The biennial NBCUS quantifies the collection, distribution and transfusion of blood and blood components on a national level to develop reliable estimates of demand, project future needs and inform policy decisions. All U.S. blood collection centers and acute care hospitals performing at least 100 inpatient surgical procedures per year are asked to participate. The response rate for the 2023 NBCUS was 92.8%, the highest ever recorded.
RBC Collections and Transfusions
The survey found that 11.58 million RBC units were collected in 2023 while 10.32 million RBC units were transfused, decreases of 1.7% and 4.1% respectively. Whole blood collections for allogeneic donations declined by 2.7% to 9.57 million units in 2023. At the same time, the number of apheresis RBC units collected increased by 3.4% to 1.99 million units.
RBC transfusion trends varied by health care setting, with notable increases in pediatric (9.4%), obstetrics/gynecology (4.6%), and surgical (3.3%) settings. The largest decrease from 2021 to 2023 occurred in neonatal settings (18.1%), reversing a 24.6% increase seen between 2019 and 2021.
Platelet, Plasma and Cryoprecipitate Collections and Distributions
The NBCUS also evaluates platelet, plasma and cryoprecipitate collections and distributions.
In 2023, the total number of platelet distributions increased by 3.6% to 2.61 million and the number of platelet transfusions increased by 2.1% to 2.22 million. Among platelet collections, 2.55 million were apheresis platelets and 61,000 units were whole blood-derived platelets, a 5.6% increase and 43.1% decrease, respectively. Apheresis platelets accounted for 97% of all platelet distributions. Transfusions of pathogen-reduced apheresis platelets (1.25 million units) increased by 49.2% and accounted for more than half of all apheresis platelet transfusions.
Plasma distributions (3.03 million) and transfusions (1.88 million) declined by 2.6% and 15.1%, respectively, since 2021.
Infectious Disease Testing
For the first time, the 2023 NBCUS examined blood unit discards due to reactive infectious disease testing for eight key markers: hepatitis B virus, Treponema pallidum, hepatitis C virus, HIV, HTLV-1/2, West Nile virus, Trypanosoma cruzi and Babesia spp.
Overall, 123,000 units were rejected in 2023 on testing for transfusion-transmitted infections, and of these 72,139 rejections were related to these eight diseases. Most (67%) of the reactive units were associated with hepatitis B virus or T. pallidum. The authors believe the increase in rejections may stem in part from donors who are aware of their HBV infection and increases in the incidence of syphilis. Previously described studies suggest that as many as two-thirds of people living with HBV may be unaware of their infection.
Additionally, data indicated that the number of units rejected on testing has more than doubled since 2015. According to the authors, this may reflect the expansion of blood donation screening to include pathogens such as Babesia spp. and highlights the effectiveness of these blood safety measures in mitigating disease transmission risk.
Stabilization of the Blood Supply
Although RBCs and whole blood transfusions declined slightly compared with 2021, the authors believe that the small variation (1% to 5%) observed during recent NBCUS cycles suggests that a new baseline for blood availability has been established in the U.S.
While they believe many factors are influencing this stability, the authors cited greater sustainability among blood collection establishments, widening adoption of patient blood management and advancements in less-invasive surgeries.
While transfusions in emergency and critical care settings increased in every NBCUS from 2017 to 2021, the trend in emergency department blood use slowed in 2023, which the authors stated requires further study.
