Blood shortages generally occur in the summer months or holidays when donor volumes recede. In this post, we will examine the shrinking volunteer blood donor pool, current and projected utilization of platelet products, and what this means for the future platelet supply chain.
While single donor platelet use has doubled since 2001, the overall blood collection rate has decreased by one-third. Figure 1 highlights pressures on the supply chain for platelets from a macro perspective. Conversely, red blood cell (RBC) usage has been in persistent decline with Blood Centers of America (BCA) reporting a reduction of over 100,000 RBC transfusions per year from 2014 to 2018. During that same period, BCA also reported a steady upward trend in platelet transfusions. A similar increase was also seen in the 2017 National Blood Collection and Utilization report with platelet transfusions finally reaching a plateau at roughly two million units transfused annually. While platelet transfusions may have leveled off, the collection of products still does not meet demand on a consistent basis.
To better understand the dynamics of demand, it is important to recognize which clinical conditions utilize the platelets most frequently. The American Association of Blood Banks (AABB) reported survey results from 2009-2013 that indicated a sizeable increase in platelet transfusions for hematology/oncology patients and steady utilization across the board for general surgery and the intensive care unit (ICU). Of note, diagnoses such as cardiovascular surgery and hematologic cancers are diagnosed more often in our elderly population, by no coincidence the most common recipients of platelet transfusions.
However, not only are the patients aging, the volunteer platelet donors are getting older as well. Data presented at the AABB in 2018 showed the increasing age of male apheresis donors. In 2001, most male donors (the most likely donors due to TRALI risk mitigation protocols) were 40-45 years of age whereas in 2017 the largest age cohort increased to 55-60.
During this same time frame, donations from 31 to 50-year-old donors decreased by more than half. When the TRALI restrictions on female donors were first put into place, the contribution by female donors decreased by 22%. The current state of volunteer blood is one of an aging population that is not being replenished with younger donors. The picture is further complicated in 2020 by a marked reduction in the number of blood drives and available donors as the COVID-19 pandemic continues in the US.
With platelet supply and demand in a constant state of imbalance, it is no surprise that health care facilities are faced with meaningful service challenges. Canceling surgeries and delaying chemotherapy or bone marrow transplantation impacts not only the institution but the patient, as well. Not only are potential delays and cancellations detrimental to the patient’s physical health but also may be a source of fear and emotional distress.
A disappearing donor population and steady demand combined with increased testing and regulatory requirements make clear the need for new platelet supply chain solutions.