Who needs blood transfusions? Where does all the blood go?

I know it sounds like a stupid question. People who lose a lot of blood need blood transfusions.

It just seems to be a blood supply/demand “mismatch.” I know lots of people that have given a lot of blood (in gallons!), but I don’t know anyone in my family that has needed it.

Thinking of my father, mother, sister, 2 brother in laws, wife, 2 kids, mother in law, father in law, nieces (small sample size I know). But none none of these people have ever needed blood. Who are all these people that need it? From what I can tell, most people can go their whole lives and never need any.

My first thought is people that experience bad car accidents, really severe injuries (chainsaws!). But that is something most people never experience and those people need what, like 1 gallon? That is not a lot.

My next thought is that there must some kind of medical situations that use a lot. Some kind of blood diseases? Maybe only 10% of the population uses like 80% of the blood donated. Is that true?

Might be TMI…but in 2002, I had severe bleeding from uterine fibroids. I had bled so much throughout the night that when I got up the next morning (thinking I was going to go to work!) I passed out. The bleeding came on suddenly - never had it before. I went to the ER twice that weekend. Finally, I was admitted to the hospital and ended up having an emergency hysterectomy. I lost a lot of blood and had to get a transfusion.

Don’t think in terms of people who have lost a lot of blood. Think in terms of people who are losing a lot of blood. Just replacing the blood that’s already lost doesn’t fix the problem, because they continue losing blood. A trauma victim can require 20 or 30 units of blood before they’re through it, which comes out to about three gallons. And there are some medical conditions, some of them chronic, that can need even more.

Blood only has a shelf life of 42 days. According to this article from Forbes, 1.3 Million pints get discarded every year.

Many cancer patients need a blood transfusion. Chemotherapy can suppress the production of red blood cells.

So perhaps demand for blood transfusions is not just a few trauma patients needing large transfusions but rather many more patients only needing a pint or two.

I had placenta previa, which means a pregnancy where your placenta implants over your cervix instead at the top of your uterus where it is supposed to. Even though this was diagnosed pre-labor and I had a planned C-section I still almost bled out in surgery. Took a lot of someone else’s blood to save me.

Just for one data point.

I knew a guy with Idiopathic Thrombocytopenia. He was hospitalized for a month and had whole blood or components every day of his hospitalization. He went through gallons of blood and blood products during his stay.

I friend of mine has a rare blood disorder called TTP. He’s been hospitalized twice for it in the past 10 years, and had to have plasmapheresis a total of 10 times or so while he’s been there. It’s not just a one-and-done thing - they have to keep doing it until his antibodies are replaced, basically. I’m not a prolific donor but he’s probably taken in about 1/3 of the amount of blood I’ve donated.

ETA: Similar to what **kayaker **posted while I was posting. ITP and TTP are about the same deal.

Almost everyone who has surgery is a candidate for blood. Not all of them turn out to need it, but it has to be available just in case.

The US is the largest exporter of blood in the world.

“$2.2 trillion. That’s how much stuff, goods and services, the U.S. sells to the rest of the world every year. “

“1.4 percent of what the U.S. exports of stuff is blood. “

Source : https://www.npr.org/templates/transcript/transcript.php?storyId=582509923

other things, too. I’ve just got out of hospital after having 3 operations (1 planned, 2 not) and my RBC was low and they gave me transfusions to get it back up.

Just break the numbers down a little to see what the blood bank face. Say there’s a unit of blood waiting for you at the local blood bank.

But blood only lasts six weeks, so that’s 8.5 units per year.

And what’s your blood type: A, B, AB, or O. Rh + or - ? That’s eight different types, times 8.5 units each, which means you want your hypothetical blood bank to have 96 units of blood per year just to make sure there’s one unit ready and waiting for you.

Now think about the accident victims, the surgery patients, the people on chemo and radiation treatments who need to have their red blood cells rebuilt, the pregnant women who have a difficult delivery, etc. etc.

That’s a lot of blood.

I needed 89. 75 of that was the first few days.

This is a complicated question with a series of complicated answers. Here’s the high points:

  1. Most people - even most hospitalized patients - don’t need a red blood cell transfusion (i.e. “need blood”). For that matter, most folks who undergo a surgical procedure don’t need blood (those surgeries that do require blood most often use small amounts - 1 or 2 units (300 or 600 mls). Acute medical conditions (GI bleeds, some hemolytic anemias) usually need small amounts of red cells (though there certainly are exceptions).

  2. While the above is true, a small handful of planned surgeries can use 10+ red cell units (~3L) usually because of unrecognized bleeding disorders or complex/difficult intraoperative issues. A few kinds of surgeries can end up needing 20-30 units (liver transplants are notoriously bloody ) - 50 or even 100 unit surgeries do happen on occasion.

  3. Trauma surgeries can use lots of red cell units, but more than 10-20 units is unusual (trauma cases tend to use more non-red cell blood products like platelets, plasma, cryo, factor concentrates, etc)

  4. Okay, so if most people don’t need blood and most surgeries don’t use much blood, where does it all go?

Cancer patients need a lot. Plus a collection of other (mostly chronic) conditions that either lead to poor red cell production or overly rapid red cell consumption (see #5).

Cancer patients can need frequent transfusions (from a unit or two a day to a couple of times a month) for extended periods of time - using a hundred units a year is not unheard of (though I’ve seen this more with platelets post- bone marrow transplant).

Speaking of bone marrow transplants, most post-BMT patients need red cells for a few weeks post-transplant…and a lot more BMTs are being done these days.

  1. Chronic conditions can lead to short term, low volume use (liver cirrhosis, GI errosions, etc) to long-term, medium-to-high volume use (monthly 10+ unit prophylatic red cell exchange transfusions for sickle-cell patients).

  2. “Wrong” blood. In addition to the ABO and Rh blood types (where “A positive” or “O negative” come from), there are hundreds of other blood typing factors - at least two dozen of which are clinically relevant at some level. The point is that getting blood for a given patient can range from “almost any unit will do” to “Call the rare blood type bank in Philly - maybe they can match something”. Thus, you may have 200 units on the shelf but still need to order blood.

  3. Waste/loss. As noted previously, red cells have a short lifespan even when frozen (and there’s decent evidence that “old” cells are physiologically less effective than “new” cells). Also, while your red cells have been lifespan of ~100 days, transfused units are more fragile band only last ~50 days…kind of a transfuson treadmill of sorts.

Blood banks do an excellent job of shifting products around to try and avoid “outdating” (at least in the US), but some blood does get wasted. Good banks try to keep this number well under 5% (though this target is variable depending on…lots…of factors).

  1. Everything else that uses lots of blood products. While I’ve focused on the red cells (since that’s what the question was about), plasma and platelet concentrates are also blood components that come directly from humans and are heavily used - more than red cells these days.

Technology also changes usage patterns: cardiac assist devices (LVADs, ECMO, etc) save people who come into the hospital “mostly dead”, but they eat blood products at a crazy rate. On the flip side, increasing laproscopic/robotic techniques reduce surgical blood use substantially.

I’ve left out lots of stuff, but this should cover the high points.

Donors are allowed to donate a pint only once every eight weeks; that’s 6.5 pints per year.

A gallon is eight pints. So if someone uses eight gallons in one traumatic incident, they’re using over a year’s worth of donations. That is a lot.

Now think of the other cases mentioned in this thread, using up to 89 units. That’s nearly 14 years’ worth of donations.

You probably know a lot more people who don’t give blood.

I, for example, can’t donate blood in the US because I lived in the UK for a couple of years in the 80s.

The old BSE/vCJD/Mad Cow issue. One of those risks that’s really hard to quantify (weird agent, funky genetic component, unclear latency timeline) and freaks people out (for some good reasons).

There are a a couple of rapid tests being worked on - though they probably have a better chance at being approved in the UK/EU rather than in the US in the near future.

And of course there are plenty of people who could donate blood if they wanted to, but just don’t feel like it.

This. The Red Cross visits my employer every eight weeks or so for blood drives. With several hundred employees on site, the drive typically collects less than 30 pints (and this often includes a handful of retirees who show up just to donate blood). It’s possible that some employees are choosing to donate off-site at a different time, but given that donating on-site means you don’t have to travel anywhere to donate, I’ll wager that these folks are pretty rare.

Thanks for the info everyone.

So it does sound like a small(ish) set of patients use a lot of blood (BMT, certain cancers, and blood disorders).

It was just this cognitive blip I had. I always hear about people giving, giving, giving. But I never knew anyone that received more than a unit or two.