I was a blood banker for nine years back in the 70's. For all that time, I was engaged in a constant struggle to increase the blood and blood product inventory while simultaneously tamping down demand, mainly from surgeons. One of the ways that I helped to reduce blood utilization and also increase useful shelf life of blood was with the maximum surgical blood order schedule (MSBOS) that placed limits on the number of units of crossmatched blood that surgeons could order preoperatively and store in the OR refrigerators (see: Hospitals Seek to Limit Blood Transfusions as a Cost-Saving Measure). Now, some four decades later, the tide is beginning to turn. Physicians are realizing that blood transfusion is not a panacea and may harm patients beyond the threat of transmission of infectious disease. Below is an excerpt from a recent article that discusses what appear to be a significant downturn in business for blood banks (see: AS DEMAND DWINDLES, US BLOOD BANKS MAKE CHANGES):
Blood banks are declaring fewer critical shortages these days and in some cases cutting staff in response to dwindling demand for blood - the result of fewer elective surgeries being performed and medical advances that curb bleeding in the operating room. The nation's blood-collection system has undergone a dramatic change from just a decade ago, when agencies that oversee the blood supply worried whether they could keep up with the needs of an aging population. Now blood banks are making fewer but more targeted appeals for donations and reducing the size of their operations. Blood centers shifted "from a collect-as-much-as-you-can mentality to a collect-to-need mentality," said Dr. Darrell Triulzi, medical director for the Institute for Transfusion Medicine in Pittsburgh and a former president of AABB...."They started collecting only what they needed. That's new to the industry. We're still learning how to do that well." Job cuts have been a part of the process.The Indiana Blood Center announced in June that it would eliminate 45 positions in a restructuring that also involved reducing its mobile operations, closing a donor center and cutting other costs because demand from hospitals had fallen 24 percent from the previous year. The Community Blood Center of the Ozarks in Springfield, Mo., announced in March that it was cutting staff by nearly 18 percent. Blood centers in Florida, West Virginia and Connecticut have taken similar steps....The need for blood is still falling even as the economy recovers. Demand dropped by 8.2 percent from 2008 to 2011 and continues to drop....Contributing to the decline are blood-management programs, which include collecting blood lost during an operation and returning it to the patient, maximizing hemoglobin levels to prevent anemia and using medications to reduce bleeding during surgery....Advances in surgical methods, including laparoscopic techniques that use small "keyhole" incisions, have also curbed the need for blood.
My gut instinct tells me that most of the decreasing demand for blood described above is based on three factors: (1) surgeons performing more laparoscopic procedures, including total hips, and adapting to the fact that patients can tolerate relatively low hemoglobin levels post-operatively; (2) pathologists and hospital executives paying even more attention to the cost of blood in this era of intense cost containment; and (3) patients exerting much more influence as consumers of healthcare services and being more aware of the complications of blood transfusion.
Unmentioned in the article above is the fact that the best surgeons and hematologists have decided/learned to simply transfuse less blood. In other words, blood transfusion rates can be used as a metric for the quality of care in a hospital (see: Lower Blood Transfusion Rates as a Metric for High Quality Care). This more negative attitude toward blood transfusion is based, in part, on recent medical research that indicates that the less transfused patients recover and heal better; this may be due to the nature of older, stored blood (see: Research that Transfusion of "Older" Blood May Be Harmful to Patients).
Udate on November 25, 2013: See: Red Cross to close Detroit blood lab