Trends in blood components and autologous use blood in Zhejiang Province from 2019 to 2023

Patient blood management (PBM) was widely implemented in Zhejiang Province from 2008 to 2010. However, recent province-wide trends in perioperative blood utilization during the maturation phase of PBM remain unclear. This study aimed to describe the temporal trends in blood components and autologous blood utilization from 2019 to 2023. This retrospective ecological study analyzed aggregated perioperative data from 427 hospitals in Zhejiang Province between January 1, 2019, and December 31, 2023. The annual utilization of allogeneic red blood cells (RBC), plasma, and autologous blood, including cell salvage and acute normovolemic hemodilution (ANH), was assessed. Temporal trends were evaluated using annual growth rate (AGR), cumulative growth rate (CGR), and compound AGR (CAGR). Utilization was further examined using both absolute volumes and normalized metrics expressed as volume (mL) per 100 surgical cases or per eligible surgical case. Over a 5-year period, the number of surgical cases increased from 3.98 million cases in 2019 to 6.12 million in 2023 (CGR 53.76%, CAGR 11.35%). In contrast, growth in allogeneic blood cases was more modest, with RBC and plasma showing CGRs of 22.26% and 15.51% (CAGRs 5.15% and 3.67%, respectively), respectively, declining in 2020 and again during 2022–2023. The RBC volume declined from 486 to 407 mL per 100 surgeries, whereas the plasma volume remained low and stable (2–3 mL per 100 surgeries). Autologous blood cases increased overall, with cell salvage demonstrating a CGR of 23.27% (CAGR 5.37%), whereas ANH showed a slight overall decrease (CGR − 7.59%, CAGR − 1.95%) despite an interim increase. Across 427 hospitals, public tertiary general hospitals conducted the majority of surgeries and transfusions. This province-wide ecological analysis showed that, during a period of established PBM practice, trends were temporally consistent with more conservative allogeneic blood utilization and increased uptake of autologous techniques, particularly cell salvage.