The COVID-19 pandemic has had an unprecedented impact on healthcare globally. In addition to the general resource scarcity of personal protective equipment and other items, hospitals and their regional blood centers have prepared mitigation strategies to best manage the blood supply during the crisis. In this post, we describe the blood industry’s quick response to protect and maintain the blood supply during the pandemic and the downstream impact of possible platelet shortages once the crisis abates.
In the early weeks of the pandemic, thousands of blood drives were canceled, while others modified to accommodate guidelines for social distancing. The need arose for a multi-faceted approach to maintain adequate blood components across the US. Transfusion medicine directors were swift to communicate with their clinical counterparts that in the near term, a blood shortage would be likely. The open dialogue helped to manage both resources and expectations. Hospital institutions adopted several mitigation steps, such as performing prospective audits for all platelet orders and lowering the threshold for platelet and red blood cell transfusions. Some hospitals also discontinued prophylactic platelet transfusions for hematology/oncology patients and implemented the splitting of platelet components.
Following weeks of ‘stay & shelter’ orders, it was apparent that the US blood supply underwent a dramatic reduction in donations due to social distancing and cancellation of blood drives. America’s Blood Centers (ABC) reported on March 27th that its members experienced a 30-40% loss of supply due to fear of some donors becoming infected. In response to the decrease in the donor pool, the Food and Drug Administration (FDA) issued several guidance documents for immediate implementation to address the urgent need for blood. The agency revised recommendations that would apply during the pandemic regarding deferral timeframes. Two of these are specific to decreasing the time of deferral if the donor traveled to malarial or Creutzfeldt-Jakob known regions. The third reduces the time of several deferrals related to the risk of HIV, including men who have had sex with other men. In addition to these measures, the deferral periods for tattoos and piercings were also reduced.
As the crisis ensued, the American College of Surgeons (ACS) issued guidance recommending that surgeons curtail the performance of “elective” surgical procedures. This guidance resulted in immediate wastage from canceled elective surgeries. The American Association of Blood Banks (AABB) conducted a survey that revealed 29% of transfusion services had seen an increase in blood component wastage, with the vast majority of those products being platelets due to their short shelf life.
Aggressive Patient Blood Management techniques, support from the FDA regarding donor deferrals, and halting elective surgeries as per the ACS recommendations seemed to address the blood shortage and supply and demand have come into equilibrium for the time being. While the current situation is stable, the re-initiation of elective surgeries and procedures or a second wave of COVID-19 could potentially destabilize the blood supply again. In a proactive move, the AABB and ABC co-wrote a letter to the American Hospital Association requesting that they include the current operational realities of the US blood supply in their roadmap for safely resuming elective surgeries. The request is for hospital clinical services to partner with their internal transfusion service and local blood suppliers to ensure blood is available for elective procedures while maintaining ample supply for transfusion emergencies, oncology patients, and those with a chronic disease requiring transfusion. AABB and ABC encouraged the continuation of blood conservation techniques employed at the beginning of the pandemic, which was a contributing factor in stabilizing the blood supply.
It is also worth mentioning the financial impact the pandemic has had on blood collection facilities. ABC and AABB also sent a joint letter to the Department of Health and Human Services seeking funding for blood centers. The near 40% reduction in blood component utilization along with the implementation of social distancing, cancellation of more than 10,000 blood drives, increased infection control procedures, and acquisition of additional personal protective equipment has inflicted additional costs to an industry already operating at best with break-even margins. The good news is that some members of Congress listened. Nearly fifty members wrote a letter to the Speaker of the House in support of financial relief for blood centers. The letter specifically calls for assistance to non-profit blood centers in the next COVID-19 relief package calling out how previous relief bills failed to address the importance of this resource in the care of critically ill patients.
Despite the mitigation strategies and eventual subsidence of the pandemic, the blood industry will need time to recover. Reduced volunteer donation may persist provoked by fear and reduced capacity remains a challenge because of social distancing protocols. Further, platelets will likely be the most challenging component to maintain due to: 1) the requirement for bacterial risk mitigation, 2) an aging donor base, 3) a short 5-7 day storage duration, and now 4) a significant and possibly permanent loss of volunteer platelet donors due to COVID-19. The scenario accelerates the urgency for a reliable, diversified supplier with a unique ability to attract donors even during difficult times.
Secure Transfusion Services (STS) offers a unique approach to help hospitals minimize future platelet shortages. By using the source plasma model, STS can provide hospitals with a consistent source of platelets that are pathogen reduced, where the risk of interrupted supply is mitigated due to our model of remunerating donors. This model dramatically improves donor recruitment and retention while maintaining adherence to all appropriate regulations and safety standards. The use of pathogen reduction not only satisfies the FDA guidance for mitigation of bacterial contamination but also addresses unknown and emerging pathogens. Consistent pedigreed donors and pathogen reduction make STS a unique solution to platelet supply chain concerns, ensuring a safe source of platelets for your patients at all times.