Trends in Red Blood Cell Distribution

Most blood programs keep daily records of distributions of blood and components to hospitals to help planning recruitment and blood drives. Changes in demands, over time, are often revealing, as is shown in the accompanying graph. The time covered is from January 2011 to April 2022 and monthly shipments of red cell units are plotted for this period time. No major changes in the number or size of client hospitals occurred during this period of time.

The effect of patient blood management and the recognition by physicians that a lower threshold for transfusion could be invoked for certain categories of patients, can be seen in the declining distributions of red blood cells in the four-year period between January 2011 and January 2015. For the next five years, relative stability in the numbers of red cell shipments suggested that there was no further reduction in red cell demand imposed by patient blood management and what benefits were to be achieved by more conservative transfusion practices had been realized.

The onset of the COVID-19 pandemic in the first quarter of 2020 can be seen in the profound decrease in shipments during that period. What has happened subsequently, over the next two years, has been a gradual increase in red cell demand for transfusion dependent patients with distributions to hospitals, on many occasions, exceeding the demands that had all but plateaued out once the patient blood management conservatism had been realized. There are a number of reasons why red cell demand should be increasing, including transfusion support for an aging population undergoing treatment for malignancy and an increasing number of hospitals providing massive transfusion protocols. Supportive evidence for increasing demands from oncology patients comes from Carter BloodCare’s experience with hospital requirements for apheresis platelet inventories, which showed a steady increase in requirement despite any patient blood management efforts made.