Demand for red cells is falling. What’s going on?

Demand for red cells is declining in Australia and internationally. In Australia, demand for red cell units dropped by 4.8 percent from 2011/12 to 2012/13, 7.9% in 2013/14, and is expected to decline by a further 3% in 2014/15. In the UK demand started to decline sharply in October 2012, with a reduction of 2.7% in 2012/13, a further 4.8% in 2013/14, and the trend forecast to continue over the medium term. Sanquin Blood Services in the Netherlands saw a greater than 20% reduction in demand from 2009 to 2013. In New Zealand the clinical use of red cell components has reduced significantly over the last decade with transfusion rates falling by almost 25% from 29.6 red cells per 1000 population in 2006 to a projected 22.3 per 1000 by the end of 2014. The US estimates 8.2% fewer transfusions in 2011 compared to 2008, with transfusion rates falling from 48.4 units per 1000 to 44.0/1000.

All organisations report that the decline in red cell demand is likely due to the growing adoption of programs to reduce wastage and improve appropriate use. In Australia, the National Blood Authority (NBA) has implemented the National Blood and Blood Product Wastage Reduction Strategy 2013-17 to facilitate improved inventory management and logistics. The NBA and other blood sector stakeholders have also been focussed on practice improvement, including improving appropriate use through the publication and implementation of Patient Blood Management Guidelines. The Australian Red Cross Blood Service has developed a transfusion education curriculum and numerous resources to promote patient blood management principles including appropriate and safe transfusion practices.

New Zealand specifically attribute the initial decrease in demand as being driven by blood conservation programs such as “Why use two when one will do?” emanating from Canterbury District Health Board and increasingly rolled out across the country. Australia is encouraging a similar theme with the single unit transfusion guide. Increasing awareness of the importance of maximising patient’s haemoglobins prior to surgery has also contributed to the fall in clinical use. Pre-operative assessment identifies many patients who are iron deficient, treatment of which improves haemoglobin levels prior to surgery with a consequent reduction in the need for transfusion. Additionally, improved surgical techniques and other patient blood management (PBM) strategies – such as cell salvage – have contributed.

What does the decline in red cell demand mean? The upside is the benefit to patients and healthcare facilities – reduced transfusion rates results in decreased adverse outcomes, such as decreased morbidity, mortality and length of stay; and decreased cost.

The downside is the impact on the blood services – the costs of the blood supply chain are relatively fixed in nature and it is challenging to reduce costs at the same rate as volume reduction. As capacity is reduced in line with longer term trends in demand, blood services remain dependent on their donors to be able to respond to short term demand pressures. In addition, there is the need to increase the proportion of rare blood group donors, especially of O negative. In managing this environment we can sometimes be seen as presenting conflicting messages to our donors.

If you would like to find out more about how the Blood Service aligns supply and demand, You can head along to the Melbourne Processing Centre, 100 – 154 Batman Street, West Melbourne on Wednesday 8 April at 1.30pm. You can also join this session by webinar, or catch up with a recorded version after the event. Register at Transfusion Online Learning on transfusion.com.au.

Some other useful resources:

Understanding red cell decline: a global challenge for blood services.
National Blood Authority Australia Annual report 2013-14.
The 2011 National Blood Collection and Utilization Survey Report. Department of Health and Human Services, USA.
NHS Blood and Transplant Annual Report and Accounts 2013/14.
New Zealand Blood Service Annual Report 2013/2014.
Sanquin Blood Supply Annual Report 2013.

Dr Sandy Minck is a Medical Officer at the Australian Red Cross Blood Service and a member of the Transfusion Practice and Education team.