The headline of an article recently published in the New York Times expressed the problem in a nutshell: “Blood Industry Shrinks as Transfusions Decline.” Blood banking is experiencing changing times, and industry leaders are adapting to new realities that are likely to be lasting ones.
The Times article reports a steep decline in the number of blood transfusions given annually in the United States, and examines the implications of this for the industry and for American healthcare. Transfusions have fallen off from about 15 million units a half-decade ago to 11 million in 2013, according to the American Red Cross, and this has caused blood bank revenue to fall precipitously. It’s supply and demand; the former is high and the latter is low, and hospitals are asking for lower price-per-unit. Jobs are going away in the blood bank business, too, and industry analysts predict more of the same—perhaps up to 12,000 jobs in the next three to five years. The Red Cross, which controls 40% of the market, has shed 1,500 jobs.
One major reason for the drop-off in transfusions is changes in medical practice, driven by revised professional guidelines. When it issued new guidelines for transfusions related to coronary bypass surgery in 2012, for instance, the Society of Thoracic Surgeons declared that post-surgical transfusions should be ordered only if a patient’s hemoglobin level falls to 7. Before then, doctors routinely ordered blood for patients whose hemoglobin fell to 10. Some doctors ordered transfusions for post-surgical patients as a matter of course.
The Times speculates that increasing computerization of medical records may be influencing clinicians to adopt and adhere to the new guidelines because, when the doctors start to order a transfusion online, their program will alert them when they depart from the standards.
Guidelines affecting therapies for anemia and cancer have also changed in ways that reduce the need for transfusions, and approaches to surgeries such as total hip replacement have had the same effect. The increasing use of minimally invasive procedures is another contributing factor. Insurance plans discourage transfusion, too; the Times article notes that Medicare pays a flat fee for a procedure regardless of how many (if any) units are transfused.
In the context of this convergence of factors, blood bank industry leaders are worried about people’s jobs and businesses’ survival. Many of them are also worried about whether the inevitable belt-tightening may compromise quality of service and investment in research to improve blood bank products and services.
It is all certainly food for thought, and reactions, and suggestions. The MLO staff would be pleased to give readers a forum for sharing insights on this important topic. Please write me at[email protected].
In the meantime, we present several articles related to the blood bank in this October 2014 issue of MLO—covering both the science side and the business side. Antigen discrepancies and bacterial contamination in platelets are explored; so are issues involved in blood bank automation, the importance of blood utilization data, and the AABB’s comments on FDA policy regarding clinical trials for cellular therapy products.
Speaking of the AABB, from October 25 through October 28, the organization will hold its Annual Meeting and CTTXPO in Philadelphia. No doubt the topics alluded to above will be discussed, among many others, at its educational sessions, abstract presentations, and industry workshops. If you are planning to be among the expected 6,000 or more attendees, please drop by and say hi to MLO at Booth 1329.