Collection and transfusion of blood in the United States, 1982-1988

Widespread concern about the safety of the national blood supply, particularly with respect to the human immunodeficiency virus (HIV), has reportedly affected the use of blood products to support patients. To examine these changes, we conducted national surveys of blood collection and transfusion in the United States in 1982, 1984, 1986, and 1987 and made a limited survey of these activities in 1988. Transfusions of whole blood and red cells reached a peak of 12.2 million units in 1986, then declined to 11.6 million units in 1987 and continued to decline in 1988. Transfusions of plasma declined from a peak of 2.3 million units in 1984 to 2.1 million units in 1987. Growth in the use of platelet transfusions (6.4 million units in 1987) also slowed; however, the proportion of platelets transfused as platelets from single donors grew from 11 percent in 1980 to 25 percent in 1987. Donations of autologous blood increased sharply, from less than 30,000 units in 1982 to 397,000 units in 1987, equivalent to 3 percent of the homologous-blood collections. The growth in collections of homologous blood slowed after 1982. The supply of homologous blood reached a peak of 13.4 million units in 1986 and did not grow between 1986 and 1988. These trends in red-cell, plasma, and platelet transfusions appear to have continued through 1988. We conclude that the unprecedented decline in transfusions of whole blood and red cells, coupled with the continued importation of packed red cells from Western Europe and the offsetting effect of autologous predeposits, forestalled serious shortages of blood that could have resulted from the decline in collections of homologous blood. We attribute these changes in blood collection and blood transfusion to the effects of the epidemic of HIV infection.