Statement of the American Association of Blood Banks
Advisory Committee on Blood Safety and Availability
Blood Supply and Utilization Data Collection
Presented By Christopher D. Hillyer, MD
April 20, 2001
Good morning. My name is Christopher Hillyer, MD. I am director of the Transfusion Medicine Program at Emory University Hospital. Today, I am speaking on behalf of the American Association of Blood Banks (AABB). The AABB appreciates the opportunity to comment on the need for ongoing federal support for the collection and analysis of blood supply and utilization data. AABB is the professional association for approximately 8,000 individuals and 2,000 institutions, including blood collection centers, hospital-based blood banks and transfusion services. AABB members are involved in all aspects of collection, processing and transfusion of blood. Our members are responsible for virtually all of the blood collected and more than 80 percent of the blood transfused in the United States. For more than 50 years, the AABB’s highest priority has been to maintain and enhance the safety of the nation’s blood supply.
Blood safety and availability are integral and inseparable requirements for ensuring optimal patient care. The safest possible blood component cannot benefit the patient if it is not readily available. We have all heard reports that the number and duration of seasonal blood shortages are increasing. Moreover, with changing demographics, an aging population, and improved, more complex medical procedures, the demand for blood is increasing.
As the committee knows, policy makers cannot make responsible public health decisions absent reliable data. Before adopting any new blood safety measures, we must carefully consider their impact on supply and availability. A wide range of data is needed to make sound decisions.
What Data Are Needed?
First, we need data regarding blood collections – that is, the number of units of each of the various blood components, by blood type, collected. These data should be collected and analyzed on a monthly as well as annual basis in order to anticipate and prepare for supply fluctuations, including seasonal changes in supply and demand. In addition, collection data should be analyzed on both a national and regional basis, since blood availability can often vary significantly across the country.
Second, we need a variety of data relating to blood utilization. Without strong utilization data, collection data are of minimal use. It is particularly important to hospital transfusion services that we have these data in order to ensure that our patients have access to individual blood products when they need them. Therefore, utilization data also must be compiled according to individual blood component and phenotype.
A number of distinct data categories should be included in the relatively broad category of blood “utilization” data. Clearly, information is needed about those medical and surgical procedures involving significant numbers of transfusions. This information is essential for patient care as well as hospital planning. For example, if a hospital is considering establishing a bone marrow transplant program, it needs to take into account how many units of different blood components it will need to ensure that the new patients receive optimal care. Information regarding changing practices in the number of doses provided per procedure as well as the number of high blood usage procedures conducted should be analyzed and made available to healthcare providers.
It is critical that we have regional and national data regarding the number of medical procedures that are postponed due to inadequate blood supply. The impact on patient care of shortages of specific blood components and corresponding surgery or transfusion postponements must be carefully analyzed.
Uniform national data are also needed regarding hospital ordering practices and how these orders are filled by the blood centers. Information regarding trends in unfilled or partially filled orders can help hospitals better prepare to meet patients’ needs. Anticipating that blood centers may not fill all of their orders, hospitals frequently manipulate their orders. Additional data regarding discarded units – whether due to outdating, positive disease testing, or damage – are also important in understanding supply issues and providing adequate units. Similarly, healthcare providers and policy makers should understand how hospitals maintain blood component inventories.
Again, national and regional statistics regarding blood utilization are called for. Some individual hospitals and blood centers may have their own utilization data, but such information is likely based on varying definitions and data parameters that need to be made uniform on a national basis. For example, individual hospitals define “inventory” differently. Are units that have been cross-matched included in a facility’s available inventory? What is the hospital’s policy for releasing cross-matched units into inventory? Common definitions (eg, of “inventory,” “shortages,” etc.) are essential if we are to fully understand the state of the nation’s blood supply and prevent possible shortages.
In addition, because many hospitals receive blood products from multiple blood centers, a single blood center cannot fully appreciate the supply and utilization issues all their customers are facing. Therefore, we cannot rely on blood center data alone as a basis for establishing critical blood safety and availability policies.
Who Should Support Blood Supply Data Collection?
Both the public and private sectors have a shared responsibility to the donors and patients of the United States to cooperate in supporting essential blood supply data collection. Ensuring that patients have timely access to blood products is clearly a public health issue. Because of the uniqueness of blood, as a publicly donated resource, special government attention is warranted. Unlike the commercial sector, the blood banking and transfusion medicine community cannot afford to support all of the collection and utilization data that are necessary to guarantee the best patient care. Therefore, significant public sector support is essential to meet our shared public health goals.
The AABB is committed to doing what we can to support blood supply data collection. In 1996, recognizing the significant need for blood supply data, the AABB conceived and founded the National Blood Data Resource Center (NBDRC). In prior years, data had been collected by the Center for Blood Research at Harvard Medical School, which received funding from the National Heart, Lung and Blood Institute (NHLBI). However, when this federal funding ceased, there was a clear vacuum in public or private support for national blood data collection, which the AABB saw the need to fill. The AABB is very proud of the fine work the NBDRC has produced, including its two important biennial Nationwide blood Collection and Utilization Surveys as well as the monthly blood collection data it has compiled and provided the NHLBI starting in fiscal year 2000.
The AABB’s National Blood Foundation (NBF) is also committed to this issue. This year, the NBF is funding a blood utilization study to gain a better understanding of the most current uses of individual blood products. This study will consider a number of blood usage characteristics, including surgical or medical procedure type, diagnosis related group (DRG), inpatient or outpatient setting and geographic distribution. We believe this study will represent an important step forward in analyzing blood utilization.
However, sustained and comprehensive blood data collection efforts cannot continue without significant federal support. We believe that it is imperative that the government honor its responsibilities, as set forth in the Public Health Service’s (PHS) Blood Action Plan, to promote a safe and available blood supply by supporting sustained data collection and analysis.
Unfortunately, ongoing support from the NHLBI for blood supply data is not continuing in FY 2001. We are grateful that the Office of the Surgeon General has recognized the critical need for these data and that the PHS will at least provide funding through the end of FY 2001 for broadly defined monthly blood collection and utilization data.
The AABB is very concerned, however, that as long as no specific agency or office within the executive branch is charged with the responsibility for supporting these critical data collection initiatives, there is no guarantee that we will be able to generate valuable and necessary long-term data. If the government decides not to support data collection, even for a few months, we risk losing whatever progress we have made so far in interpreting trends across time and different seasons. Additional, annual support from Congress and the executive branch is needed to collect and analyze on a routine, timely basis information to even better forecast and take steps to avoid possible blood supply shortages. We believe that the NBDRC – the only national organization with a long-term commitment to collecting essential blood collection and utilization data – is the best possible organization to garner and provide these data.
Therefore, the AABB strongly urges the Committee to recommend to Congress, the Bush Administration and the Secretary of Health and Human Services to designate an appropriate office within the Public Health Service to be responsible for this important issue in the future. In addition, the Committee should recommend that sufficient federal dollars be appropriated to support ongoing, long-term efforts of the NBDRC to collect, analyze and distribute data about the state of the nation’s blood supply.