Attachment 1 -National Blood Collection and Utilization Survey

THE 2007
NATIONAL
BLOOD COLLECTION
AND UTILIZATION
SURVEY

Report

The United States Department of Health and Human Services
2007 National Blood Collection and Utilization Survey was conducted under contract (HHSP23320062209TC) with the AABB.

Project Directors:
Barbee I. Whitaker, PhD
Project Director for AABB
8101 Glenbrook Road
Bethesda, MD 20814
301.215.6574
[email protected]
Richard A. Henry, MPH
Project Director for HHS
US Department of Health and Human Services
1101 Wootton Parkway
Tower Building, Suite 250
Rockville, MD 20852
[email protected]

Report Authors:
AABB—Barbee I. Whitaker, PhD
Westat—James Green, MA; Melissa R. King, MSPH;
Linda L. Leibeg, MS; Sunitha M. Mathew, MS;
Karen S. Schlumpf, MPH; George B. Schreiber, ScD
Editorial Reviewers:
DHHS—Jerry Holmberg, PhD
AABB—Laurie Munk, MLS

Table of Contents
List of Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
1. Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Important Trends in the US Blood Supply. . . . . . . . . . . . . . . . . . . . . . . .1
Blood Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Blood Transfusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Biovigilance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
2. Key Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
3. Introduction and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Sampling Frame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Sample Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Response Rates. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Edit and Imputation Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Sampling Weights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Characterization of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Limitations of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
4. Blood Collected and Processed in the United States . . . . . . . . . . . . . . . . . . . .15
Total WB/RBC Collections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Whole Blood Collections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
RBC Apheresis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Non-RBC Components Produced . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Platelets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Plasma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Cryoprecipitate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Granulocytes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
5. Blood Transfused in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Whole Blood and Red Blood Cells Transfused . . . . . . . . . . . . . . . . . . .21
WB and RBC Recipients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Non-RBC Components Transfused . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Platelet Dosage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Outdated Units. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24

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THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

6. Component Modification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Prestorage Leukocyte Reduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Transfusion of Irradiated and Leukocyte-Reduced Components . . . . . .29
7. Current Issues in Blood Collection and Screening . . . . . . . . . . . . . . . . . . . . . .31
Severe Donor Adverse Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Diversion Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
Issue of Blood to Non-Hospital Transfusion Services and
Military Installations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
8. Current Issues in Transfusion and Transplantation . . . . . . . . . . . . . . . . . . . . . .33
Blood Inventory Shortages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
Bacterial Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Biovigilance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Therapeutic Apheresis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Crossmatch Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36
Red Cell Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Platelet Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Tissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
9. Component Costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Red Blood Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41
Plasma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Whole-Blood-Derived Platelets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Apheresis Platelets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Cryoprecipitate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Hematopoietic Progenitor Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46
10. Cellular Therapy Products . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
Characterization of Reporting Facilities . . . . . . . . . . . . . . . . . . . . . . . .47
Collections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Infusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
11. Historical Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Time Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
Blood Supply Adequacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
US Population Trends. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
12. Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
13. References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65

iv

List of Tables
Table 3-1.

Sampling Frame Counts and Sampling Rates . . . . . . . . . . . . . . . . . . .9

Table 3-2.

Response Rates by Type of Facility and Surgical Volume. . . . . . . . . .9

Table 3.3.

Raw Sampling Weights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Table 3-4.

Weighting Class Adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Table 3-5.

Final Sampling Weights. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Table 3-6.

United States Public Health Service Regions . . . . . . . . . . . . . . . . . .14

Table 4-1.

Estimated 2006 Collection and Transfusion by US Blood
Centers and Hospitals of Whole Blood (WB) and Red Blood
Cells (RBCs) (expressed in thousands of units) . . . . . . . . . . . . . . . . .16

Table 4-2.

Estimated 2006 Collection and Transfusion by US Blood
Centers and Hospitals of Non-Red-Blood-Cell Components
(expressed in thousands of units) . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Table 5-1.

Outdated Components as a Percentage of the Total Volume of
Each Type Processed for Transfusion in 2006 . . . . . . . . . . . . . . . . .25

Table 6-1.

Blood Components Modified by Prestorage Leukocyte
Reduction in All Facilities in 2006. . . . . . . . . . . . . . . . . . . . . . . . . .27

Table 6-2.

Change in Number of Prestorage Leukocyte-Reduced Blood
Component Units Processed in All Facilities from 2004 to 2006
(expressed in thousands of units) . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Table 6-3.

Estimated Number of Blood Component Units Modified by
Irradiation or Leukocyte Reduction and Transfused by All
Facilities in 2006. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Table 6-4.

Irradiated, Prestorage Leukocyte Reduced and Poststorage
Leukocyte Filtered Component Units Transfused in 2006 and
2004 (expressed in thousands of units) . . . . . . . . . . . . . . . . . . . . . .29

Table 8-1.

Cancellation of Elective Surgeries by US Hospitals, 1997-2006. . . .33

Table 8-2.

Transfusion-Related Adverse Reactions Reported to the
Transfusion Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36

Table 8-3.

Therapeutic Apheresis Procedures in 2006 by Specific
Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37

Table 8-4.

Human Tissue Implants/Grafts Used in 2006. . . . . . . . . . . . . . . . . .39

Table 8-5.

Adverse Events Associated with Tissue Transplants . . . . . . . . . . . . .39

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THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Table 9-1.

Mean Hospital Amount ($) Paid per Selected Component Unit
in 2006 and 2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Table 9-2.

Average Hospital Component Cost ($) by USPHS Region . . . . . . . .42

Table 9-3.

Average Hospital Component Cost ($) by Surgical Volume . . . . . . .43

Table 9-4.

CMS Hospital Outpatient Prospective Payment System Rates
for Selected Blood Components . . . . . . . . . . . . . . . . . . . . . . . . . . .45

Table 10-1.

Autologous Cellular Therapy Product Collections Performed. . . . . .48

Table 10-2.

Allogeneic Cellular Therapy Product Collections Performed . . . . . .49

Table 10-3.

Cellular Therapy Products Processed. . . . . . . . . . . . . . . . . . . . . . . .50

Table 10-4.

Cellular Therapy Products Issued and/or Infused . . . . . . . . . . . . . . .51

Table 10-5.

Cellular Therapy Product Collections by Hospitals, by
Surgical Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52

vi

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

1. Executive Summary

The Assistant Secretary for
Health and the Office of
Public Health and Science
along with the DHHS operating divisions [CDC, Centers for Medicare and
Medicaid Services (CMS),
Food and Drug Administration (FDA), and the
National Institutes of Health
(NIH)] sponsored this survey, which was conducted
under contract to AABB
(formerly the American
Association of Blood
Banks). The purpose of this
national survey was twofold—to assess the amount
of blood collected and
transfused in the United
States in 2006 and to establish the baseline denominators for the US Biovigilance
Network.
The facilities surveyed
included all non-hospitalbased blood collection
centers (blood centers), a
sample of hospitals from
the American Hospital
Association (AHA) database, AABB member
hospitals not in the AHA
database, and a sample of
cord blood banks. Hospitals

reporting fewer than 100
inpatient surgeries per year
were not included. Hospitals with annual surgical
volumes between 100 and
1,399 were stratified and
randomly sampled at a
combined rate of 40%,
while all hospitals with
1,400 surgeries or more
were included in the sample.
The 2007 NBCUS response
rate for blood centers was
91.4% (128/140); for hospitals, 59.9% (1,707/2,848);
and for cord blood banks,
51.9% (14/27). Statistical
procedures were used to
verify that the sample was
representative of the study
universe and to develop
sample weights to produce
national estimates.

Important Trends in the
US Blood Supply
The supply of available
allogeneic Whole Blood
(WB) and Red Blood Cell
(RBC) units after accounting
for test discards was

15,688,000. This number
exceeded transfusions of
allogeneic WB/RBCs
(14,461,000) by a margin of
1,227,000 units—7.8% of
available supply. This
excess of supply is cause for
optimism. These data, combined with the lowest rate
of units outdated in recent
years, suggest that hospitals
and blood centers continue
to improve efficiencies in
delivering the appropriate
product when needed.
This supply was provided
by 9,553,000 allogeneic
donors who successfully
gave blood—2,726,000
(28.5%) of whom were firsttime donors and 6,828,000
(71.5%) of whom were
repeat donors. These repeat
allogeneic donors provided
11,697,000 donations, the
equivalent of 1.7 donations
per donor. These data on
the number of first-time and
repeat donors are the first
national estimates available and should in subsequent surveys enable the
blood banking community
to track participation rates.
The allogeneic blood col-

Executive Summary

1

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Blood Collection
The NBCUS indicates that
the total supply of WB/
RBCs in 2006 was
16,174,000 units before
testing. This is 5.8% more
than was reported in 2004;
however, the difference
might be attributable, in
part, to changes in weighting application in the two
years.*
Blood centers were responsible for the collection of
15,378,000 units or 95.1%
of the supply, whereas hospitals collected 796,000
units or 4.9%. Much of the
increase in collections can

be attributed to the contribution of collections by red
cell apheresis. Apheresis
collections accounted for
1,619,000 RBC units, an increase of 96.4% over 2004.
Blood centers reported 99%
of the red cell apheresis
collections (Figure 1-1).

Blood Transfusion
The total number of WB/
RBCs transfused in 2006
equaled 14,650,000 units.
This 3.3% increase in transfusion activity from 2004
was not statistically significant.†
†

Allogeneic units transfused
(including the pediatric contribution expressed as adult equivalent
units) equalled 14,461,000.

The total number of platelet
units provided to patients in
2006 was 10,388,000, a
small (5.2%) but not statistically significant increase
over 2004. The transfusion
of apheresis platelets
increased 9.0% from
8,338,000 to 9,092,000
platelet concentrate
equivalent units (one
apheresis platelet pack =
six platelet concentrate
equivalent units). The transfusion of whole-bloodderived platelet concentrates continued a downward trend, decreasing
15.7% from 1,537,000
units in 2004 to 1,296,000
units in 2006, although this
difference was not statistically significant.

18000
15000
Thousands of Units

lection rate was 84.1 units
per thousand US population of donor age (18-64
years) in 2006 compared to
83.1 units per thousand in
2004. The US WB/RBC
transfusion rate in 2006 was
48.9 units per thousand
persons in the overall US
population, statistically
unchanged from 2004
(Figure 11-4).

12000
9000
6000
3000

*Blood center data were not
weighted for nonresponse in the
2004 data. The 2006 data were
weighted to represent the full
national supply. Therefore, the
2004 collection totals may have
been slightly underrepresented,
making the increase between the
years seem greater than it actually
was.

2

Executive Summary

0
1999

2001

Traditional Allogeneic Collections

2004

2006

RBC Apheresis Collections

Figure 1-1. Growth in use of RBC apheresis technology.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Biovigilance
In the interval between the
2005 and the 2007 NBCUS
reports, there has been a
coordinated effort between
the public and private sectors to develop the US Biovigilance Network
(USBVN). The USBVN was
created by an interorganizational task force of leaders from the transfusion and
cellular therapies community, and coordinated in a
public-private partnership
between the transfusion
and transplantation community and the federal government, with shared
responsibilities for program
development, operation
and management, and
funding.
The USBVN will provide a
central, coordinated system for identifying adverse
events and near-miss incidents occurring at any point
in the collection, process-

ing, distribution, transfusion, or transplantation
processes for blood, tissue,
and cellular products. The
network’s data can be analyzed to identify where
practices can be improved
to provide better experiences for donors and better
outcomes for patients.
It is anticipated that the
hemovigilance module of
this system, within the Centers for Disease Control and
Prevention (CDC) National
Healthcare Safety Network
(NHSN), will begin operations for a limited number
of facilities in 2009. To help
establish a baseline, data
were collected for major
adverse transfusion reactions for 2006.
An estimated total of
72,000 transfusion-related
adverse reactions were
reported for 2006. These
were defined as events that
required any diagnostic or
therapeutic intervention.

This represents an adverse
reaction rate of approximately 0.32% of all components transfused. This rate is
on the lower end of rates
reported by hemovigilance
systems in other countries,
with rates of 0.3% to 0.7%.
A fine tuning in the reporting of adverse reactions is
anticipated as educational
materials harmonize definitions nationally and consistent standards of reporting
are applied in the context of
the USBVN.
Another module of the
USBVN will seek to identify
and track donor adverse
reactions. National baseline
data for severe adverse
reactions were collected for
the first time in this survey.
Approximately 11,000
severe adverse donor reactions were reported by
blood collectors in 2006,
for a rate of approximately
0.07%.

Executive Summary

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THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

2. Key Findings

The results of the 2007
NBCUS provide an update
of US blood services and
related activities assessed
by the four previous
national surveys conducted
in 2005, 2002, 2000, and
1998. Notable findings
from the 2007 NBCUS and
comparisons with the 2005
report were as follows:
• Total WB/RBC collections in 2006 increased
from 2004 by 5.8%, to
16.2 million units.
• Total WB/RBC transfusions in the same period
increased by 3.3%, to
14.7 million units.
• Autologous collections
declined significantly by
26.9% to 335,000 units.
• The margin between
test-negative allogeneic
WB/RBC units collected and those transfused in 2006 was
1,227,000 units.
• RBC apheresis collections were significantly
higher by 96.4% for a
total of 1.6 million
units.

• Test losses declined
significantly to 151,000
units.
• The total number of all
components transfused
in 2006 was 30,044,000.
• There was a statistically
significant 20.3%
decrease in the number
of outdated WB/RBC
units.
• The transfusion of
whole-blood-derived
platelet concentrates
continued to decrease
(–15.7%), while the use
of apheresis platelets
increased by 9.0%.
• A total of 492 hospitals
reported the cancellation of elective surgery
on one or more days
due to blood inventory
shortages. This affected
412 patients, 25% fewer
than in 2004.
• The average hospital
cost of a unit of RBCs
increased by 6.4%.
• The WB/RBC collection
rate per thousand US
donor population (estimated at 18-64 years of
age) was 84.1 units in

•

•

•

•
•

•

2006, compared to
83.1 in 2004.
The WB/RBC transfusion
rate of 48.9 units per
thousand US population, compared to 49.6
in 2004.
The transfusion of leukocyte-reduced (LR)
components decreased
12.1%—9.9% for
prestorage LR components and 52.7% for
poststorage LR components.
The rate of adverse
transfusion reactions
reported to the hospital
transfusion service was
0.32%.
The rate of severe donor
reactions was 0.07%.
Of the 9,553,000 allogeneic donors who successfully gave blood,
28.5% were first-time
donors and 71.5% were
repeat donors.
The donation rate for
repeat donors was 1.7
donations per donor in
2006.

Key Findings

5

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

3. Introduction and Methods

The Assistant Secretary for
Health and the Office of
Public Health and Science
along with the DHHS operating divisions [CDC, Centers for Medicare and
Medicaid Services (CMS),
Food and Drug Administration (FDA), and the
National Institutes of Health
(NIH)] sponsored this survey, which was conducted
under contract to AABB
(Bethesda, MD). This report
presents the results of the
fifth NBCUS, conducted in
2007. The Office of Management and Budget (OMB)
control number for the
information collected was
0990-0313. In 2005, as in
2007, the survey was conducted by DHHS under
contract with AABB. Previous surveys in 2002, 2000,
and 1998 were conducted
by the National Blood Data
Resource Center, a wholly
owned subsidiary of AABB.

Objectives

Data Collection

The objectives of the survey
were to generate national
estimates for blood collection and utilization activities in the US in 2006; to
provide comparisons with
previous years; to provide
baseline data for national
biovigilance safety monitoring; and to characterize
business practices in the
blood collection, transfusion medicine, and cellular
therapies community.

The 23-page questionnaire,
cover letter, and postagepaid return envelope were
mailed in August 2007 to
the 3,044 facilities in the
sample described below.
Survey packets were
addressed to the director of
either the blood center or
the hospital blood bank or
transfusion service. A
reminder postcard was
mailed a month later. A
second mailing of the survey questionnaire was sent
to 2,025 initial nonresponders six weeks later.
Facilities that did not
respond by the September
deadline were contacted by
e-mail, telephone, or both.
Data collection via paper
surveys concluded on
December 31, 2007. Survey nonresponders were
then invited to complete an
abbreviated web-based survey consisting of critical
questions from the survey.
Web-based data collection
concluded on January 31,
2008.

The survey instrument was
designed to capture quantitative data regarding blood
collection, processing,
transfusion, and final disposition, as well as other
information describing current policies and practices,
and the adoption of new
technologies by the blood
community.

Introduction and Methods

7

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Data coding, keying, and
verification were performed by Westat (Rockville, MD). Validation of
survey data was achieved
by comparison with 2004
survey data and by direct
contact with individual
respondents as necessary.

Sampling Frame
The sampling frame for the
2007 NBCUS was compiled from two data
sources. The first source
was the AABB database,
which is a list of all nonhospital-based blood collecting facilities and cord
blood banks in the 50
states. This list also contains
hospitals that are members
of the AABB. The second
source was the comprehensive 2006 AHA hospital
database.
Non-federal (state, county,
city, corporation, etc) hospitals located within the 50
United States (or the District
of Columbia) and Veteran’s
Affairs hospitals providing
general medical and surgical; children’s general medical and surgical; cancer;
heart; obstetrics and gynecology; eye, ear, nose, and
throat; or orthopedic services were considered eligible population members.
The sampling frame was
restricted to hospitals with

8

Introduction and Methods

annual inpatient surgical
volumes of greater than 100.
To prepare the AABB database for sampling, hospitals on the AABB list were
matched to the AHA database and the AHA identification numbers were
assigned to avoid duplication. Hospitals on both lists
were included, subject to
the hospital eligibility criteria given above. Hospitals
unique to AABB were
included in the study with
certainty (ie, a probability
of 1.0). Within the AABB
database, the facilities were
categorized into three
groups: hospitals unique to
AABB, blood collection
centers, and cord blood
banks. The final list of eligible facilities (from both
AABB and AHA) contained
a total of 4,219 hospitals,
blood collection centers,
and cord blood banks.

Sample Selection
The NBCUS sampling
frame consisted of all eligible hospitals in the 2006
AHA dataset and all hospitals unique to AABB, as
well as all blood collection
centers and cord blood
banks on the AABB list. A
total sample of 3,044 facilities was selected from the
combined frame. Hospitals
from the AHA dataset were
stratified into six categories

according to annual inpatient surgical volume. The
strata are defined as follows: 100-999 surgeries,
1,000-1,399 surgeries,
1,400-2,399 surgeries,
2,400-4,999 surgeries,
5,000-7,999 surgeries, and
8,000 or more surgeries.
Hospitals of unknown surgical volume, such as those
unique to the AABB database for which no surgical
volume could be determined, were assigned to an
additional group. Hospitals
with 1,400 or more surgeries were sampled at a rate
of 100%. Hospitals with
100-999 surgeries and
1,000-1,399 surgeries were
sampled at rates of 33%
and 66%, respectively.
Table 3-1 shows the sampling frame counts and the
sampling rates by strata.

Response Rates
Table 3-2 summarizes the
outcome of data collection
efforts for blood centers,
collectively, and for hospitals by surgical volume.
After eliminating ineligible
institutions (29 sampled
institutions that had ceased
operations, changed status,
or chose to be reported for
by an affiliate), the combined response rate was
61.3%. The response rate
for blood centers was
91.4% (128/140). The
response rate for sampled

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Table 3-1. Sampling Frame Counts and Sampling Rates
Type of Facility
Hospitals
100-999 surgeries/year

Total
Population

Sample

Sampling
Rate (%)

1,577

525

33.3

1,000-1,399 surgeries/year

368

245

66.6

1,400-2,399 surgeries/year

658

658

100.0

2,400-4,999 surgeries/year

831

831

100.0

5,000-7,999 surgeries/year

344

344

100.0

≥8,000 surgeries/year

235

235

100.0

35

35

100.0

144
27

144
27

100.0
100.0

4,219

3,044

72.1

Unknown surgical volume
Blood Centers
Cord Blood Banks
Total Facilities

Table 3-2. Response Rates by Type of Facility and Surgical Volume
Type of Facility
Hospitals
100-999 surgeries/year

Number
Eligible

Respondents

Response
Rate (%)

520

304

58.5

1,000-1,399 surgeries/year

243

131

53.9

1,400-2,399 surgeries/year

654

386

59.0

2,400-4,999 surgeries/year

825

514

62.3

5,000-7,999 surgeries/year

343

214

62.4

≥8,000 surgeries/year

234

139

59.4

29

19

65.5

140
27

128
14

91.4
51.9

3,015

1,849

61.3

Unknown surgical volume
Blood Centers
Cord Blood Banks
Total Facilities

Introduction and Methods

9

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

hospitals was 59.9%
(1,707/2,848). Response
rates by surgical volume
classes ranged between
53.9% and 62.4%. The
total number of individual
survey responses from the
hospital sample was 1,707.
Slightly more than half,
51.9%, of the cord blood
banks responded.

Edit and Imputation
Procedures
Internal consistency of the
2007 NBCUS data was
ensured by developing
machine edit specifications
to check the logic and internal consistency of the data
before imputation. Imputation was limited to critical
questions only. Missing
data for these questions
were imputed using a
model-based regression
method for continuous and
categorical variables for
both hospitals and blood
centers. “Check all that
apply” variables were
imputed together as a unit.
Missing items on the survey questionnaires were
imputed using the following
four steps:
1. A preliminary hot deck
imputation of missing
items.
2. Searching for key covariates through stepwise
regression modeling.

10

Introduction and Methods

3. Re-imputation of missing items using predictive means matching,
through nearest neighbor matching on regression predicted values.
4. Cycling through steps 2
and 3 until the process
converged.
The imputation models
were developed separately
for blood centers and hospitals and included region
and transfusion volume
and/or collection volume
strata, as appropriate.
Imputed cases were flagged
to allow the analyst to
identify which cases were
imputed.

Sampling Weights
The final sampling weights
for hospitals were calculated for each stratum using
a three-stage process. In the
first stage, a base weight
was computed as the reciprocal of the selection probability for each stratum to
adjust for differences in the
sampling rates applied to
the strata. The base weight
for hospitals was calculated as follows:
Base Weight =
Number in Surgical
Volume Stratum
Number Sampled in
Surgical Volume Stratum

The “number sampled” in
the denominator includes
all units sampled, includ-

ing those later determined
to be ineligible. These ineligible units remain in the
denominator because they
represent other, unidentified ineligible units in the
sampling frame. If these
ineligibles were removed
from the raw weight calculation, resulting data estimates would be overstated.
Table 3-3 shows the number in each stratum, the
number sampled, and the
results of the base weight
calculation.
In the second stage, a
weighting class adjustment
(WCA) was derived to correct for imbalance among
the strata due to different
response rates from the
units in the sample, and differences in surgical volume
between responding and
nonresponding units. The
numerical adjustment was
computed as the ratio of
weighted (ie, using the base
weight) surgical volume for
all eligible units in the sample (ie, respondents and
nonrespondents) to
weighted surgical volume
for all responding units in
the stratum. This WCA was
calculated as follows:
WCA =
Weighted surgical
volume for all eligible units
(respondents and nonrespondents)
Weighted surgical volume
for all responding units

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Table 3-3. Raw Sampling Weights
Type of Facility
Hospitals
100-999 surgeries/year
1,000-1,399 surgeries/year
1,400-2,399 surgeries/year
2,400-4,999 surgeries/year
5,000-7,999 surgeries/year
≥8,000 surgeries/year
Unknown surgical volume
Blood Centers
Cord Blood Banks
Total Facilities

Table 3-4 displays the number of eligible facilities, the
number of responding facilities, and the computed
weighting class adjustments for each stratum.
Only eligible sample members were included in this
calculation.
The final sampling weight
was then calculated as the
product of the base weight
and the WCA. The final
sampling weights appear in
Table 3-5 together with the
base sampling weights from
Table 3-3 and the weighting
class adjustment from
Table 3-4.

Number in
Stratum

Number Sampled
in Stratum

Raw Sampling
Weight

1,577
368
658
831
344
235
35

525
245
658
831
344
235
35

3.00
1.50
1.00
1.00
1.00
1.00
1.00

144
27

144
27

1.00
1.00

4,219

3,044

Survey Respondents
Table 3-2 summarizes the
outcome of data collection
efforts—collectively for
blood centers and by surgical volume for hospitals.
The individual sites
(regional blood centers) of
large collectors such as the
American Red Cross Blood
Services and United Blood
Services were enumerated
separately. The combined
survey response rate was
61.3%, as stated above,
representing an increase
over the combined survey
response rate of 58.4% for
the 2005 survey. The
response rate for blood centers was 91.4% (128/140).
The overall response from
eligible sampled hospitals

that reported for themselves
was 59.9% (1,707/2,848).
Response rates by surgical
volume classes ranged from
53.9% to 62.4%, with the
2007 rates increasing for
the smaller surgical volume
hospitals but decreasing
slightly for the larger surgical volume hospitals in
comparison to 2005. The
actual number of hospitals
that responded to the current survey was greater in
2007 by 103 (1,707 vs
1,604). The additional facilities were distributed across
all geographic regions.
An abbreviated, web-based,
critical items survey was
available for approximately
30 days to facilities that had
not responded to the paper

Introduction and Methods

11

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Table 3-4. Weighting Class Adjustments

Type of Facility

Number Eligible in
Weighting Class

Number Eligible
and Responded in
Weighting Class

Weighting Class
Adjustments

Hospitals
100-999 surgeries/year
1,000-1,399 surgeries/year
1,400-2,399 surgeries/year
2,400-4,999 surgeries/year
5,000-7,999 surgeries/year
≥8,000 surgeries/year
Unknown surgical volume

520
243
654
825
343
234
29

304
131
386
514
214
139
19

1.78
1.89
1.70
1.61
1.61
1.69
1.53

Blood Centers
Cord Blood Banks

140
27

128
14

1.09
1.93

3,015

1,849

Total Facilities

Table 3-5. Final Sampling Weights
Raw Weight

Weighting Class
Adjustment

Final Sampling
Weight

Hospitals
100-999 surgeries/year
1,000-1,399 surgeries/year
1,400-2,399 surgeries/year
2,400-4,999 surgeries/year
5,000-7,999 surgeries/year
≥8,000 surgeries/year
Unknown surgical volume

3.0038
1.5020
1.0000
1.0000
1.0000
1.0000
1.0000

1.78
1.89
1.70
1.61
1.61
1.69
1.53

5.34
2.84
1.70
1.61
1.61
1.69
1.53

Blood Centers
Cord Blood Banks

1.0000
1.0000

1.09
1.93

1.09
1.93

Type of Facility

12

Introduction and Methods

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Figure 3-1. Distribution of blood center and hospital respondents by USPHS region.

survey. The 20 institutions
responding via the Internet
represent a response rate of
1.7% for those blood centers and hospitals that had
not responded on a paper
form. Use of the web-based
critical item questionnaire
increased the response from
blood centers by 1.4% and
from hospitals by 0.6%.
Because electronic data
collection was employed to
collect only essential data

elements, its utility as a
potential mode of data collection for any future
NBCUS could not be
assessed.
Figure 3-1 illustrates the
distribution of responding
blood centers and hospitals
among the 10 geographic
regions as defined by the
US Public Health Service
(USPHS; Table 3-6).

Characterization of
Respondents
The majority of blood centers self-identified as such.
However, 19 centers
selected the centralized
transfusion service option,
“A local or regional blood
center that collects blood
from donors and supplies
blood, components, and
crossmatched blood products to participating facili-

Introduction and Methods

13

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Table 3-6. United States Public Health Service Regions
USPHS
Region
I
II
III
IV
V
VI
VII
VIII
IX
X

States
CT, ME, MA, NH, RI, VT
NJ, NY, (PR, VI)*
DE, DC, MD, PA, VA, WV
AL, FL, GA, KY, MS, NC, SC, TN
IL, IN, MI, MN, OH, WI
AR, LA, NM, OK, TX
IA, KS, MO, NE
CO, MT, ND, SD, UT, WY
AZ, CA, HI, NV, (Guam, American Samoa, CNMI, FSMI,
RMI, Palau)*
AK, ID, OR, WA

*Although these territories and possessions are a part of the USPHS regions, the
NBCUS did not survey hospitals and blood centers outside of the 50 United States.

ties, such as a centralized
transfusion service,” to
describe themselves. Hospital respondents identified
themselves either as a transfusion service (1,383), or as
a hospital-based blood
bank and transfusion service that collects blood
(236). Another classification
option available to survey
respondents was “An
independent facility that

14

Introduction and Methods

collects, process, manufactures, stores, or distributes
cellular therapy products.”
This option was chosen by
12 respondents.

Limitations of the Survey
The weights described here
account for the probabilities of selection that vary
by stratum, survey nonre-

sponse, and multiple
chances of selection given
the nature of establishment
samples. Sampling strata
were used as nonresponse
adjustment cells, and were
effective to the extent that
facilties within the same
strata are (on average) similar. Several respondents
provided data for themselves as well as other facilities included in either the
sample or on the sampling
frame. These other facilities
were both contained within
the same sampling stratum
as well as in other sampling
strata compared to the
responding facility. In these
instances, an overall joint
probability of selection was
calculated as a function of
the probability of selection
associated with the constituent facilities. In all cases,
the overall joint probability
of selection evaluated to
1.0, as one or more of the
constituent facilities were
associated with a probability of 1.0.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

4. Blood Collected and Processed
in the United States

Total WB/RBC
Collections
The total whole-bloodderived and apheresis
RBCs collected in the US
in 2006 were 16,174,000
(±688,000) units, before
laboratory testing (Table 41). Blood centers collected
15,378,000 units, or 95.1%
of the total. The remaining
796,000 units (4.9%) were
collected by hospitals.
Compared to total collections from 2004, 2006 collections increased 5.8%.*
The increase is primarily
attributed to a 96.4%
increase in RBC apheresis
collections that accounted
for 10% of total blood collections in 2006. The total
units rejected on testing
*Statistical comparisons were
conducted for significant differences between the 2006 and
2004 data. Because the variance
estimates for 2004 were not
readily available, these tests
assumed that 2004 and 2006
variances were equal.

decreased by 44.1% in
2006. Between 2004 and
2006, testing methods were
licensed and implemented
by many blood collection
facilities; these measures
appear to have reduced the
discard rate due to laboratory testing. This resulted in
16,023,000 usable units
collected in 2006 (p<0.05),
99.1% of those collected.

Whole Blood Collections
Donations of WB in 2006
totaled 14,555,000. These
collections, reported
according to the type of
donation, are shown in
Table 4-1. Community
donations, excluding
directed donations,
accounted for 87.5% of collections; directed donations totaled 0.4%; and
autologous donations contributed 2.1%. A total of
1,619,000 RBC units
(10%) were collected by
apheresis, discussed below.

Allogeneic donations
totaled 14,151,000
(±621,000) of which 95.3%
were collected by blood
centers and 4.7% by hospitals. The percentage
increase in allogeneic
donations between 2004
and 2006 was 1.9%, which
was not statistically significant. Directed donations
declined by 40.1%, to
70,000 units (p<0.001). Of
these, 43.3% were eventually used as part of the community supply.
Autologous, or self-directed
units, totaled 335,000
(±20,000), a decrease of
26.9% compared to 2004
(p<0.001). Hospitals collected 27.8% of all autologous units.

RBC Apheresis
In addition to WB collections, 1,619,000 (±99,000)
RBC units were collected
by apheresis, which typically yields a double vol-

Blood Collected and Processed in the United States

15

16

Blood Collected and Processed in the United States
131

Outdated WB/RBCs

*Significantly different from 2004 data.

716
7
0
5
729

13,486
242
47
1,603
15,378
137
15,241

Transfusions
Allogeneic (excluding directed)
Autologous
Directed (to designated patient)
Pediatric
Total Transfusions

Collections
WB Allogeneic (excluding directed)
WB Autologous
WB Directed
RBC Apheresis
Total Supply
Rejected on Testing
Available Supply

Activity

Blood
Centers

269

13,262
182
125
352
13,921

665
93
22
16
796
14
782

Total

17

340
16
31
61
376

122
13
7
5
131
4
129

±95% CI

Hospitals

400*

13,978
189*
126
357*
14,650

14,151
335*
70*
1,619*
16,174
151*
16,023*

2006
Combined
Total

20

439
16
31
61
468

621
20
9
99
688
11
684

±95% CI

2.5

95.4
1.3
0.9
2.4
100.0

87.5
2.1
0.4
10.0
100.0
0.9
99.1

503

13,720
270
132
60
14,182

13,890
458
116
824
15,288
270
15,019

% of Total
Collections/
Transfusions 2004 Total

–20.6

1.9
–30.0
–4.7
495.7
3.3

1.9
–26.9
–40.1
96.4
5.8
–44.1
6.7

% Change
2004-2006

Table 4-1. Estimated 2006 Collection and Transfusion by US Blood Centers and Hospitals of Whole Blood (WB) and Red Blood
Cells (RBCs) (expressed in thousands of units)
THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

ume of RBCs. Apheresis
procedures in 2006 yielded
a 96.4% increase in RBC
units in comparison to the
824,000 collected in 2004,
which was statistically significant (p<0.001). RBCs
collected in this manner
contributed 10.0% of the
total WB/RBC supply in
2006. Autologous RBC collections accounted for
0.7% of the apheresis total
and directed donations
accounted for 0.1% of the
total.
The growth of apheresis
collections occurred largely
in blood centers that
accounted for 99.2% of
reported units. In 2004, 115
blood centers and 30 hospitals reported apheresis collections. In 2006, 118
blood centers reported
employing this technology,
and 33 hospitals reported
collecting RBCs by apheresis. Among institutions that
reported RBC apheresis collections (unweighted data),
the mean number of units
collected by blood centers
was 12,419.24 and by hospitals was 284.30. The minimum number of units
collected by any facility
reporting apheresis collections was 4 and the maximum was 74,563.
Note: In the 2007 survey,
responding institutions provided the actual number of
products resulting from

apheresis procedures. This
is in contrast to the 2005
survey, where an adjustment of 1.9 units/RBC
apheresis procedure was
made, based on consultation with participating
blood centers.

Non-RBC Components
Produced
Non-RBC component units
collected or processed
include apheresis platelets
and plasma as well as platelets, cryoprecipitate, and
granulocytes from whole
blood. The total number of
non-RBC components produced for transfusion in
2006 was 11,106,000
(apheresis platelets counted
as platelet doses, not as
concentrate equivalent
units).

Platelets
Platelet concentrates were
derived from 2,396,000
units of WB, a decrease of
43% (p<0.001) of the 2004
volume (Table 4-2). Platelets were prepared from
16.9% of all allogeneic WB
collected, vs from 30.3% of
the total collection in 2004.
Blood centers processed
2,215,000 units (92.4%),
while hospitals produced
181,000 (7.6%).

An estimated 1,167,000
plateletpheresis procedures
were completed, yielding
1,823,000 apheresis platelet components. This volume indicates a split rate of
64% overall. For comparison with production of WBderived platelets, it is
assumed that the number of
platelets in each apheresis
collection is equivalent to
six units of platelet concentrates, yielding the equivalent of 10,939,000 platelet
concentrate units. This was
a significant increase of
19.4% from 2004 (p<0.001).
Blood centers collected
94.1% of apheresis platelets, while hospitals were
responsible for 5.9%.

Plasma
A total of 5,684,000 units of
plasma were produced for
transfusion. This is an
increase of 22.2% from
2004, which is statistically
significant (p<0.001). Blood
centers produced 93.0% of
the plasma (5,286,000
units), and hospitals produced the remaining 7%
(398,000 units). A total of
124,000 plasmapheresis
procedures were reported,
generating 578,000 units of
apheresis plasma for transfusion.* The remaining
5,106,000 units of plasma
*See page 36 for a discussion of
therapeutic apheresis.

Blood Collected and Processed in the United States

17

18

Blood Collected and Processed in the United States
411
223
634
215
56
424

Transfusions
Apheresis Platelets†
WB-Derived Platelet Concentrates
Total Platelets
Plasma‡
Cryoprecipitate

Outdated Non-RBC Components

*Significantly different from 2004 data.
†
platelet concentrate equivalent units (apheresis packs); includes splits.
‡
for transfusion, includes apheresis plasma.

10,297
2,215
12,512
5,286
1,173

Blood
Centers

Collection/Production
Apheresis Platelets†
WB-Derived Platelet Concentrates
Total Platelets
Plasma‡
Cryoprecipitate

Activity

451

8,681
1,073
9,754
3,795
938

642
181
823
398
24

Total

46

509
176
534
140
68

185
65
204
88
9

±95% CI

Hospitals

875*

9,092 (1,515)
1,296
10,388
4,010
993

10,939 (1,823)*
2,396*
13,335
5,684*
1,197

2006 Total

58

526
212
589
168
73

569
233
660
306
95

±95% CI

1,079

8,338
1,537
9,875
4,089
890

9,161
4,202
13,362
4,651
1,164

2004 Total

–18.9

9.0
–15.7
5.2
–1.9
11.6

19.4
–43.0
–0.2
22.2
2.8

% Change
2004-2006

Table 4-2. Estimated 2006 Collection and Transfusion by US Blood Centers and Hospitals of Non-Red-Blood-Cell Components
(expressed in thousands of units)
THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

were derived from whole
blood. In addition,
8,730,000 units of plasma
were produced that were
intended for further manufacture, with 97.9% coming
from blood centers—overall, a 12% increase from
2004 levels. This is due to
the increased demand for
plasma for fractionation
worldwide and to more
blood collection facilities
meeting the European certification criteria.

Cryoprecipitate

Granulocytes

A total of 1,197,000 units of
cryoprecipitate were prepared. This increase of
2.8% over 2004 was not
statistically significant.
Blood centers accounted
for 98.0% of cryoprecipitate produced.

Granulocytes, which are
prepared from both apheresis and WB buffy coat units,
totaled 5,766 units produced. This is a 56%
decrease from the amount
produced in 2004. Blood
centers reported 87.3% of
this total.

Blood Collected and Processed in the United States

19

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

5. Blood Transfused in the United States

Whole Blood and Red
Blood Cells Transfused
Transfusions of WB and
RBCs of all donation types
totaled 14,650,000
(±468,000) units, a 3.3%
increase from 2004 (see
Table 4-1). Allogeneic units
transfused, including pediatric units expressed as
adult equivalent units,
accounted for 98.7% of
units transfused or
14,461,000 units. The 3.3%
increase in the transfusion
of allogeneic units (community, directed, and pediatric combined) was not
statistically significant compared with 2004. In contrast, there was a significant
increase (p<0.001) in pediatric transfusions reported
in 2006. This appears to be
attributable to an increase
in the response by pediatric hospitals in the sample
rather than to a change in
transfusion practice.
The percent of available
allogeneic units (directed
and pediatric use included)
that was used in transfu-

sions was 93.4% in contrast
with 95.5% and 93.7% in
2004 and 2001, respectively.
The number of autologous
units transfused (189,000)
represented 56.4% of the
335,000 units donated preoperatively by patients in
2006. Autologous units
accounted for 1.3% of all
units transfused in 2006.
Autologous transfusions,
which were statistically
unchanged from 1999 and
2001, declined significantly from 2001 to 2004,
and again from 2004 to
2006 (p<0.001). Only a
very small number of units
(3,000 or 0.8% of the autologous units collected) were
reported to have been
crossed over to the community supply in 2006.
Directed donations, the
donation of allogeneic
blood for a designated
patient other than the
donor, accounted for
126,000 (±31,000) units
transfused. Of the 70,000
(±9,000) directed units
donated, 30,000 were

reported to have been
crossed over to be transfused to non-designated
patients, leaving a considerable gap between the
reported number of
directed units collected and
the reported number transfused, with approximately
84,000 directed collections
not accounted for. Only an
additional 2,000 units of
apheresis RBCs were
directed collections
(reported as apheresis collections for purposes of
comparison with the previous survey). It is not clear
why this accounting is at
odds.

WB and RBC Recipients
The 2007 NBCUS captured
the number of recipients of
transfused WB/RBCs of
each donation type. Based
on unweighted data, 1,597
facilities reported transfusing 8,275,000 allogeneic
units (including directed) to
2,740,000 recipients or 3.0
units per recipient, an
increase from 2.7 units per

Blood Transfused in the United States

21

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

recipient in 2004. Autologous recipients received an
average of 1.6 units per
transfusion (1.5 in 2004
and 1.6 in 2001). Finally,
for recipients of pediatric
units, the rate was 2.7 units
per recipient, a slight
increase over the rate of 2.3
per recipient in 2004.
Extrapolating the ratios of
3.0, 1.6, and 2.7 units per
recipient population proportionally to WB/RBCs
transfused yields a national
estimate of 5.0 million total
WB/RBC recipients in
2006. This represents a
6.6% decrease in transfusion recipients compared to
the estimated 5.3 million
recipients of 2004, but
approximately the same
number as in 2001.

Non-RBC Components
Transfused
National estimates for nonRBC components transfused
in 2006 are presented in
Table 4-2.
An estimated total of
10,388,000 platelet units
were transfused to US
patients in 2006, an
increase of 5.2% from
2004. The transfusion of
apheresis platelets
increased by 9.0% from
8,338,000 to 9,092,000

22

platelet concentrate equivalent units.
The transfusion of platelet
concentrates (derived from
whole blood) continued on
a downward trend, declining 15.7% to 1,296,000
from the previous survey
estimate of 1,537,000. This
has been the trend in platelet usage since 1994 and is
a smaller (and not statistically significant) decrease
than in previous surveys.
The combined total of FFP
and apheresis plasma
resulted in 4,010,000 units
transfused, a decrease of
1.9% over the 2004 volume
(4,089,000). Reporting
institutions indicated the
volumes of transfused
plasma that had been processed by a variety of methods as shown in Figure 5-1.
The results, for which overlap is possible, are as follows.
• FFP represented 77.2%
of plasma transfused
(3,094,000 units).
• Plasma, Frozen Within
24 Hours After Phlebotomy, accounted for
15.3% of that transfused
(613,000 units).
• Jumbo plasma
accounted for 1.8%
(73,000) of plasma
transfused.
• Pediatric-sized plasma
accounted for 1.0%

Blood Transfused in the United States

(42,000 units) of plasma
transfused.
• Cryoprecipitate-reduced
plasma, a new category
on the survey, accounted
for 4.7% of the total
plasma transfused
(188,000 units).
In this survey, use of donor
retested plasma and solvent/detergent-treated
plasma was not included,
because the 2004 survey
indicated that these represented less than 1% of the
plasma transfused, and the
product was withdrawn
from the US market.
The median volume of
plasma reported transfused
during a single transfusion
episode was 300 mL
(n = 1,396), the same as
reported in the 2005 and
2002 surveys.
Cryoprecipitate transfusions increased by 11.6% to
993,000 units. An additional 10,000 units were
reportedly issued for fibrin
sealant, compared with
15,000 units reported for
2004 (a 36% decline), continuing the downward trend
since 2001. Other uses of
cryoprecipitate were not
assessed.
Granulocytes, prepared
from both apheresis and
WB buffy coat units,
resulted in a total of 1,652
units transfused, compared
with 2,174 reported for

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Jumbo
Plasma
1.8%

Plasma, Cryo
reduced
4.7%

products and 248,000
whole-blood-derived platelet concentrates (see Figure
5-2). Blood centers reported
the transfusion of 36,000
plateletpheresis doses and
9,000 whole-blood-derived
platelet concentrates. Overall, the ratio of apheresis
platelet concentrate doses
transfused to whole bloodderived doses transfused
changed dramatically in
2006 to 4.8:1 from the
3.7:1 ratio reported for
2004 and 2.2:1 reported for
2001. This indicates a trend
toward apheresis platelet
use.

Pediatric
sized Plasma
1.0%

Plasma,
frozen w ithin
24 hours
15.3%

FFP
77.2%

Figure 5-1. Types of plasma transfused in 2006.

2004, a 24.4% decrease.
Because of the specialized
nature of these transfusions
and the hospitals that perform them, the apparent
decline in granulocyte
transfusions may be
affected significantly by
hospital sampling and
response.
The total number of units of
all components transfused
in the United States in
2006, both RBC and nonRBC components, was
30,044,000, an increase of
1,006,000 (3.5%) in comparison with 2004.

doses of each type of platelets. Hospitals reported the
transfusion of 1,196,000
doses of plateletpheresis

Hospitals reporting wholeblood-derived platelet concentrate doses also indicated the most common

Whole Blood
Derived Platelet
Doses
17%

Apheresis
Platelet Doses
83%

Platelet Dosage
Institutions reporting platelet transfusions indicated
the number of therapeutic

Figure 5-2. Therapeutic platelet doses transfused by
hospitals and blood centers in 2006.

Blood Transfused in the United States

23

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

dosage of that product used
in their institutions (Figure
5-3; n=459). As in 2004,
the majority of hospitals in
2006 (45.8%) reported
using six concentrates.
However, an increasing
percentage reporting using
five or fewer: 18.3%
reported using five and
17.4% reported fewer than
five, for a total of 35.7%
compared to 22.9% reporting five or fewer in 2004.

Outdated Units
The national estimate for
the number of units of WB
and all components outdated by blood centers and
hospitals in 2006 was
1,276,000 (Table 5-1).

Blood centers accounted
for 43.5% of all outdates.
Allogeneic, non-directed
RBC outdates were shared
evenly between blood centers and hospitals in 2006,
while hospitals were
responsible for most of the
directed and autologous
outdates (89.3% and
97.4%, respectively). Most
non-RBC components, with
the exception of wholeblood-derived platelets,
were outdated by hospitals.

percentage of outdated WB/
RBCs contributed by each
collection type is illustrated
in Figure 5-4. The mean
number of units outdated
by blood centers was 940,
an increase from 923 in
2004, while the mean for
hospitals was 69, a large
increase from 2004 (33
units) but lower than that
seen in previous surveys
(eg, 114 units averaged in
2001). As shown in Table
5-1, outdated WB/RBCs
accounted for 2.4% of all
WB/RBC units processed in
2006.

Outdated WB and RBCs
totaled approximately
401,000, of which 252,000
were allogeneic, nondirected RBC units. The
remaining outdates were:
autologous units (131,000),
directed units (5,000), and
whole blood (13,000). The

Because many facilities
reported difficulty in gathering data regarding blood
group for WB/RBC outdates, the current survey
inquired only about group

Percentage of hospitals

60
50.3
48.5
45.8

50
40

2001

2004

2006

35.7

30
22.9

20

17.9

16.6
13.3

13.1

10.1

10

9.8
5.2

1.3

1.3

0.9

0
<=5

6

7

8

9

10

Platelet concentrate dosage (in units)
Figure 5-3. Most common platelete concentrate dosage reported by hospitals.

24

Blood Transfused in the United States

>10

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Table 5-1. Outdated Components as a Percentage of the Total Volume of Each Type
Processed for Transfusion in 2006
Whole-BloodDerived
Apheresis
WB/RBCs
Platelets
Platelets
Outdated Total
Processed/Produced
Percent Outdated

401,000
16,745,000
2.4

O-positive and -negative
outdates (Figure 5-5). In
2006 such outdates
accounted for 12.2% of the
total outdated allogeneic
WB/RBCs: 8% of outdated
units were group O positive
and 4% were group O negative. Previous surveys suggested a comparable
outdate percentage for
group O units (9% and 4%,
respectively).
The total number of WB/
RBC outdated units was significantly fewer than the
2004 total by 20.6%
(p<0.001). Only 2.4% of
WB/RBC units outdated,
compared with 3.2% from
the 2004 survey. The percentage of directed and
autologous units outdated
(1.2% and 32.7%, respectively) fell from their 2004
levels of 9% and 44.2%.
Still, more than one-third of
the autologous donations
were not used.

533,000
2,396,000
22.2

197,000
1,811,000
10.9

Plasma

Cryoprecipitate

All
Components

111,000
5,684,000
2.0

34,000
1,197,000
2.8

1,276,000
27,833,000
4.6

There was a significant
(–18.9%) decrease in outdates of other components
as well (p<0.001). As has
been the case in previous
surveys, whole-bloodderived platelet concentrates accounted for the
greatest percentage of total
components outdated,

41.8% (533,000/1,276,000;
Figure 5-6). There were
229,000 fewer wholeblood-derived platelet units
outdated than reported in
2004. Outdated platelets
from WB accounted for
22.5% of all whole-bloodderived platelets processed
in 2006.

Whole Blood
3.2%

Autologous
32.7%

Allogeneic (nondirected) RBCs
62.8%
Directed
1.2%

n=401,000

Figure 5-4. WB/RBC unit outdates by collection type.

Blood Transfused in the United States

25

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

O+
8%

Other
88%

Apheresis platelets, plasma,
and cryoprecipitate combined accounted for 26.8%
of all outdated units, almost
7% more than in 2004. This
can be attributed to the
increased outdates in
plasma and cryoprecipitate.

O4%

Overall, efficiency of utilization of all blood components continues to improve
with a decrease in outdated WB/RBC and platelet
components. The percentage of processed units to be
outdated declined slightly
from 2004 to 2006, from
5.8% to 4.6%.

n=252,000

Figure 5-5. Percentage of allogeneic RBC outdates by
blood group and type.
Apheresis platelets contributed 197,000 units, or
15.4% of total outdates.
This volume represented
10.9% of apheresis platelets
processed, down 7.1%
from 2004 and indicating
better utilization of apheresis platelets in 2006. Some
of this improved utilization
may be due to the PASSPORT 5- to 7-day platelet
study, where platelets had
extended shelf life and were
less likely to outdate.

The number of outdated
cryoprecipitate units was
34,000, 2.8% of the cryoprecipitate processed.

Outdated plasma units
totaled 111,000, only 2.0%
of the plasma units processed for transfusion.
Plasma from whole blood
contributed 96,000 units to
the total and apheresis
plasma accounted for
15,000 units.

26

Blood Transfused in the United States

Plasma
(111,000 units)
9%

Cryoprecipitate
(34,000 units)
3%

WB/RBCs
(401,000 units)
31%

Apheresis Platelets
(197,000 units)
15%

Whole-Blood-Derived
Platelets
(533,000 units)
42%
(n = 1,276,000
components)

Figure 5-6. Outdates by component type.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

6. Component Modification

Prestorage Leukocyte
Reduction

Table 6-1. Blood Components Modified by Prestorage
Leukocyte Reduction in All Facilities in 2006

Blood components are leukocyte reduced (LR) to
reduce the risk of febrile
nonhemolytic reactions,
transmission of cytomegalovirus infection, and HLA
alloimmunization that may
lead to platelet refractoriness. Other indications
exist, but are controversial.
Leukocyte reduction may
occur during collection or
at some time before components are placed in inventory; this is considered
prestorage leukocyte reduction. A total of 13,913,000
(51.4%) component units,
including pediatric aliquots
were leukocyte reduced by
blood centers and those

Blood Component

Prestorage
Leukocyte-Reduced

% of Total Units
LeukocyteReduced

11,312,000
897,000
1,688,000
16,000
13,913,000

70.6
37.4
92.6
0.2
51.3

All Facilities
WB/RBCs
WB-Derived Platelets
Apheresis Platelets
Other Component Units
Total Component

hospitals that collect blood
(Table 6-1). Blood centers
produced 13,495,000 units
(97.0%), and hospitals produced 418,000 units (3.0%).
The most frequently LR
components were WB/
RBCs and apheresis plate-

lets. The percent of all WB/
RBCs that were leukocytereduced before storage in
2006 was 70.6% (an
increase of 9% over 2004).
Although 92.6% of apheresis platelets produced were
reported to be leukocytereduced, this is most likely

Table 6-2. Change in Number of Prestorage Leukocyte-Reduced Blood Component Units
Processed in All Facilities from 2004 to 2006 (expressed in thousands of units)
Blood Centers

Hospitals

All Facilities

Modification

2006

2004

%
Change

2006

2004

%
Change

2006

2004

%
Change

Leukocyte-reduced,
prestorage

13,495

12,094

11.6

418

755

–44.6

13,913

12,849

8.3

Component Modification

27

28

Component Modification
1,073,000
277,000
617,000
174,000
2,141,000

HOSPITALS
WB/RBCs
WB-Derived Platelets
Apheresis Platelets†
Other Component Units
Total Components

*Acting as hospital transfusion services.
†
Apheresis platelet units (not platelet concentrate equivalents).

80,000
66,000
24,000
10,000
180,000

1,153,000
343,000
641,000
184,147
2,322,000

Irradiated
Units

WB/RBCs
WB-Derived Platelets
Apheresis Platelets†
Other Component Units
Total Components

BLOOD CENTERS*

WB/RBCs
WB-Derived Platelets
Apheresis Platelets†
Other Component Units
Total Components

ALL FACILITIES

Blood Component

7,677,000
586,000
1,148,000
504,000
9,914,000

208,000
87,000
58,000
7,000
361,000

7,886,000
673,000
1,206,000
510,440
10,275,000

Prestorage
LeukocyteReduced Units

188,000
69,000
5,000
29,000
291,000

3,000
0
0
0
3,000

190,000
69,000
5,000
28,600
293,000

Poststorage
LeukocyteFiltered Units

7,865,000
654,000
1,153,000
532,000
10,205,000

211,000
87,000
59,000
7,000
364,000

8,076,000
742,000
1,212,000
539,040
10,569,000

Total LeukocyteReduced Units

7.3
21.4
40.7
3.5
9.5

0.5
5.1
1.6
0.2
0.8

7.9
26.5
42.3
3.7
10.3

Irradiated:
% of
Total Units

53.7
50.5
76.1
10.6
45.4

1.4
6.7
3.9
0.1
1.6

55.1
57.2
80.0
10.8
47.0

LeukocyteReduced: % of
Total Units

Table 6-3. Estimated Number of Blood Component Units Modified by Irradiation or Leukocyte Reduction and Transfused by All
Facilities in 2006

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

a reporting anomaly,
because the collection process provides leukocyte
reduction.
Blood centers are taking on
more of the responsibility
for leukocyte reduction.
Component units leukocyte-reduced before storage increased by 11.6% in
blood centers, and declined
by 44.6% in hospitals
(Table 6-2). Overall prestorage leukocyte reduction
increased by 8.3% from
2004 (Figure 6-1).

Transfusion of Irradiated
and Leukocyte-Reduced
Components
Table 6-3 summarizes the
types and numbers of irradiated and leukocyte-reduced
blood component units
transfused during 2006. A
total of 180,000 irradiated
units were reported as

Figure 6-1. Component modification trends (all components).

transfused by blood center
transfusion services and
2,141,000 by hospital
transfusion services. In
total, 10.3% of all component units transfused were
irradiated.
In 2006, some 10,569,000
LR component units were
transfused, 364,000 (3.4%)
by blood center transfusion

services and 10,205,000
(96.6%) by hospital transfusion services. Of the total
LR units transfused, 97.3%
were leukocyte-reduced
before storage and 2.8%
after storage. Substantial
proportions of all RBCs and
platelets transfused in 2006
were leukocyte-reduced:
55.1% of WB/RBCs, 57.2%
of whole-blood-derived

Table 6-4. Irradiated, Prestorage Leukocyte-Reduced and Poststorage Leukocyte-Filtered
Component Units Transfused in 2006 and 2004 (expressed in thousands of units)
Units
Modification

2006

2004

Change 2004-2006

Total, all units
Irradiated
Leukocyte-reduced, total
Prestorage
Poststorage

12,890
2,322
10,569
10,275
293

14,334
2,310
12,024
11,405
619

–1,444
12
–1,455
–1,130
–326

% Change
–10.1
0.6
–12.1
–9.9
–52.7

Component Modification

29

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

platelets, and 80% of
apheresis platelets (see previous comment regarding
apheresis platelets).
Table 6-4 summarizes the
changes that occurred
between 2004 and 2006 in
numbers of irradiated and
LR component units transfused. During this period,

30

Component Modification

the number of irradiated
units transfused remained
essentially constant,
whereas LR units transfused decreased by 12.1%.
While in 2004, there was
an increase in transfusion of
prestorage leukocytereduced units when compared to prior years, in
2006 this declined by

9.9%, most likely reflecting
a shift toward cost sensitivity in the market. Continuing the trend of declining
poststorage leukocyte
reduction observed in
1999, 2001, and 2004,
transfusion of poststorage
LR units declined by 52.7%
in 2006 (Figure 6-1).

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

7. Current Issues in Blood Collection and
Screening

In 2006, 12,142,000 individuals came to donate
blood, of whom 2,588,000
were deferred before donating. The majority (96.5%)
presented at blood centers
with only 3.5% presenting
at hospital donor centers.
Of the 9,554,000 allogeneic donors who successfully gave blood, 2,726,000
(28.5%) were first-time
donors and 6,828,000
(71.5%) were repeat
donors. These repeat allogeneic donors provided
11,697,000 donations, the
equivalent of 1.7 donations
per donor.
On the basis of predonation
screening, the deferral rate
was 21.3%. Hospitals had a
slightly higher rate (28.9%)
compared to blood centers
(21.0%). Predonation
screening includes physical assessments, such as
determining hematocrit /
hemoglobin levels, and
administering the Donor
History Questionnaire
(DHQ).

Because Chagas disease is a
growing concern in the US
blood collection community, the 2007 survey specifically asked blood
collecting organizations
how many donors were
deferred based on their
responses to the standard
DHQ question regarding
Chagas disease. There were
764 presenting donors
deferred because of their
response to the history of
Chagas disease screening
question.*
As is exhibited in Figure
7-1, an additional 151,000
units, from 1.2% of donors
(0.9% of units tested) are

*Laboratory tests for antibodies to
Trypanosoma cruzi, the agent of
Chagas disease, were introduced
in January 2007, the year following this survey. The small number
of individuals identified through
the DHQ suggests that those
donors who would be detected
by a valid screening test either do
not report or do not know of their
exposure to the parasite.

rejected on testing (including infectious disease
testing, bacterial contamination, etc). Testing loss
was significantly lower than
in the previous survey
(p<0.001), most likely due
to the implementation of
new testing platforms
between 2004 and 2006.
Only 77.5% of individuals
presenting to donate ultimately provide a usable
unit, not including units lost
to insufficient collection
volume.

Severe Donor Adverse
Events
For the purposes of this survey, severe donor adverse
events were defined as
adverse events occurring in
donors attributed to the
donation process that
included, for example,
major allergic reaction,
arterial puncture, loss of
consciousness of a minute
or more, loss of conscious-

Current Issues in Blood Collection and Screening

31

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Issue of Blood to NonHospital Transfusion
Services and Military
Installations

Rejected o n
Testing
1.2%
DHQ Deferred
21.3%

Successful
77.5%

Figure 7-1. Deferral rates for presenting allogeneic
donors.

ness with injury, nerve irritation, etc. There were
11,000 of these events
reported by collection organizations for 2006. The rate
of severe adverse events
was 11,000/16,174,000
collected units (0.07%).

Diversion Devices
Bacterial contamination of
platelets has been one of
the most frequent transfusion-associated infection
risks. The most common
cause of bacterial contamination is the inoculation of
bacteria on the skin surface
at the time the needle is
inserted into the arm at
donation.
32

As an additional mechanism to prevent bacterial
contamination, collection
of blood components using
unit diversion devices has
been implemented at some
institutions. This device,
integrated with the blood
collection pouch, diverts
the initial aliquot of blood
into a separate but connected pouch. In so doing,
the possibility that a skin
plug harboring bacteria will
contaminate the collection
bag is reduced. In 2006 half
(50.4%) of all institutions
used diversion devices for
collecting apheresis platelets; 37.6% used them for
whole blood collections.

Current Issues in Blood Collection and Screening

Institutions collecting blood
sometimes issue blood to
home transfusion services,
freestanding surgery centers,
or other off-site non-hospital
transfusions services such
as dialysis centers. Additionally, blood may be issued
for use by military installations. Thirty-six percent of
collection sites issued 67,000
units of blood to off-site nonhospital transfusion services. The majority, 82.0%
or 55,000 units, were RBCs,
followed by platelets
(14.1%), and FFP (3.9%).
Although fewer collection
centers (16.6%) issue blood
to military installations, the
number of units issued is over
three times what is issued to
other off-site non-hospital
transfusion services. Of the
222,000 units that were
issued, RBCs accounted for
68.1% of all issued units,
followed by FFP (18.5%),
platelets (7.6%), and cryoprecipitate (5.8%).*
*While the number of units issued
was reported to the survey, much
of this blood was not transfused
and was returned for civilian use.
There was also some overlap
between sites that house Veterans
Administration hospitals and military hospitals and there may have
been reporting overlap for some
of these sites.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

8. Current Issues in Transfusion and
Transplantation

Blood Inventory
Shortages
The current and previous
surveys asked hospitals to
indicate the number of days
in the past year that elective
surgery was postponed
because of blood inventory
shortages, as well as the
number of days that they
were unable to meet other
blood requests. The results
are based on actual
(unweighted) responses.
A total of 117 hospitals
(6.89%) reported that elective surgery was postponed

on one or more days in
2006 because of blood
inventory shortages. Table
8-1 provides a characterization of cancellation reports
in 2006 and prior survey
years. This represented considerably fewer hospitals
reporting surgery delays
than in 2004 and 2001. The
range of days postponed
(1-120) was wider than in
2004. However, two hospitals were outliers, reporting
50 and 120 days of surgical
delays. The remaining hospitals reported between
1 and 16 days of delay in
2006, a much narrower
range than in previous sur-

vey years. There were no
significant differences
between hospitals when
grouped by surgical volume.
Hospitals indicated separately that the total number
of surgical procedures that
were postponed was 412
compared with 546 in
2004. This is a decrease of
25%. Numbers of surgeries
postponed varied widely
among hospital strata, but
hospitals performing
between 1,400 and 2,399
surgeries reported the highest numbers of surgeries

Table 8-1. Cancellation of Elective Surgeries by US Hospitals, 1997-2006

Year

% Hospitals with
Cancellation of ≥1 Day

Range
of Days

Median
Number of Days

Number of Patients
Affected

1997
1999
2001
2004
2006

8.60
7.40
12.70
8.40
6.89

1-21
1-150
1-63
1-39
1-120

2.0
2.0
2.0
2.0
3.0

Not determined
568
952
546
412

Current Issues in Transfusion and Transplantation

33

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

postponed because of
blood shortages.
Hospitals indicated the
number of days in which
nonsurgical blood requests
were not met. Of responding hospitals, 13.5% (231/
1707) experienced at least
one day in which nonsurgical blood needs could not
be met vs 16.0% (257/
1604) in 2004. The total
number of days reported
was 5,460 and the range
was 1 to 365. There is a
slight increase in the mean
number of days of unmet
nonsurgical needs for all
respondents between 2004
(19.27) and 2006 (22.0). Six
hospitals reported 365 days
in which nonsurgical blood
requests were not met in
2006, whereas eight
reported an entire year of
unmet need in 2004.
Also, hospitals were asked
to indicate the number of
days on which the regular
or standing order was
incomplete. The total number of days was 44,910. On
any given day, 123 hospitals are without their standing order. It is likely that
most facilities estimated this
number given the round
values that were reported.
This data element is probably best used as an indicator of customer service.
Although standing orders
were incomplete on numer-

34

ous occasions, the more
important variables are the
number of postponed surgeries (a 25% improvement
over 2004) and the unmet
nonsurgical blood need
(2.5% fewer hospitals
reporting, although those
reporting unmet need
reported an overall increase
of 2.7 days).

Bacterial Testing
The 2007 NBCUS included
a new section on bacterial
testing that all facilities
were asked to complete.
Only 27.3% of the institutions performed bacterial
testing of platelets in 2006.
Of the 127 blood centers
responding, 117 (92.1%)
reported testing; however,
only 29.6% of hospitals
reported testing.
Respondents were asked to
indicate the test methods
for platelet components.
Among the 74% reporting
testing of apheresis platelets, 35% of respondents
reported using culturebased testing. Of those
reporting testing of wholeblood-derived platelets singly (96%), 67% reported
using pH methods and
another 34% reported using
glucose methods (respondents were told to check all
that apply). Swirling methods were chosen by 15%
and culture-based testing

Current Issues in Transfusion and Transplantation

by 12% of those reporting.
Among the 75% reporting
on pooled whole-bloodderived platelets, the most
common method was pH
testing for bacterial contamination (18%).
Approximately 1,485,000
units were tested for bacteria in 2006. Culture-based
methods accounted for
57% of the units tested
(826,000) and for 283
(52.4%) of the 540 confirmed positives. Blood centers accounted for 87% of
the culture-based testing
and for only 26.3% of the
alternative method testing.
Considerably more falsepositive results (12,000)
were reported with alternative methods of testing
(1.8% vs 0.15% reported
for culture-based testing).

Biovigilance
Since the 2005 NBCUS,
public and private sectors
have coordinated efforts to
develop the USBVN. In
order to establish a baseline, data were collected for
major adverse transfusion
reactions for 2006. It is
anticipated that the NBCUS
will collect biovigilancerelated data until the
USBVN achieves the statistical robustness required to
accurately sample US transfusion practice.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Implementation of the
USBVN and the promulgation of common definitions
and reporting criteria
should increase the rate at
which reactions are recognized and reported. The
smaller the surgical volume
of the hospital, the higher
the rate of transfusionrelated adverse reactions
reported (see Figure 8-1).
This may be related to the
frequency with which
patients are transfused or to
the reporting thresholds
possible at smaller facilities.
It is generally understood
that many adverse events
are not recognized and/or
reported to the transfusion
service and that there is a
need for additional education at all points in the
transfusion chain.

Of the adverse events
reported, 1,522 were
reported as transfusionrelated acute lung injury
(TRALI). The frequency of
TRALI is generally acknowledged to be approximately
1/5,000 transfusions.* On
the basis of this rate, one
would expect approximately three times the rate
reported; therefore TRALI
appears to be underdiagnosed or underreported, or
occurring at a lower frequency than previously
reported. The numbers

*Goldman M, Webert KE, Arnold
DM, et al. Proceedings of a consensus conference: Towards an
understanding of TRALI. Transfus
Med Rev 2005;19:2-31.

Adverse Reactions/Total Components Transfused

An estimated total of
72,000 transfusion-related
adverse reactions occurred
in 2006. These were
defined as events that
required any diagnostic or
therapeutic intervention.
This represents an adverse
reaction rate of approximately 0.32% (72,000/
22,466,000), a rate on the
lower end of the rates
reported through other
national hemovigilance
reporting systems
(0.3%-0.7%).

reported for other reaction
types to be tracked by the
USBVN are included in
Table 8-2.
Participants reported
whether or not they had an
electronic system for tracking events. Events were
defined as unplanned,
unexpected, and undesired
occurrences. Only 34% of
the responding hospitals
reported having such a system to track events, which
suggests that the planned
electronic event tracking
capabilities of the USBVN
will be of use to the many
hospitals without systems of
their own.

3.00
2.50
2.00
1.53
1.50
1.00
0.50

0.35

0.26

0.27

0.27

0.24

1,4002,399

2,4004,999

5,0007,999

≥?8,000

0.00
100-999

1,0001,399

Hospital Surgical Volume

Figure 8-1. Rate of adverse transfusion reactions by hospital annual surgical volume.

Current Issues in Transfusion and Transplantation

35

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Table 8-2. Transfusion-Related Adverse Reactions Reported to the Transfusion Service
Number of
Occurences

Adverse Transfusion Reactions
Total number of occurrences that required any diagnostic or
therapeutic intervention
Severe allergic reactions

Rate (All Components)
from Reporting Facilities
n=22,466,000*

72,000

1:312

4,944

1:4,540

Delayed hemolysis

1,770

1:12,681

Transfusion-related acute lung injury (TRALI)

1,522

1:14,748

Transfusion-associated circulatory overload (TACO)

1,110

1:20,222

Posttransfusion sepsis

240

1:93,525

Reactions that were life-threatening, requiring major medical
intervention following the transfusion, eg, Vasopressors,
blood pressure support, intubation, or transfer to the ICU
Acute hemolysis

236

1:95,110

141

1:159,191

64

1:350,719

ABO incompatibility

*Apheresis platelets counted as doses (not as concentrate equivalents).

Therapeutic Apheresis
A total of 27.2% of facilities
reported that they perform
therapeutic apheresis procedures. Among blood centers, 52.8% provide
therapeutic apheresis and
among hospitals, 26.4%
perform these services. The
total number of therapeutic
apheresis procedures was
112,109, 20% (22,821) by
blood centers and 80%
(89,288) by hospitals. The
specific indication for
which the most facilities
reported performing therapeutic apheresis was throm-

36

botic thrombocytopenic
purpura treatment, with
25,791 procedures (23% of
all therapeutic apheresis
procedures). There were
16,706 procedures for
hemochromatosis and
10,798 procedures for
myasthenia gravis (15%
and 10% of all therapeutic
apheresis procedures,
respectively). Other therapeutic apheresis procedures
were peformed for GuillainBarré syndrome, multiple
sclerosis, sickle cell disease, chronic inflammatory
demyelinating polyradiculoneuropathy, and Goodpasture’s syndrome, each

Current Issues in Transfusion and Transplantation

less than 5% of all reported
procedures. An additional
42,744 procedures were
categorized as “other”
(38% of all therapeutic apheresis procedures). (See
Table 8-3.)

Crossmatch Procedures
Transfusing facilities
reported the total number of
crossmatch procedures, as
well as the percentage of
procedures performed serologically and electronically. Weighted hospital
data on crossmatch procedures indicate that

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Table 8-3. Therapeutic Apheresis Procedures in 2006 by Specific Indications

Total
Other
Thrombotic thrombocytopenic purpura
Hemochromatosis
Myasthenia gravis
Sickle cell disease
Chronic inflammatory demyelinating
polyradiculoneuropathy
Guillain-Barré syndrome
Multiple sclerosis
Goodpasture’s syndrome

18,774,000 procedures
were performed in 2006,
compared to 11,221,000,
an increase of 67.3%. Of
the crossmatch procedures
reported, serologic methods
were estimated to account
for 93.6% and only 4.4%
were estimated to be performed electronically.
In order to calculate the
crossmatch to transfusion
ratio, the total number of
allogeneic WB/RBC units
transfused was used as the
denominator (14,461,000).
The overall C:T ratio was
1.3 procedures per unit
transfused.
When analyzed by surgical
volume, the smaller hospitals had the lowest C:T
ratios. Hospitals with fewer
than 999 surgeries/year

Blood
Centers

Hospitals

Total
Procedures

% of Total
Procedures

22,821
9,603
6,557
858
1,934
936
835

89,288
33,141
19,234
15,849
8,864
3,876
3,252

112,109
42,744
25,791
16,706
10,798
4,812
4,087

100
38
23
15
10
4
4

1,227
509
363

2,415
1,722
935

3,643
2,231
1,298

3
2
1

reported a 0.99:1 C:T ratio,
(which is within the range
of error); hospitals performing from 1,000 to 1,399
surgeries reported C:T ratios
of 1.05:1. The largest two
strata >5,000 surgeries
reported closer to a 1.4:1
C:T ratio. Smaller hospitals
were more likely to report
performing crossmatches
serologically; larger-sized
hospitals were more likely
to report use of some electronic crossmatch procedures (Figure 8-2).

hospitals responded, an
increase from the 488
responding in the last survey. The data were not
weighted. Hospitals were
asked to indicate whether
they reported a calculated
age or an estimate of age.
The estimated mean age
was 16.4 days and the
mean calculated age was
19.5 days at transfusion.
Only 7.8% (or 45 hospitals) were able to calculate
and report the component
age at transfusion.

Red Cell Age

Platelet Age

In follow up to earlier surveys, the 2007 survey has
attempted to clarify the data
on the average age of a unit
of RBCs at the time of transfusion. In this survey, 573

In the 2007 survey, 350
hospitals responded with an
average age of wholeblood-derived platelets at
transfusion. Again, the data
were not weighted. Hospi-

Current Issues in Transfusion and Transplantation

37

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

100.0

Percent

80.0

Electronic
Crossmatch
Serologic
Crossmatch

60.0

40.0

20.0

0.0
100-999

1,000-1,399

1,400-2,399

2,400-4,999

5,000-7,999

≥?8,000

Hospital Size by Surgical Volume

Figure 8-2. Electronic and serologic crossmatch by hospital size.

tals were asked to indicate
whether they reported a
calculated age or an estimate of age. The estimated
mean age was 2.09 days
and the mean age for the
calculated days was 2.33
days at transfusion. Only
6% (21 hospitals) were able
to calculate the component
age at transfusion. Quite a
few more hospitals (661/
1707 or 39%) responded
with an age for apheresis
platelets at the time of
transfusion. The mean
reported age for 5-day
apheresis platelets at transfusion was 3.2 days,
whether calculated or estimated by the hospital. Surprisingly, 7-day apheresis
platelets were transfused at
2.4 days (estimate) to 2.8

38

Orthopedics
Opt hamology
0.8%
1.0%

Hospital in-house Cardiology
t issue bank
0.1%
0.6%

Speciality department,
other
1.7%

Laborat ory medicine/
pat hology
1.1%
Blood Bank
14.0%

Operating Room
80.7%

Figure 8-3. Department with the most responsibility for
human tissue.

Current Issues in Transfusion and Transplantation

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

days (calculation). Only 17
(1%) and 53 (8%) hospitals
were able to provide calculated values for 7-day and
5-day components, respectively.

Table 8-4. Human Tissue Implants/Grafts Used in 2006

Used/Implanted
Discarded
Returned
Total Reported

Tissue
Forty-three percent of all
surveyed institutions
reported maintaining an
inventory of, or using,
human tissue for transplantation. Of these institutions, 80.7% reported that
their operating rooms had
the most responsibility for
ordering, receiving, storage,
tracking, and issuing
human tissue, as illustrated
in Figure 8-3. The second
most commonly reported
department with responsibility for tissue was the
blood bank (14%). As
detailed in Table 8-4, in
2006, the total number of
human tissue implants/
grafts that reporting facili-

Blood
Centers

Hospitals

All
Facilities

14,236
1,885
1,422
17,543

214,879
6,294
5,931
227,103

229,115
8,179
7,353
244,647

ties used or implanted was
229,115. This dramatic
increase from the 3,095
implants reported in 2004 is
most likely the result of the
addition of a separate tissue
section to the NBCUS questionnaire that was distributed to all hospitals and
blood centers. The total
number of implants discarded was 8,178; the total
number returned to the supplier was 7,353.
Of institutions that used or
maintained an inventory of
human tissue, 12.3%
reported maintaining an

inventory of human skin.
The most common average
daily inventory of human
skin maintained was 2
square feet. The total average daily inventory of
human skin reported was
2,999 square feet, more
than a third of that total
coming from hospitals with
2,400-4,999 surgeries/year.
In 2006, 43 adverse events
associated with human tissue implants/grafts were
reported. Of those, 14
events (32.6% of all adverse
reactions) were related to
virus transmission; 15

Table 8-5. Adverse Events Associated with Tissue Transplants

Viral Transmission
Bacterial Infection
Structural Failure
Other Adverse Events
All Adverse Events

Blood
Centers

Hospitals

All
Facilities

0
4
0
0
4

14
11
12
2
39

14
15
12
2
43

% of Total Reported % of All Tissue
Human Tissue
Adverse
Transplanted
Reactions
0.006
0.007
0.005
0.001
0.019

32.6
34.9
27.9
4.7
100.0

Current Issues in Transfusion and Transplantation

39

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

(34.9%) were related to
bacterial infection; and 12
(27.9%) were related to
structural failure. (See Table
8-5.) It is likely that structural failures are underreported, because the failures
may occur long after the
transplant procedure. The
number of adverse tissue
events occurring in the total
number of human tissue
implants/graft procedures

40

(43/229,115) was 0.02%
(1 adverse reaction per
5,300 tissue procedures).
With the implementation of
the Transplantation Transmission Sentinel Network
(TTSN)* it is anticipated
that there will be growing
recognition and reporting
of adverse events associated with tissue transplantation.

Current Issues in Transfusion and Transplantation

*TTSN is a web-based system
designed to collect data on organ
and tissue donation and implantation, including adverse outcomes. The system is the result of
collaboration between the CDC
and the United Network for
Organ Sharing (UNOS) and is
being piloted in 2008.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

9. Component Costs

Hospitals were requested to
report the average dollar
amount paid per unit in
2006 for each of eight specific components. The
mean hospital cost for each
component is presented in
Table 9-1 and compared
with the 2004 value. Table
9-2 displays the average
hospital cost of each component by region of the
country and provides a statistical comparison with the
national average. Average
component costs are stratified by hospital surgical
volume in Table 9-3.

Red Blood Cells
The mean of the average
amount paid nationally for
a unit of leukocyte-reduced
RBCs in 2006 was $213.94
(Table 9-1). This was a
minor increase from the
2004 average of $201.07.
When analyzed by United
States Public Health Service
(USPHS) region, the mean
hospital amount paid was
significantly higher than the
national mean in the Northeastern and Southwestern
states (Regions I, II, and IX).

Significantly lower means
were found in the Southeastern and Central states
(Regions IV, V, VI, and VII).
When analyzed by surgical
volume, the largest hospitals (hospitals reporting at
least 8,000 surgeries per
year) paid significantly
lower than the mean price
for RBCs, an average of
$206.64, while the other
surgical strata clustered
around the mean
(Table 9-3).

Table 9-1. Mean Hospital Amount ($) Paid per Selected Component Unit in 2006 and 2004
Average Amount Paid ($)*
Component

2006

2004

% Change

Red cells, leukocyte filtered
Plasma, frozen within 24 hours of phlebotomy
Whole-blood-derived platelets, not leukocyte
reduced, not irradiated
Apheresis platelets, leukocyte reduced
Cryoprecipitate

213.94
59.84
84.25

201.07
56.29
63.67

6.4
6.3
32.3

538.72
53.31

510.05
—

5.6
—

*Calculations are based on unweighted estimates.

Component Costs

41

42

Component Costs

186

42

IX

X
213.94

222.89

238.56

223.63

199.58

206.72

209.77

0.0627

<0.0001

0.1066

<0.0001

0.0014

<0.0001

<0.0001

0.0871

<0.0001

<0.0001

p-value

59.84

84.51

62.25

78.06

52.55

63.43

59.00

54.27

57.08

59.47

58.68

Avg

0.1296

0.2711

0.0013

0.0004

0.2023

0.7593

0.0172

0.0629

0.7819

0.4271

p-value

Plasma, frozen

84.24

175.00

176.17

139.00

133.56

60.90

85.16

79.52

72.49

79.83

77.00

Avg

0.0979

0.0903

0.2496

0.2298

0.0003

0.9294

0.6980

0.1317

0.7314

0.3295

p-value

538.72

596.75

555.94

591.82

485.38

540.66

516.80

513.70

538.45

598.23

554.76

Avg

0.0628

0.0050

0.0723

<0.0001

0.7710

0.0003

0.0001

0.9748

<0.0001

0.1718

p-value

WB Derived Platelets Apheresis Platelets

Mean Dollar Values†

*The number of responses for each blood component varies because some hospitals did not provide answers to all questions.
†
Calculations are based on unweighted estimates.

1,606

57

VIII

All Hospitals

108

VII

199.87

302

196

V

312

IV

VI

196.72

161

III

243.16

253.03

82

160

Avg

I

Number of
Hospitals*

II

USPHS
Region

RBCs

Table 9-2. Average Hospital Component Cost ($) by USPHS Region

53.31

85.03

64.11

59.69

45.80

51.81

53.08

43.66

45.72

62.46

54.40

Avg

0.0221

0.0278

0.0350

0.0001

0.6475

0.9530

<0.0001

<0.0001

0.1897

0.7082

p-value

Cryoprecipitate

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

485

204

129

1,400 – 2,399

2,400 – 4,999

5,000 – 2,399

≥8,000
213.94

206.64

214.00

213.19

216.69

211.49

216.53

Avg

<0.0093

0.9845

0.7250

0.2687

0.5237

0.3514

p-value

59.84

52.27

56.57

57.30

59.41

59.25

72.89

Avg

<0.0001

0.0622

0.0633

0.8165

0.7836

<0.0075

p-value

Plasma, Frozen

84.25

84.22

74.78

77.27

89.02

107.32

97.69

Avg

0.9990

0.2879

0.3471

0.6697

0.3159

0.3889

p-value

538.72

522.54

535.79

539.86

538.62

544.20

545.35

Avg

0.0109

0.7004

0.8103

0.9858

0.5784

0.5285

p-value

WB-Derived Platelets Apheresis Platelets

*The number of responses for each blood component varies because some hospitals did not provide answers to all questions.
†
Calculations are based on unweighted estimates.

1,606

367

1,000 – 1,399

All Hospitals

294

127

100 – 999

Number of
Hospitals*

Annual
Surgical
Volume

RBCs

Mean Dollar Values†

Table 9-3. Average Hospital Component Cost ($) by Surgical Volume

53.31

48.23

50.51

53.86

53.64

57.17

58.85

Avg

0.1041

0.2696

0.8532

0.9037

0.4679

0.3797

p-value

Cryoprecipitate

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Component Costs

43

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Plasma
The hospital cost for
Plasma Frozen Within 24
Hours After Phlebotomy
averaged $59.84 nationally
(Table 9-1), 6.3% higher
than the 2004 average of
$56.29. When analyzed by
USPHS Region, hospitals
paid more in Region VIII,
the Mountain states, and
statistically less in Regions
IV and VII, the Southeast
and the Central states.
The hospitals with the
smallest surgical volume
(100-999 surgeries per year)
reported an average cost for
plasma for transfusion
($72.89) that was significantly higher than the overall mean (Table 9-3). The
largest hospitals (>8,000
surgeries per year) had costs
of $52.27, significantly
lower than the mean.

Whole-Blood-Derived
Platelets
The national hospital average paid for a unit of
whole-blood-derived platelet concentrate (individual
concentrate, not pooled),
not leukocyte reduced or
irradiated, was $84.25 in
2006 (Table 9-1). This was
a large increase (32.3%)
over the 2004 cost. The
increase may reflect costs
associated with bacterial

44

Component Costs

detection requirements for
this product.
Hospitals in USPHS Region
VI, the South Central states,
paid significantly less for
whole-blood-derived platelets than the national norm.
There were no cost differences reported by hospital
surgical volume.

Apheresis Platelets
For a unit of apheresis
platelets hospitals paid an
average of $538.72 in comparison with $510.05 in
2004, a small increase of
5.6%. When stratified by
surgical volume, the largest
hospitals paid significantly
less than other hospitals.
The mean was significantly
higher in USPHS Regions II
and IX, New York-New Jersey and the Pacific Southwest. The mean hospital
cost was significantly lower
for apheresis platelets in
Regions IV, V, and VII, the
Southeast, Central, and
North Central states.

Cryoprecipitate
The average hospital cost
for a unit of cryoprecipitate
was $53.31 in 2006. This
was the first time the price
for this component was
reported on the NBCUS. As

with many of the other
components, the price was
lower as hospital surgical
volume increased, although
differences from the mean
were not statistically significant.
Hospitals paid significantly
more for cryoprecipitate in
USPHS Regions VIII, IX,
and X, the Mountain and
Western states. The mean
hospital cost for a unit of
cryoprecipitate was significantly lower than the US
mean in USPHS Regions III
and IV, the Mid-Atlantic
and Southeastern states.

Hematopoietic
Progenitor Cells
This survey queried the cost
of hematopoietic progenitor
cells (apheresis, marrow,
and cord) to hospitals. The
response rate to this question was very low, with
only 23, 9, and 7 hospitals
reporting costs of apheresis,
marrow, and cord blood
products, respectively. The
variance and standard deviations were so high as to
render the data nonrepresentative. This response rate
also suggests that many
hospitals using these products do not purchase them
externally but collect them
for their own use.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Reimbursement
The Centers for Medicare
and Medicaid Services
(CMS) hospital outpatient
prospective payment system (OPPS) reimbursement
rates for the five components assessed are reported
in Table 9-4. Although hospital costs for components
increased from 5.6% to
32.3% between 2004 and
2006, most CMS OPPS
reimbursement rates
increased 20.8 to 60.7%,
except for the rate for
plasma for transfusion,
which decreased by 25.9%.

On the basis of these figures, the reimbursement for
a unit of RBCs is approximately 76% of the average
hospital cost; for a unit of
plasma for transfusion,
approximately 118% of the
average cost; for a unit of
whole-blood-derived platelets, approximately 61% of
the average cost. For a unit
of apheresis platelets, reimbursement covers 92% of
the average cost paid by
hospitals; for cryoprecipitate, reimbursement is
approximately 88% of the
average hospital cost of a
unit.

CMS OPPS rates are
reported here because they
are the only simple measure
of Medicare reimbursement for individual blood
components. Most Medicare reimbursement for
blood is part of the diagnosis-related group (DRG)
payment made for inpatient services and is nearly
impossible to tease apart
from the other aspects of
the DRG. Other payers,
besides Medicare, pay for
blood using varying mechanisms that are not included
in this report.

Table 9-4. CMS Hospital Outpatient Prospective Payment System Rates for Selected Blood
Components
Reimbursement
Rate

Reimbursement Code

CPT/ HCPCS

APC

2006†

2004*

%
Change

Red Blood Cells (leukocyte-reduced)

P9016

954

163.16

119.26

36.8

Fresh Frozen Plasma (frozen between 8 and
24 hours after phlebotomy)

P9017

955

70.40

95.00

–25.9

Whole-blood-derived platelets

P9019

957

51.50

41.44

24.3

Apheresis platelets (leukocyte-reduced)

P9035

09501/1014

493.12

408.81

20.6

Cryoprecipitate

P9012

952

47.10

29.31

60.7

Blood Component

*Department of Health and Human Serives. Medicare program; Chages to the Hospital Outpatient Prospective Payment System
and Calendar Year 2004 Payment Rates; Final rule w/ comment period.
†
Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates;
Final rule w/ comment period.
CMS = Centers for Medicare and Medicaid Serives; CPT = current procedural terminology; HCPCS = health-care common procedure coding system; APC = ambulatory patient classification.

Component Costs

45

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Summary
In summary, the average
hospital cost of a unit of
platelets derived from
whole blood increased by
32.3% between 2004 and
2006. RBCs, plasma for
transfusion, and apheresis
platelets increased in cost
by less than 7% in the same
period. Average costs for

46

Component Costs

the components assessed
were generally higher in US
Public Health Service
Regions VIII, IX, and X
(Mountain and Western
states); and lower in
Regions IV, V, VI, and VII
(Southeastern and Central
states). As seen in previous
surveys, larger hospitals
typically pay less than the
national average for blood

components, which is likely
the result of more favorable
pricing agreements with a
supplier based on the volume purchased. Suppliers
may also offer hospitals
preferential pricing for
components that are closer
to expiration, an option that
would only be feasible for a
large transfusion service.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

10. Cellular Therapy Products

Because of increased interest in hematopoietic transplantation and novel
cellular therapies, the 2007
NBCUS collected data on
collection, processing, and
infusion of cellular therapy
products, including
hematopoietic progenitor
cells collected by apheresis
(HPC-A), HPCs derived
from marrow (HPC-M), and
HPCs from cord blood
(HPC-C).
This year, the survey
included questions on the
collection, processing and
infusion of donor lymphocyte infusions (or unmanipulated nonmobilized
peripheral blood mononuclear cells), hematopoietic
stem/progenitor cells
(expanded), immunotherapies (natural killer cells,
dendritic cells, T cells,
other), non-hematopoietic
stem cells [mesenchymal
stem cells (MSC or multipotent stromal cells per ISCT
recommendations), other],
and other products.
Public cord blood banks
were identified and sur-

veyed, including AABB
member and nonmember
cord blood banks, blood
centers, and hospitals in
this survey. The majority of
independent cord blood
banks are private, in that
the cells are collected,
stored, and processed at the
private expense, and for the
future use, of a family.
Twenty-eight cord blood
banks were included in the
sample for the 2007
NBCUS and 14 of them
submitted responses. Three
of those reporting were private banks; the remainder
provided both types of services.

Characterization of
Reporting Facilities
The relative proportions of
collection, processing, and
infusion activities performed by blood centers
and hospitals are shown in
Tables 10-1, 10-2, 10-3, and
10-4, respectively. HPC-A
and HPC-M collection, processing, and infusion activities continue to be more

common in hospitals than
in blood centers because
these are most often part of
a stem cell transplant procedure, which is a hospitalrelated activity. The number of hospitals collecting
autologous HPC-A products
exceeds the number collecting allogeneic HPC-A
products (77 vs 56), both
reduced from the 2005 survey. More blood centers
and hospitals reported collecting cord blood in 2006
than in 2004.
The 186 facilities that completed the cellular therapy
section of the 2007 questionnaire were asked to
describe their program as
one of the following:
• A blood center performing HPC collections
only (6.9%)
• A blood center collecting, processing, and/or
storing HPCs (21.5%)
• An HPC collection facility within a hospital
(8.0%)
• An HPC collection, processing, and storage

Cellular Therapy Products

47

48

Cellular Therapy Products
25
0
2
1,899

22
1
4
2
0

4
0
1

HPC-A
HPC-M
HPC-C
Lymphocytes
Hematopoetic stem/
progenitor cells,
expanded
Immunotherapies
Nonhematopoietic
stem cells
Other products
All Products

*105 Cells Generated in Culture were collected in 2004.

1,643
1
225
2
0

No.

Product Type

Products
Collected

Blood Centers

2

7
2

77
24
16
4
1

No.

12
17,125

113
28

15,749
188
932
30
73

Products
Collected

Hospitals

0

0
1

1
0
6
0
1

No.

0
96,081

0
338

193
0
95,406
0
145

Products
Collected

Cord Blood Banks

Table 10-1. Autologous Cellular Therapy Product Collections Performed

15
115,105

138
365

17,585
189
96,563
32
218

Products
Collected

*
17,297

14,083
195
2,349
565

565.5

24.9
–2.9
4,010.8
–94.3

All Products % Change
2004
2004-2006

All Facilities

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

0
0
1
15,012

21
1
5
8
0

0
0
1

HPC-A
HPC-M
HPC-C
Lymphocytes
Hematopoetic stem/
progenitor cells,
expanded
Immunotherapies
Nonhematopoietic
stem cells
Other products
All Products

*262 Cells Generated in Culture were collected in 2004.

540
2
14,390
78
0

No.

Product Type

Products
Collected

Blood Centers

3

5
1

56
43
4
36
1

No.

80
17,306

88
41

3,497
766
12,128
670
37

Products
Collected

Hospitals

0

0
1

1
0
7
1
1

No.

0
17,866

0
164

93
0
17,510
4
96

Products
Collected

Cord Blood Banks

Table 10-2. Allogeneic Cellular Therapy Product Collections Performed

81
50,184

88
204

4,130
768
44,028
752
133

Products
Collected

*
19,650

3,298
665
14,398
1,023

155.4

25.2
15.4
205.8
–26.5

All Products % Change
2004
2004-2006

All Facilities

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Cellular Therapy Products

49

50

Cellular Therapy Products
1
9,206

1

*393 Cells Generated in Culture were processed in 2004.

0

0
0

0

10
4
4
2
0

HPC-A
HPC-M
HPC-C
Lymphocytes
Hematopoetic stem/
progenitor cells,
expanded
Immunotherapies

Nonhematopoietic
stem cells
Other products
All Products

928
47
8,199
32
0

No.

Product Type

Products
Processed

Blood Centers

2

7

5

55
38
16
27
0

No.

Table 10-3. Cellular Therapy Products Processed

18
25,350

103

104

20,801
590
3,080
653
0

Products
Processed

Hospitals

0

0

0

1
1
10
1
0

No.

0
152,241

0

0

285
2
151,950
4
0

Products
Processed

Cord Blood Banks

19
186,798

103

104

22,014
639
163,229
689
0

Products
Processed

*
49,092

14,684
754
32,125
1,136

280.5

49.9
–15.2
408.1
–39.4

All Products % Change
2004
2004-2006

All Facilities

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

0
0
1

Cellular Therapy Products
117
6,161

Other products
All products

*147 Recipients for Cells Generated in Culture in 2004.

5,783
170
10
8
2
69
3

HPC-A
HPC-M
HPC-C
Lymphocytes
Hematopoietic stem/progenitor cells, expanded
Immunotherapies
Nonhematopoietic stem cells

Product Type

7
8
6

79
50
28
25
2

No.

259
118
618
12,862

10,009
831
480
517
31

Infusion
Episodes

Hospitals

30
4,808

2,634
748
838
454
29
49
25

Allogeneic

No. of Recipients

Autologous

0
0
1
1,012

11
3
4
1
0

HPC-A
HPC-M
HPC-C
Lymphocytes
Hematopoietic stem/progenitor
cells, expanded
Immunotherapies
Nonhematopoietic stem cells
Other products
All products

*147 Cells Generated in Culture were infused in 2004.

467
94
436
13
0

No.

Product Type

Infusion
Episodes

Blood Centers

Table 10-4. Cellular Therapy Products Issued and/or Infused

147
10,969

8,417
918
848
462
31
118
28

Total

0
0
0

1
0
3
0
0

No.

641
10,811

*

6,050
571
624
380

Recipients
2004

0
0
0
66

10
0
56
0
0

Infusion
Episodes

Cord Blood Banks

–77.0
1.5

39.1
60.7
35.9
21.6

% Change
2004-2006

259
118
619
13,940

10,486
925
972
530
31

Infusion
Episodes

*
643
9,818

7,280
615
639
494

Episodes
2004

All Facilities

–3.8
42.0

44.0
50.4
52.1
7.4

% Change
2004-2006

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

51

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

facility within a hospital (35.0%)
• A cord blood collection
facility only (11.5%)
• A cord blood processing/storage facility only
(9.2%)
• An HPC processing/storage facility within a hospital (7.7%)
Of those responding that
they performed some collection activity, 69%
reported collecting products for third-party vendors, including cord blood
banks, National Marrow
Donor Program, and other
suppliers of cellular therapy
products. Of those facilities
that collect for third parties, most collect HPC-A
(83%) and HPC-M (62%)
products. Twenty-four percent collect HPC-Cs and
12% collect other products.

Of the facilities reporting
that their program collects
cord blood, 89.7% use a
nurse/midwife or obstetrician to perform the collection, the other 10.2% report
using a dedicated cord
blood bank collector.
Of hospitals reporting collection activity for cellular
therapy products, those
with higher surgical volumes generally were more
likely to have the higher
levels of collection activity,
consistent with previous
surveys. The reported volume of these collections is
shown in Table 10-5 and
Figure 10-4.
Interestingly, 5.7% of the
respondents to this section
reported using some cellular therapy products for cardiac applications.

Collections
Autologous and allogeneic
cellular therapy product
collections are illustrated in
Tables 10-1 and 10-2, and
Figure 10-1. HPC-C products made up the largest
category of cellular therapy
products collected in 2006
(85.1%), exceeding the volume of all other products.
HPC-A products made up
the next largest group, at
13.1% of all collections.
The majority of HPC-A
products were autologous;
there was a 25% increase in
autologous HPC-A collections since 2004. The
change was seen at both
blood centers and hospitals,
which showed 13% and
25% increases, respectively, in autologous HPC-A
collections in comparison
to 2004. Allogeneic HPC-A

Table 10-5. Cellular Therapy Product Collections by Hospitals, by Surgical Volume
Collections

Surgeries Per Year
100-999
1,000-1,399
1,400-2,399
2,400-4,999
5,000-7,999
≥8,000
Unknown surgical volume
All hospitals

52

Cellular Therapy Products

Number of
Facilities

% of
Facilities

3
1
8
17
19
42

3.3
1.1
8.9
18.9
21.1
46.7

90

100.0

Autologous Allogeneic
320
28
2,540
2,291
1,482
10,702
82
17,445

0
0
1,362
357
547
3,527
11,515
17,306

Total
320
28
3,902
2,648
2,028
14,228
11,597
34,752

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Immunotherapies
0.1%

Nonhematopoietic
stem cells
0.3%

and 10-2). These are predominantly MSCs, which
can act as “stem cells” in a
variety of applications.

Hematopoietic stem
cells
0.2%
Other Products
0.1% HPC-A

Lymphocytes
0.5%

13.1%

HPC-M
0.6%

Processing

HPC-C
85.1%

Figure 10-1. Collection of all cellular therapy products.

collections had also
increased a proportionate
25% from 2004. These
approach the numbers of
products reported collected in 2001. It is not
clear if this is because of the
increased use of HPC-A
over HPC-M or because of
increased transplant applications.
Private/family (or autologous) HPC-C collections
(collections intended for the
use of the family from
whom they were collected
and whose collection and
storage costs are paid by
the family) increased dramatically. This increase is
likely due to the recruitment of more cord blood
banks as participants in the

survey, the vigorous marketing on behalf of private
cord blood banks, and federal funding for the C.W.
Bill Young Cell Transplantation Program.
Two of the cell therapy
product categories from the
2005 survey (lymphocytes
and cells generated in culture) were either better
defined in the 2007 survey
or expanded to include new
types of products. These
product lines—stem cells
and immunotherapies—are
primarily collected in small
numbers and in hospital
environments, with the
exception of nonhematopoietic stem cells, which
are also collected by cord
blood banks (Tables 10-1

Processing activity for cellular therapy products is
displayed in Table 10-3 and
Figure 10-2. The increase in
processing of HPC-C units
was to be expected with the
inclusion of more cord
blood banks in the survey
sample. Blood banks and
hospitals also processed
more HPC-Cs in 2006 than
in 2004, suggesting
increased popularity of the
practice (163,224 HPC-C
collections processed in
total). There is normally
greater than a 1:1 ratio of
collected to processed
units, because of inadequate collection, contamination, etc. However, as
with the 2004 survey, that
inverse ratio was not
reported in 2006. Underreporting of cord blood collections is most likely
responsible for the higher
ratio of processing to collection reported here. Cord
blood banks that reported
processing but not collecting cord blood might be
processing collections from
several hospitals, perhaps
not all of them being represented on this survey or
having reported on this section. Some cell therapy proCellular Therapy Products

53

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Infusion
Nonhematopoietic
Lymphocytes
stem cells
Hematopoetic Immunotherapies 0.4%
0.1%
0.1%
stem/progenitor
Other products
cells, expanded
0.0%
0.0%
HPC-A
11.8%
HPC-M
0.3%

HPC-C
87.4%

Figure 10-2. Processing of all cellular therapy products.

cessing facilities might also
perform contract work for
other collection or administration facilities.
Processing of HPC-A
increased by 50% over
2004. Most of the increase
in processing was seen at
hospitals (55% over 2004
volume), where the
increase was seen in the
numbers of units processed,
rather than in numbers of
hospitals reporting activity.
Hospitals report performing more manipulations of
products in preparation for
more transplant and more
double transplant procedures.

54

Cellular Therapy Products

Immunotherapies
1.9%
Hematopoetic
stem/progenitor
cells, expanded
0.2%

There was an attempt to
elicit better responses to the
cellular therapies section
for the 2007 survey and it
appears to have been successful. Issue/infusion activity (Table 10-4 and Figure
10-3) increased in comparison to 2004 for all cell therapy product types (42%
increase overall) to numbers comparable to the
2001 survey. There was a
44% increase in HPC-A
procedures reported, as
well as an increase in both
autologous and allogeneic
recipients (26% and 80%,
respectively). The number
of HPC-M infusion procedures increased by 50%,

Nonhematopoietic
stem cells
0.8%

Other products
4.4%

Lymphocytes
3.8%
HPC-C
7.0%

HPC-M
6.6%

HPC-A
75.2%

Figure 10-3. Infusion of cellular therapy products.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

14,000
11,515

12,000
Autologous
Allogeneic

10,000
Number of Products

10,702

8,000

6,000
3,527

4,000
2,540
2,000

1,362
320

0

2,291

0

100-999

357

28 0
1,0001,399

1,4002,399

2,4004,999

1,482
547
5,0007,999

82

≥?8,000 Unknown
Volume

Hospitals by Annual Surgical Volume

Figure 10-4. Cellular therapy product collections by hospitals.

while the number of both
autologous and allogeneic
recipients increased by
61%. Twenty-eight hospitals and four blood centers
infusing HPC-Cs accounted
for 94.2% of the 1,000 infusions reported. Although
autologous (or family) cord
blood banking remains a
popular option, the data
show that infusions of
autologous HPC-C are rare
events with just four recipients reported in 2004 and
10 in 2006. Most infusions
in the private banking sys-

tem are currently for siblings needing transplants. It
is not clear if the autologous infusions reported
were truly autologous or if
they were for siblings and
incorrectly reported. Numbers of recipients of other
cellular therapies are listed
in Table 10-4, providing an
indication of the distribution of the procedures
among hospitals and the
numbers of patients to
whom they are given.

A comparison of the category of “Other” between
2004 and 2006 is interesting. The questionnaire
offered an expanded list of
potential options from
which to choose, so that the
number of infusion episodes categorized as
“Other” could be reduced.
Nevertheless, 619 infusions were grouped into this
category, only 4% fewer
than in the prior survey. It is
possible that these were
misreported or that they
represent tumor vaccines,

Cellular Therapy Products

55

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

which are more commonly
performed in academic
hospitals. In these trials,
recipients may receive multiple infusions or injections. These “other”
products most likely come
from the collection/processing category of “immunotherapy, nonhematopoietic,
and other.” Many of these
commonly result in multiple infusions from the same
product processing. They
are also more likely to be
autologous, with the exception of allogeneic MSCs for
graft-vs-host disease treatment currently in clinical
trials. Although the survey
captured an additional 408
events under the new cate-

56

Cellular Therapy Products

gories, clearly there is infusion and transplantation
activity that does not fall
into the predefined areas.
Eighty percent of these
other infusions were autologous and went to 117 recipients.

Summary
As seen in previous surveys,
cord blood products represent a sizable proportion of
collection (85.1%) and processing (87.4%) activities
among surveyed facilities,
but only a very small
amount of the infusion
activity (7.0%). In hospitals
and blood centers, the

majority of the cord blood
activity is associated with
the collection and storage
of HPC-C from unrelated
donors to provide a bank
from which potential transplant recipients can identify
a suitably matched cellular
therapy product. Recent
congressional funding of a
National Cord Blood Inventory managed by the Health
Resources and Services
Administration (HRSA) will
permit addition of up to
150,000 genetically diverse
units to the public inventory. This will continue to
be monitored for its growth
and use.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

11. Historical Perspectives

The Department of Health
and Human Services 2007
NBCUS continues to be the
major mechanism for
assessing blood collections
and utilization in the US.
The current survey follows
previous national blood
surveys conducted in 2005,
2002, 2000, and 1998, and
earlier assessments of blood
services activities conducted by the National
Heart, Lung, and Blood
Institute and the Center for
Blood Research. These continuous efforts allow trend
analysis to extend back to
1989.

ber 11, 2001. Collections
remained about the same in
2004 before increasing
5.8% to 16.2 million units
in 2006.
Autologous donations,
which declined dramatically over the period 1992
to 1997, appeared to level
off at approximately
600,000 units from 1997 to
2001. In 2004, a declining
trend re-emerged, continuing into 2006 where autolo-

gous collections comprised
only 335,000 units, or
2.1% of total collections.
Figure 11-2 illustrates the
trends in allogeneic WB/
RBC collections and transfusions from 1989 to 2006,
as well as the excess in collections over utilization,
which is discussed below in
the section on Blood Supply Adequacy. The rise in
the number of allogeneic
transfusions reported since

Time Trends
WB and RBC collections for
the past 17 years are illustrated in Figure 11-1. Total
collections, which dropped
to a decade low of 12.6
million units in 1997,
reached 15.3 million in
2001, due largely to an
increase in allogeneic
donations following the
nation’s response to the terrorist activities of Septem-

Figure 11-1. Allogeneic, autologous, and total whole blood
and red blood cell collections 1989-2006.

Historical Perspectives

57

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Figure 11-2. Allogeneic whole blood and red blood cell collection and transfusion, 1989-2006.

1994 reached a high of
14.5 million in 2006. The
total increase in allogeneic
transfusions in the nine
years between 1997 and
2006 was 30.3%. The
increase in allogeneic collections from 1997 to 2006
was 32.8%, reaching a high
of 15.8 million units.
Platelet use overall between
2004 and 2006 increased
by 5.2%, which was not
statistically different. The
decline in the use of wholeblood-derived platelet concentrates, first observed in
1999, continues, although
not at the rate seen in previous surveys. Figure 11-3
illustrates the increased use
of apheresis platelets

58

Historical Perspectives

(+9.0%) and the decrease in
transfusion of whole-bloodderived platelet concentrates (–15.7%). The ratio of
apheresis platelets (in concentrate equivalents) to
whole-blood-derived platelet concentrates used has
increased from 1.7:1 in
1997 to 7.0:1 in 2006.

Blood Supply Adequacy
The available supply of
both WB/RBCs and nonRBC components was sufficient to meet overall transfusion demands in 2006.
With the increase in both
the supply and the excess
capacity, there is cause to
be more optimistic than in

previous reports regarding
the adequacy of the US
blood supply. Provided that
there are open lines of communication and transportation between centers of
needed products, in most
cases, there is adequate
supply to cover local and
national needs.
An analysis of the margin
between allogeneic WB/
RBC supply and demand
depicted in Figure 11-2
provides an indication of
sufficiency. In 1989, allogeneic collections totaled
13.6 million, with a margin
of 1.9 million, 13.8% of
supply. By 1997, the margin had decreased to
862,000, 7.2% of the sup-

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

12,000
Units Transfused (in thousands)

Apheresis platelet s*

Whole-blood-derived plat elet concentrates

10,000
2,614

8,000

3,396

1,537

1,296

3,036

6,000
4,000

7,582
5,640

6,017

1997

1999

8,338

9,092

2,000
0
2001

2004

2006

*expressed as plat elet concentrate equivalent unit s.

Figure 11-3. Trends in platelet transfusions.

ply. In response to a sharply
increasing demand for
RBCs, blood centers successfully increased allogeneic collections in 1999 to
13.2 million, increasing the
margin to 9.1% in spite of
an 8.1% increase in
demand. Collections
increased significantly
(p<0.0001) in 2001 due
largely to the extraordinary
events of September 11;
however, there was a concomitant increase in transfusions of similar
magnitude. There were
nearly 1.2 million excess
units collected, or 8.0% of
supply. The 2004 data indicated a reduction in the
margin to 6% of supply. In
2006, however, there was

an increase in allogeneic
collections to 15.8 million
units accompanied by a
smaller increase in transfused units to yield a margin of 1.3 million units, or
8.5% of supply, a margin
comparable to that seen in
2001.
A similar analysis can be
performed using the available allogeneic supply. The
available allogeneic supply
is composed of those units
that have passed all laboratory tests and are available
for transfusion. In 2006, the
available supply of
screened allogeneic WB/
RBCs, 15,688,000 units,
exceeded transfusions of
allogeneic WB/RBCs

(14,461,000) by 1,227,000
units, almost twice the
number seen in 2004. The
2006 available margin was
7.8%, compared to 4.5% in
2004. Due much to a significantly smaller loss of units
to reactive test results
(p<0.001), this margin of
available supply is the
highest achieved since
1997 and is cause for optimism.
In summary, 2006 NBCUS
data indicate an increased
margin of available supply,
primarily due to the 44.1%
decrease in test loss combined with significant
increases in collection from
red cell apheresis technologies (96.4%, p<0.001).

US Population Trends
Figure 11-4 illustrates the
trends in the estimated rates
of WB/RBC collection and
transfusion in the US from
1980 to 2006. The rate of
collection, the upper line,
was calculated from the
national estimate of total
WB and RBCs collected per
thousand population aged
18 to 64 for a given survey
year to be consistent with
historical data. The rate of
transfusion, the lower line,
was calculated from the
national estimate of WB/
RBC units transfused per
thousand total population
of all ages for that year.
Historical Perspectives

59

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

Figure 11-4. Estimated rates (per 1000 eligible population) of allogeneic blood collection and
transfusion in the United States, 1980-2006.

Population figures were
obtained from the US
Bureau of the Census.
Allogeneic blood collection per thousand US population of donor age was
84.1 units in 2006 compared with 83.1 units in
2004 and 88.0 units in
2001. This shows a comparatively steady state for
the donor age population if
the 2001 collection year
can be considered something of an anomaly.*
This is the first survey to
report on actual numbers of
donors and it will be interesting to track trends in

60

Historical Perspectives

future reports. Approximately 3.2% of the total US
population donated in
2006. If the population is
age-adjusted for donor eligibility (ages 16-64) the rate
increases to 4.8% of the eligible population donated in
2006. Although there are
certain indications that the
potential eligible donor
base may be smaller than
*There is increasing recruitment
of and collection from donors
between the ages of 16 and 18
years of age. Adding this age
cohort to the population of donor
age reduces the rate of allogeneic
blood collection to 80.3 units per
thousand US population of donor
age in 2006.

previously assumed,† the
rate of donations per 1,000
persons of eligible age
(using the slightly reduced
age categories imposed by
the US Census) has
remained constant, no
doubt because of active
recruiting and retention of
qualified donors.
The US WB/RBC transfusion rate in 2006 was 48.9
units per thousand overall

†

Riley W, Schwei M, McCullough
J. The United States’ potential
blood donor pool: Estimating the
prevalent donor-exclusion factors
on the pool of potential donors.
Transfusion 2007;47:1180-8.

THE 2007 NATIONAL BLOOD COLLECTION AND UTILIZATION SURVEY REPORT

population. Although not
statistically different from
the rate in 2004 (49.6/
1,000 population), this suggests that the rate of transfusion may have approached

a steady state, provided
environmental factors
remain constant.
Note: blood collection per
thousand total population

in 2006 was 52.9. The ageadjusted value of 84.1 was
used in Figure 11-4 for consistency with historical
analyses.

Historical Perspectives

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12. Acknowledgments

The authors acknowledge the following individuals who contributed their time and considerable expertise to this project:
AABB
Caryl Auslander
Russell Cotten
Nina Hutchinson
Linda Johnson
Kathy Loper, MHS,
MT(ASCP)
Aaron Lyss
Philip Schiff, JD
Namara Smith
Theresa Wiegmann, JD

DHHS
Richard A. Henry, MPH
Jerry Holmberg, PhD

Westat
Susan L. Acker, BA
Yu Sun, MD, MPH, PhD
Wen Hu

Acknowledgments

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13. References

US Department of Health and Human Services. The 2005 Nationwide Blood Collection
and Utilization Survey Report. Washington, DC: DHHS, 2007.
National Blood Data Resource Center. Report on Blood Collection and Transfusion in the
United States in 2001. Bethesda, MD: AABB, 2003.
Sullivan MT, Wallace EL. Blood collection and transfusion in the United States in 1999.
Transfusion 2005;45:141-8.
Read EJ, Sullivan MT. Cellular therapy services provided by blood centers and hospitals in
the United States, 1999: An analysis from the Nationwide Blood Collection and Utilization
Survey. Transfusion 2004;44:539-46.
Sullivan MT, McCullough J, Schreiber GB, Wallace EL. Blood collection and transfusion in
the United States in 1997. Transfusion 2002;42:1253-60.
Wallace EL, Churchill WH, Surgenor DM, et al. Collection and transfusion of blood and
blood components in the United States, 1994. Transfusion 1998;38:625-36.
Wallace EL, Churchill WH, Surgenor DM, et al. Collection and transfusion of blood and
blood components in the United States, 1992. Transfusion 1995;35:801-12.
Wallace EL, Churchill WH, Surgenor DM, et al. Collection and transfusion of blood and
blood components in the United States, 1989. Transfusion 1993;33:139-44.
Surgenor DM, Wallace EL, Hao SH, et al. Collection and transfusion of blood and blood
components in the United States, 1982-88. N Engl J Med 1990;332:1646-51.

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