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The country could be on the brink of another blood supply shortage

The country may no longer be in crisis mode, like back in January, but the threat of a blood shortage still looms.
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Will Varner

· 5 min read

For now—like right now—most hospitals seem to have enough blood in their inventory to meet the immediate needs of patients. That’s no small feat given that just this past January, the American Red Cross declared the “first-ever blood crisis,” indicating the country was experiencing “its worst blood shortage in over a decade” amid the omicron surge.

While blood centers and hospitals aim to have at least a five-day supply of blood—enough to treat trauma patients, surgical cases, blood disorders, and other issues—facilities nearly reached blood insolvency during the crisis. The Red Cross said it saw donor turnout dip after the delta variant became dominant in summer 2021, which continued as omicron took over, until blood supplies reached crisis levels in January.

“We went down to many blood centers having only a one-day supply on their shelf,” said Claudia Cohn, chief medical officer at the Association for the Advancement of Blood and Biotherapies (AABB), a nonprofit that develops standards for the industry and accredits blood centers. “Which means one significant event—like a big car crash or a natural disaster or a human-made disaster—could have wiped out the blood supply for that particular metropolitan area.”

Blood centers have recovered somewhat, though they’re still not in the comfortable five- to seven-day supply range, and there’s some regional variation in supply, Cohn said. The Red Cross has a three- to five-day supply, said spokesperson Rodney Wilson.

Closing up shop

Covid lockdowns shuttered traditional venues for blood drives, including businesses and schools. Even after workers returned to the office and students to classrooms, many organizations were hesitant to allow in-person events to occur in their facilities, including blood drives, Wilson said.

The pandemic also exposed and exacerbated existing cracks in the blood-collection industry. For example, there’s already a shortage of blood-collection professionals, as fewer people enter the field of phlebotomy, said Raymond Comenzo, who is the director of transfusion medicine at Tufts Medical Center and runs its myeloma and amyloid program. It’s only gotten worse; the Bureau of Labor Statistics projects there will be about 21,500 openings for phlebotomists each year, on average, over the next decade.

“Overall the medical technology field has really been hit quite hard by Covid and by the fears of dealing with potentially infectious material,” he said.

Paying the price

Another dagger undermining the stability of the nation’s blood supply has been a drop in the price paid for blood.

Changes in medical practice, like the introduction of minimally invasive procedures, have decreased demand for blood, and hospitals have been able to pay less for it. A 2016 Rand report also noted that “ongoing consolidation among hospitals has added to the financial stress on blood centers and suppliers of blood-related equipment, goods, and services by shifting negotiating power toward buyers.”

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That’s still happening today, Cohn said.

The price to collect and manufacture a unit of blood has gone up over the years with each new test required by the FDA to keep blood safe, Cohn said, and the cost of the blood has not kept up.

Reports show hospitals typically pay blood centers between $150 and $300, and survey data published in the journal Transfusion last August puts the average at $215.

At the same time, hospitals may charge patients 10 times that or more for that blood, according to PolitiFact, though what hospitals are actually paid is generally dictated by the terms of insurance contracts.

Insurance payments haven’t been a boon for blood centers, either, as pre-Covid industry analysis published in the New England Journal of Medicine found that “traditional mechanisms of insurance reimbursement still funnel payments to the hospital, not the blood collector, and frequently adjust slowly to the changing cost of blood.”

When hospitals supply their own blood

Hospitals face their own enormous pricing pressures, explained Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. She also challenged the conclusion that consolidation of hospitals is really driving blood prices down.

“The cost of healthcare is of concern to Americans broadly, and hospitals are doing everything they can to manage their own cost of care,” she said.

Not that blood centers and hospitals are necessarily at odds. One way some health systems shore up their blood supply is by having their own blood centers. That’s what Ochsner Health has been doing for nearly a half century, which opened its first blood center in 1975. Now, the New Orleans-based health system has three collections centers and another transfusion center (where blood is dispensed, but not collected) accredited by AABB.

“It does help quite a bit to insulate us,” said Shannon Cooper, senior medical director of transfusion medicine at Ochsner Health. “We can ramp up our own blood drawing by advertising to our previous donors, and by asking our own employees to donate.”

Even hospitals with their own blood centers aren’t immune to the swings in blood-supply levels. Ochsner also gets blood through a large nonprofit national blood center, Vitalant, said Cooper.

Still, with all the instability in the nation’s blood supply, it really helps to have an in-house contingency.

“We supplement it with what we draw,” he said. “That’s the value of having our own blood center.”

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