Mitigating Blood Shortage in a Hospital-Based Blood Bank amid a Pandemic: Effects on Inventory and Usage

Background/Case Studies:

As a result of the COVID-19 pandemic, 2,700 blood drives across the country were cancelled in March 2020, resulting in 86,000 fewer blood donations and a sharp drop in supply for blood centers. Our goal is to describe our mitigation plan and assess its impact on blood utilization, collection and availability.

Study Design/Methods:

Starting March 12, 2020, in an effort to reduce the risk of transmission of COVID-19, all elective surgeries, procedures and outpatient visits were cancelled. On March 20, due to the impending blood shortage, we developed a set of recommendations for our clinicians to use more restrictive transfusion guidelines, namely a lower hemoglobin threshold, a lower platelet transfusion dosage in non-bleeding patients, and a revision of other special transfusion thresholds (e.g: platelet of 50K for sickle cell patients). We also reviewed each blood component order closely and monitored the collection and usage of red blood cells and platelets. Finally, we put into place an emergency plan for extreme blood shortage situations, which included such measures as extending platelet storage from 5 to 7 days under Authorized Medical Exception. Meanwhile, we actively recruited donors to maximize collection. We analyzed the year-over-year changes in collection and utilization for March/April 2020 vs. 2019 and made changes to our collection targets accordingly.

Results/Findings:

The results are shown in Table 1. While RBC collection remained unchanged in March 2020 v. March 2019 (-1%), RBC utilization decreased with the implementation of strict transfusion guidelines and the cancellation of elective surgeries. Thus, we decreased our RBC collection target to avoid a large surplus. Platelet collection decreased by a greater extent (-23%) than utilization (-17%) in March 2020 v. March 2019, leading to a short-lived, intermittent shortage, so we increased our platelet collection target for April 2020 to avoid further shortages. Overall, collection for March/April 2020 decreased compared to March/April 2019 (RBC: -10%, PLT: -13%), but our overall utilization decreased as well (RBC: -9%, PLT: -26%).

Conclusions:

Since both collection and utilization decreased during the pandemic, a significant shortage was not observed. Closely overseeing collection and utilization, and having an emergency plan, reviewing it and changing it as conditions dictated, helped us navigate through an event that fell outside our normal operations.