Transfusion Report Examines Lessons Learned from the COVID-19 Pandemic for Hospital Transfusion Services

An analysis in Transfusion explores the effect of the COVID-19 pandemic on the availability of blood, the scheduling of elective surgeries, and the effect on transfusion practice through the lens of hospital transfusion services. The report is based upon findings from a multiweek survey of hospital-based AABB members that addressed blood banking/transfusion medicine (BB/TM)-related operations and practices, including the administration of COVID-19 convalescent plasma (CCP). A Working Group of AABB members and staff within AABB’s Division of Science and Practice developed and distributed the survey to 887 hospital-based members, and 479 unique respondents participated. 

Following the first surge of COVID-19 (May 2020), 54% of hospital-based members reported increased wastage in the early phase of the pandemic. This percentage decreased to 4.5% by the end of June and throughout the rest of 2020. Additionally, 54.8% of respondents reported receiving alerts related to supply challenges from their blood suppliers. These alerts were most frequent throughout June, in the first week of July, and from September through December 2020. Throughout the pandemic, red blood cell units, especially O-positive and O-negative, were in the shortest supply, followed by platelets, plasma and cryoprecipitate.

The survey also documented how hospital-based members adapted their practices in response to blood supply pressures. On average, 45% of respondents lowered their RBC transfusion hemoglobin threshold to 7 g/dL and implemented prospective auditing of orders for RBCs and platelets. Furthermore, 12.7% of respondents lowered their RBC transfusion thresholds below 7 g/dL. The authors noted that the lower transfusion threshold is a surprising finding, as current AABB and other society guidelines recommend a restrictive transfusion threshold of 7 g/dL for most patients.

The survey also tracked the pandemic’s effect on elective procedures. Between March 23 and April 13, 2020, an average of 12% of respondents reported that their respective institutions continued to perform elective surgical procedures. This increased to 95% by mid-August 2020. The most commonly cited limitations to resuming elective surgeries included availability of intensive care unit beds, hospital COVID-19 caseload, blood availability, personal protective equipment and testing capacity.

Additionally, the survey addressed CCP transfusions. More than 75% of hospital-based members were consistently transfusing CCP as early as mid-May 2020, plateauing at more than 90% as early as late October. Respondents consistently prioritized the following patients for CCP transfusion: 46.9% used CCP for severely ill patients, 21.2% used CCP as the last resort if all other treatment options failed to demonstrate clinical improvement, and 13.4% used CCP for moderately ill patients.

According to the authors, the findings speak to the importance of planning ahead, staying organized, and maintaining close communication between hospitals and blood suppliers. They suggest that blood banks may also revise transfusion practices now in accordance with current evidence-based guidelines and recommendations.

“Blood banks and their affiliated hospitals always have the opportunity to implement elements of a patient blood management program such as transfusion auditing and preoperative anemia management,” the authors concluded. “This would not only crystalize institutional blood needs but also make vacillations in manufactured blood components potentially more predictable and more manageable.”