Securing the future of the U.S. blood supply: an open letter to the health care community

October 2019

By Chris Hrouda, president, Biomedical Services at the American Red Cross

Driven by the growing fragility of the U.S. blood supply, it was a year ago I addressed the industry on the need for action. A rally call, so to speak, for healthcare providers and blood collectors to work in tandem to protect our nation’s blood system before patient care is meaningfully harmed by inadequate supplies and limited product advancements.

Progress has been made to restore a more stable blood supply, however, obstacles remain. Industry demand for red blood cells continues to decline. While the pace of deterioration has slowed, its disruption to blood center operations and financial stability has not. Blood providers still confront the very real challenges of rightsizing their operations while working to fill the distinct demand for products like O negative red cells, AB plasma, pediatric units, and whole blood to meet the changing needs of the hospitals they serve.

Conversely, platelet use has grown nearly four percent each of the past four years. The U.S. transfuses more than 7,000 platelets a day and frequent shortages may indicate the true need is even greater. Worse, hospitals outside medium and large-sized cities often have limited access to platelets leaving their patients vulnerable to suboptimal care. The short two to three-day shelf life post-processing and bacterial testing make for a near-constant struggle with the donor-dependent supply. 

This demand imbalance between platelets and red cells only increases the challenge of attracting and directing the right donors to the right blood drives to collect the optimum products. Universal and rare type donors are essential when stocking fewer products but recruiting and retaining these donors proves difficult and costly. With less than 10 percent of the eligible population donating blood, blood centers must operate a carefully orchestrated supply chain that can easily be upset by unplanned events. Natural disasters such as this year’s Polar Vortex wreak havoc on a well-balanced supply network and results in weeks-long recovery times.    

Intensifying the risk of too few eligible donors is the rapid proliferation of paid plasma collections and the potential cannibalization of volunteer blood donations. Plasma collections in the U.S. have nearly quadrupled since 2005.  Both volunteer and paid plasma collections are important contributors to healthcare, however, U.S. paid plasma collections far exceed the U.S. demand for the resulting therapies. 

Further, as regulators pursue well-intended recommendations for blood and platelet safety, blood collectors bear the burden of implementing complex and costly requirements. Recent guidance on babesia mandates that blood collections in defined states be tested and/or pathogen inactivated to protect against babesiosis.  Geographic based testing requirements are unprecedented and serve to disadvantage in-state hospitals as well as endemic blood collectors and national providers who must incur additional work and expense while other providers remain largely unaffected. The industry has yet to fully understand or adapt to the underlying market consequence that accompanies geography-specific testing and its associated costs.

And on the heels of babesia testing is the now final guidance on bacterial risk control strategies for platelets.  This much anticipated regulatory mandate will materially impact the ability of all blood providers to produce an adequate and cost-effective supply of platelets in the future. Suppliers stand at the forefront of advocating for practical solutions, nonetheless, they have little choice but to pass these costs on to hospitals or risk further degradation of their infrastructure.  As previously established, the Red Cross will seek cost recovery price increases upon the implementation of any mandated requirement.

The culmination of these factors has operational expenses increasing and the cost to serve far surpassing current blood center prices. Blood providers continue to operate without suitable cost recovery. The result is extended periods of inventory weakness and continued decline in the resiliency of the U.S. blood supply as blood suppliers lack the investment capability to ensure stability. As predicted, acute inventory shortages have become more prevalent and public service announcements decrying an emergency need for blood donations more common.

Increasingly hospitals and blood centers acknowledge that sustainability is best realized through collaboration, innovation, and improved cost recovery. Industry partners continue to forge opportunities to best align assets, rationalize resources, and reduce redundancy. Currently, 64 blood centers operate in a field that just ten years earlier counted twice the size. Consolidation and strategic partnerships offer collaborative solutions to effectively leverage blood center and community resources for the betterment of the whole system.

Advances have been made through innovation as well. Blood suppliers, including the Red Cross, are investing in new technologies and product improvements to modernize their services. Bots and web-based applications are automating routine activities to streamline operations and drive productivity. Blood centers are also better harnessing data to adapt their services to changing hospital practices and needs. Plus, the growing expansion of pathogen reduction technologies grants hospitals and blood providers economical offsets while making safer, ready to transfuse products available for patients. Pathogen reduction is the preferred approach of the American Red Cross for enhancing the safety and availability of platelets for transfusion.

Sustainable solutions and a safe blood system are a shared responsibility. The market must undergo change alongside blood providers.  Without improved pricing, product innovations, and practicable service levels, blood collectors will continue to struggle meeting the changing needs of their hospital partners and won’t realize the financial soundness that is necessary for the collective wellbeing of the industry.  We must all - blood centers, hospitals, and donors - strive to restore a strong and stable blood supply. Together we can secure an enduring blood system that safeguards adequate supplies and fosters continued investment in patient-focused products.