Changes in hospital component therapy in response to reduced availability of whole blood

The effects of a systematic reduction of whole blood (WB) availability on transfusion practice were studied at a large university-affiliated community hospital from 1978 through 1985. The reduction in WB availability was part of a planned statewide shift in blood procurement and processing from hospitals' individual blood banks to a new statewide blood center. Hospital WB use declined 96 percent, from 3400 to 109 units annually, with a net addition of more than 3000 units of plasma to the statewide stocks. A large increase in the use of other blood components occurred when WB was withdrawn, but this use fell sharply in 1984 and 1985, despite the continued relative unavailability of WB. Analysis of individual hospitals' services showed that increases in the use of packed red cells were distributed across all the services that frequently use red cell transfusions. However, a disproportionate rise and then fall in the use of fresh-frozen plasma and platelets for cardiovascular operations were observed. The data suggest that education and more conservative transfusion practices are reducing the use of blood components despite continued restricted availability of WB.