TY - JOUR
T1 - Blood transfusion trends in the United States
T2 - National inpatient sample, 2015 to 2018
AU - Goel, Ruchika
AU - Zhu, Xianming
AU - Patel, Eshan U.
AU - Crowe, Elizabeth P.
AU - Ness, Paul M.
AU - Katz, Louis M.
AU - Bloch, Evan M.
AU - Tobian, Aaron A.R.
N1 - Funding Information:
This study was supported in part by grants from the National Institutes of Health (R01AI120938 and R01AI128779 to A.A.R.T, K23HL151826 to E.M.B., T32AI102623 to E.U.P.).
Publisher Copyright:
© 2021 by The American Society of Hematology.
PY - 2021/10/26
Y1 - 2021/10/26
N2 - Blood transfusions are among the most common therapeutic procedures performed in hospitalized patients. This study evaluates contemporary national trends in red blood cell (RBC), plasma, platelet, and cryoprecipitate transfusions. National Inpatient Sample, the largest all-payer inpatient database representing 94% to 97% of the US population, was evaluated from the fourth quarter (Q4) of 2015 through 2018. Quarterly trends for the percentage of hospitalizations with a transfusion procedure were separately examined for each blood product using log binomial regression and reported as quarterly percent change (QPC). The percentage of hospitalizations with an RBC transfusion decreased from 4.22% (2015Q4) to 3.79% (2018Q4) (QPC 5 20.72; 95% confidence interval [CI], 21.26 to 20.19; Ptrend 5.008). Although plasma transfusions also decreased, QPC 5 21.33 (95% CI, 22.00 to 20.65; Ptrend,.001), platelet transfusions remained stable QPC 5 20.13 (95% CI, 20.99 to 0.73; Ptrend 5.766). In contrast, hospitalizations with cryoprecipitate utilization significantly increased QPC 5 2.01 (95% CI, 0.57 to 3.44; Ptrend 5.006). Significant quarterly reductions in RBC transfusions were also seen among many, but not all, strata of sex, race/ethnicity, patient risk severity, and admission type (elective vs nonelective). Despite significant declines in RBC transfusions among older adults, there were no significant changes among pediatric age-group (,18 years) and those 18 to 49 years. The decline in RBC and plasma transfusions suggests steady incorporation of robust evidence base showing safety of restrictive transfusions. Increased cryoprecipitate use may be reflective of wider adoption of hypofibrinogenemia management and hemostasis testing for coagulopathic patients.
AB - Blood transfusions are among the most common therapeutic procedures performed in hospitalized patients. This study evaluates contemporary national trends in red blood cell (RBC), plasma, platelet, and cryoprecipitate transfusions. National Inpatient Sample, the largest all-payer inpatient database representing 94% to 97% of the US population, was evaluated from the fourth quarter (Q4) of 2015 through 2018. Quarterly trends for the percentage of hospitalizations with a transfusion procedure were separately examined for each blood product using log binomial regression and reported as quarterly percent change (QPC). The percentage of hospitalizations with an RBC transfusion decreased from 4.22% (2015Q4) to 3.79% (2018Q4) (QPC 5 20.72; 95% confidence interval [CI], 21.26 to 20.19; Ptrend 5.008). Although plasma transfusions also decreased, QPC 5 21.33 (95% CI, 22.00 to 20.65; Ptrend,.001), platelet transfusions remained stable QPC 5 20.13 (95% CI, 20.99 to 0.73; Ptrend 5.766). In contrast, hospitalizations with cryoprecipitate utilization significantly increased QPC 5 2.01 (95% CI, 0.57 to 3.44; Ptrend 5.006). Significant quarterly reductions in RBC transfusions were also seen among many, but not all, strata of sex, race/ethnicity, patient risk severity, and admission type (elective vs nonelective). Despite significant declines in RBC transfusions among older adults, there were no significant changes among pediatric age-group (,18 years) and those 18 to 49 years. The decline in RBC and plasma transfusions suggests steady incorporation of robust evidence base showing safety of restrictive transfusions. Increased cryoprecipitate use may be reflective of wider adoption of hypofibrinogenemia management and hemostasis testing for coagulopathic patients.
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U2 - 10.1182/bloodadvances.2021005361
DO - 10.1182/bloodadvances.2021005361
M3 - Article
C2 - 34551093
AN - SCOPUS:85118572214
SN - 2473-9529
VL - 5
SP - 4179
EP - 4184
JO - Blood Advances
JF - Blood Advances
IS - 20
ER -