‘Big strain’ on blood supply amid COVID-19 pandemic could force difficult decisions
The American Red Cross, as well as cancer centers and hospitals across the country, have issued an emergency call for blood donors because of a shortage brought on by various medical and societal complications related to COVID-19.
“As a nation, this is a time where we must take care of one another, including those most vulnerable among us in hospitals,” Gail McGovern, president and CEO of American Red Cross, said in a press release. “One of the most important things people can do right now during this public health emergency is to give blood. If you are healthy and feeling well, please make an appointment to donate as soon as possible.”
Government-imposed restrictions that have limited public events or gatherings do not apply to giving blood, which is considered an essential activity.
Still, the American Red Cross reports that nearly 2,700 blood drives have been canceled across the country, many due to school and workplace closures. These cancellations have resulted in about 86,000 fewer blood donations.
Blood and platelet donations are critical for certain patients with cancer, as well as people with other medical conditions, victims of natural disasters or those with traumatic injuries. Blood drive cancellations — along with the ongoing need for donations to support essential treatments — could trigger a critical shortage, experts warn.
“There are two main places where people give blood: mobile drives and fixed sites,” Alan Mast, MD, PhD, an ASH medical expert who serves as medical director of transfusion medicine and senior investigator at Versiti Blood Center of Wisconsin, told Healio. “Mobile drives usually happen at schools or businesses, and most of those have now been shut down. Fifty percent of blood collected in the U.S. is collected at mobile sites, so that has put a big strain on the blood supply.”
Healio spoke with Mast about the potential for a critical blood shortage in the U.S. and what can be done to prevent it.
Question: Where should people go to give blood, and should they be concerned about being exposed to COVID-19 at donation sites?
Answer: We have had a good response so far at the fixed sites because word has gotten out from the White House, politicians and media outlets that there is a blood shortage. We need to keep this going because many blood drives at high schools — where 10% to 15% of blood donations occur — or colleges have been canceled and are unlikely to resume until the fall.
Blood centers need to make sure that donors feel comfortable coming in and that the facility is cleaned very frequently. Strategies are being implemented across the country to make people feel safe about coming to the blood center to donate.
The American Red Cross has implemented new measures that include:
- checking the temperature of staff and donors before entering a drive to make sure they are healthy;
- providing hand sanitizer for use before the drive, as well as throughout the donation process;
- spacing beds where possible;
- following social distancing practices among blood donors; and
- enhanced disinfecting of surfaces and equipment.
Q: What are some concerns about the impact of a potential blood supply shortage on hematology and oncology patients in particular?
A: A big concern, particularly for hematology and oncology patients, is the blood platelet supply. Platelets can only be stored for 5 days before they are outdated. So, we could have a shortage of platelets much quicker than whole blood, which can be stored for 42 days.
Platelets can be donated at the same location where whole blood is collected. Apheresis donations — in which you can do combinations of donations at the same time — take about an hour and a half, and you usually have to make an appointment ahead of time to make sure a machine is available. Clinicians should consider asking donors if they wouldn’t mind giving platelets when they come to the fixed site.
Q: Does being infected with COVID-19 affect your ability to donate blood?
A: If you know you are infected or don’t feel well, you should not donate blood. We screen everyone who comes in to see if they have a fever and ask if they have coughing or shortness of breath. The problem with COVID-19 is that many people do not have symptoms.
The AABB has notified members that, according to the FDA, there have been no reported or suspected cases of transfusion-transmitted COVID-19 and that there were never any cases of transfusion-transmission reported for SARS or Middle East respiratory syndrome-related coronavirus during the past 2 decades.
Q: What would happen if there is a blood shortage?
A: If we don’t have enough blood, we would have to make decisions on who gets it and who doesn’t. We would first look for patients who aren’t critically ill and give them, say, one unit of blood instead of their normal two units. If we get to a critical stage where there just isn’t enough blood, there would have to be medical decisions and discussions that you are seeing now with ventilators. Those are big ethical issues, and no one wants to make those decisions. To tell you the truth, I don’t even know how we would make those decisions. That’s why we are trying to get the word out to the public now that we need donors, so that we can maintain the blood supply and not get to that point.
Q: Have some treatments been scaled back or canceled because of a blood shortage?
A: Treatments have not been canceled because of a lack of blood. The big concern right now is that these shutdowns will continue long term, especially because of the decreased collections from mobile blood drives. We have to continue to get the word out month after month after month that we need blood. – by John DeRosier
Disclosure: Mast reports researching funding and honoraria from Novo Nordisk.