 1), although the number of directed transfusion episodes seems to be on the rise (Table 2). A significant proportion of unused directed RBCs were crossed over into the allogeneic RBC supply providing some relief to the allogeneic supply. Overall, although a few hospitals reported RBC shortages for at least 1 day during the year, the RBC supply seems to be adequate to meet the needs of the majority of recipients. The trends in platelet (PLT) collections and transfusions are also interesting (Tables 3 and 4). More than 60 percent of the total PLT collections in both 1999 and 2001 came from apheresis donations accounting for a similar proportion of PLT transfusions. By 2004 the rising trend toward apheresis PLTs continued with a sharp (41%) decline in whole-blood PLT (WBP) transfusions (Table 4). The latter trend is explained by the March 2004 introduction of a bacterial screening mandate by the AABB. Bacterial culturing techniques are easier to perform on apheresis PLTs, although the cost of a single apheresis PLT unit was at least $120 USD more expensive than a nonleukoreduced pool of six WBPs in both 2001 and 2004.1, 2 The availability of PLT pool and store systems may reverse the trend toward apheresis PLTs in the future. Although simple inspection of the PLT supply versus transfusion numbers indicates an overall excess of PLTs, it would have also been very informative to have data on the number of days in which the PLT demand outstripped the supply, that is, how many days in which the number of WBPs per dose was temporarily reduced or if patients requiring nonurgent PLT transfusions had to be deferred until more adequate stocks were available. The DHHS is implementing a monitoring system to collect this type of information. The production and transfusion of fresh-frozen plasma increased by more than 4 percent from 2001 to 2004, indicating the increasing use of these components.1, 2 This is not the case for cryoprecipitate, however, withessentially no change in the transfusion volumes of this component over this same time period. The processing and transfusion of leukoreduced blood products, especially prestorage leukoreducted products, increased between 1999 and 2001 and seems to have plateaued by 2004 (Tables 5 and 6). The trend in poststorage leukoreduction seems to show that it is indeed waning from both processing and transfusion standpoints. One reason for this drop in poststorage leukoreduction likely relates to the increased use of apheresis PLT products during the study period, nearly all of which are leukoreduced at the time of collection. Additionally, the technical difficulties associated with using bedside leukoreduction filters and the inferior quality of the resulting products are also probably responsible for its declining use. The number of transfused irradiated products decreased from 1999 to 2001 but increased 16 percent to the highest observed levels in 2004 (Table 6). Finally, Sullivan and coworkers1 analyzed the trends in stem cell (SC) harvesting and transplantation. While the number of SC infusions was approximately the same in 1999 as it was in 2001, the nature of the transplanted cells was changing; transplant physicians were moving away from marrow-derived SCs and toward cord blood. This trend toward using cord blood SCs continued through 2004 when the number of cord blood SC transplants exceeded the number of marrow-derived SC transplants.2 The most common source of SCs from 1999 through 2004 was peripheral blood. Furthermore, although the use of cells grown in culture rose considerably in 2001 relative to 1999, its use seems to have fallen out of favor with transplant physicians by 2004 where it accounted for only a small fraction of all such transplants.2 Donor lymphocyte infusions, while popular in 2001, also seem to have declined by 2004 perhaps due to improvements in the chemotherapy and immunosuppressive regimens used in SC transplantation.2 There are a few other points to consider in analyzing the trends presented by Sullivan and coworkers.1 Foremost, consider that by the time the 2001 data were published they were approximately 6 years old. As medical and surgical practice evolves, so too do the types of blood components required to support them; the blood component information presented in this article reflects transfusion practices in 2001 and does not necessarily reflect the current state of the art. The 2004 data indicate significant changes in practices such as: a large drop in topical cryoprecipitate use, increased use of irradiation procedures, and decreased hematopoietic progenitor cell collections. Interpretation of data reporting the cost of blood products is also hampered by old data—reporting the cost of apheresis PLTs for example in 2001 dollars is not meaningful in 2007. Clearly, timeliness is an important factor in assessing the value of these kinds of surveys. Analysis of several other articles on this subject by these authors showed the mean time from the end of the data collection year to publication was 4.2 years.3, 5-9 One of the main objectives of a proposed national biovigilance program in the United States, as in other countries with a similar monitoring system, is to provide accurate incidence rates of adverse transfusion events. The denominator in such an equation is the number of blood products transfused per unit of time. Therefore, to provide reasonably current information, a mechanism for the timely reporting of the type of data that Sullivan and associates1 provide in this issue will need to be devised. In summary, the data reported in this article, the NBCUS report, and earlier studies along these lines are of clear importance; they allow blood centers and transfusion services to informally benchmark their practices against their peers, they show trends in blood requirements and transfusion practices that aid in setting donation goals by blood centers, and they indicate the patterns of procurement and transplantation of SCs. Most importantly, for biovigilance programs to be effective, these data must be collected frequently, analyzed quickly, and reported in a manner such that it will actually be of benefit to the transfusion community." @default.
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• W2029046974 title "Messages from national blood data collection reports" @default.
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