The current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) outbreak, is having an effect on health-care systems all over the world. In December 2019, a strange viral contagion was found in Wuhan City, China. The infection spread very rapidly and warning signs of pneumonia were reported by many patients worldwide.[2–4] The outbreak of COVID-19 was acknowledged by the World Health Organization (WHO) on January 31st, 2020 as a public well-being crisis of international concern. COVID-19 has since become a global pandemic. For the treatment of several patients, the accessibility of safe blood and its components remains a major challenge globally during pandemic. Replacement donors, voluntary non-remunerated blood donors and mobile blood camps are the key sources of donated blood. It is important to maintain an adequate blood supply as it is lifesaving in many conditions. The occurrence of SARS-CoV-2 infection in 2003 had a detrimental effect on blood donation and blood inventory worldwide. In a pandemic condition like COVID-19, due to declining blood donations, blood transfusion services (BTSs) faces difficulties in delivering a safe and adequate blood supply. Fortunately, blood transfusion-transmitted case of SARS-CoV-2 has not been confirmed.[9–12] The US Food and Drug Administration (FDA) does not mandate SARS-CoV-2 screening of blood donors or donated blood. Blood centres should, however, take preventive steps to reduce the risk of spreading SARS-CoV-2 amongst the staff of the blood centre and the donors, as there is still a hypothetical risk of spreading SARS-CoV infection.[13,14] The use of personal protective equipment, maintaining physical distance, thermal screening of blood donors and following the biosafety laboratory standards were included in the safety measures to prevent the spread of COVID-19.[15–17]
Patients having disorders such as haematological malignancies, thalassaemia, polytrauma and critical surgical procedures required blood and its components constantly during the ongoing pandemic. Blood centres faced the shortage of blood resources during the pandemic. Thus, it is necessary to plan BTSs during a pandemic to ensure sufficient blood supply management to meet the needs of the patient. It is, therefore, imperative to have a level of knowledge of patient’s blood component requirements and their effects on the actual supply of blood. During this phase, a key task for blood centres is the monitoring of blood demand to maintain adequate blood supplies to meet ongoing critical needs, such as major trauma and thalassaemia. The purpose of the present study was to help find the efficient ways of managing BTSs during the COVID-19 pandemic and similar global health emergencies in the future. The study intended to evaluate the collection, demand and supply of blood components to the patients and its correlation with age, sex, blood group and diagnosis of the patients during the outbreak of COVID-19.
MATERIAL AND METHODS
In the Department of Transfusion Medicine, at King George’s Medical University, a Tertiary Care Hospital in Northern India, the present retrospective study was conducted during COVID-19 outbreak from 1 April 2020 to 30 September 2020. The present study was approved by the Institutional Ethics Committee (KGMU/No. 1059/Ethics/2021 dated 13 August 2021). Data were gathered from donor registers and blood inventory records (6 months before and 6 months during the COVID-19 pandemic).
The present study assessed the requirement of blood components with respect to different age groups, gender, blood group and diagnosis of the patients. Before and during the COVID-19 outbreak, the total number of blood donations, the number of blood units issued and actual number of blood units requested were also calculated and analysed to help with effective blood supply management and minimise blood shortages.
Data were recorded in a structured proforma and were entered using Statistical Package for Social Sciences (SPSS) statistical software version 25.0 (IBM Corporation, Armonk, NY, USA). Descriptive statistics are reported as mean ± standard deviation, numbers and percentages.
According to the distribution of the patients by age, a maximum requirement for blood components was recorded for the age group of 30–39 years (23.6%), followed by the age group of 20–29 years (22.7%) and 40–49 years (15.3%). High demand was also seen for the lower age (<10 years) with a 14.5% proportion (Table 1). The requirement of blood components was recorded at 56.1% in females and 43.9% in males; the demand for blood in females was relatively high compared to males and the difference was significant (P < 0.001). The maximum demand of blood components was recorded for the blood group O-positive patients (32.6%), followed by the blood group B-positive patients (30.0%). A high demand for A-positive patients (18.2%) and AB-positive patients (10.7%) was also recorded (Figure 1). If we compare the demand for blood and its components according to the diagnosis of the patient, the maximum demand for blood components was observed for severe anaemia (49.9%), cancer (20.4%), trauma (16.4%) and thalassaemia (9.5%) patients (Figure 2). The maximum demand of packed red blood cells (PRBC) was noted for severe anaemia patients, the demand for random donor platelet was highest for cancer patients and the demand for fresh frozen plasma was maximum for trauma patients.
The demand for cryoprecipitate was found for burn patients, snake bite, lupus nephritis and pancreatitis. However, no significant association between demand and supply gap was found with the diagnosis of patients (P = 0.892) (Table 2). In June and September 2020, there was a slight increment in the inventory, i.e. +105 and +13 whole blood units, respectively, while in the month of April, May, July and August 2020, there was a decrease in the blood inventory (Figure 3). During the pandemic, the total whole blood collection was 13,872 only. Out of 13,872 whole blood donations only 436 (3.2%) donations were voluntary, while 13,436 (96.8%) donations were replacement donations. This shows most of the donations were replacement donations (Figure 4). The collection of whole blood in 6 months during the pandemic was 13,872 units, the demand was 15,657 units and the number of blood units issued was 14,603. Thus, the issue of blood units was less as compared to the demand of blood units attributed to lower blood collection. During the pandemic, the demand and issue of blood were relatively lesser than before the pandemic. There was a drop of 53.4% and 45.4% in blood collection and blood demand, respectively, during COVID-19 outbreak. The supply of blood and its components was also reduced by 32.97% during the COVID-19 pandemic in comparison to pre-COVID-19 outbreak (Table 3).
The constant replenishment of blood supply is very important because blood and its components, particularly platelets, remain an integral part of patient management and cannot be manufactured or put in storage for prolonged times. PRBCs have a shelf life of up to 42 days, while platelets have a shelf life of just 5 days.[18,19] We studied the total collection of whole blood, demand and blood supply before and during the ongoing COVID-19 pandemic in our hospital. In this study, we also intend to determine the necessity and indications of blood components among various age groups, gender, blood group and diagnosis of the patient during the COVID-19 pandemic. In the present study, the maximum demand of blood was recorded for the O-positive patients in age groups of 30–39 years with the diagnosis of severe anaemia. The finding is correlated with the fact that the most common blood group in India is O-positive, so the maximum patient belonged to O-positive blood group. The demand for blood in females of the reproductive age group was significantly higher than males. In India, anaemia is also more common in females with reproductive age groups owing to multiple pregnancies and poor nutrition. That is why in our study the demand for blood is more in females of reproductive age groups.[21,22]
During the initial months of the pandemic, the demand for blood was covered; after that, the demand exceeding blood donation and the deficiency was recovered partly by blood centre inventory, in-house donation camps and mobile blood drives. During the pandemic, the demand and issue were relatively lesser than before the pandemic due to the stoppage of elective surgeries and outpatient departments in the hospital. The regular online consultations to the patients were provided by our hospital. There was a drop of 45.4% in blood demand in the initial 6 months of the COVID-19 pandemic, while in another study, the drop in blood demand was 21.7%. The supply of blood and its components was also reduced by 33% during the COVID-19 pandemic as compared to another study, the drop in blood supply was 39.5%.
There was a 53.4% drop in blood collection in comparison to pre-pandemic. The cause could be decreased donor attendance in the hospital for blood donation. Most of the donors had a fear of exposure to SARS-CoV-2 at our hospital-based blood centre. This observation is consistent with a current American Red Cross analysis. In this report, the decline in blood supply can be clarified by the decrease in donors arriving for donation and also donor anxiety of exposure to SARS-CoV-2 at blood centres in hospitals.[24,25] This drop in blood requests in the pandemic is in accordance by whatever was found in Beijing (April to June 2003) and Toronto, Ontario, Canada, in the course of the SARS epidemic. During the ongoing pandemic, the decline in blood demand is mostly attributable to reduced emergency admissions, decreased accidents due to lockdown and mass gathering, delayed elective operations and just lifesaving blood transfusions. In addition, there was the cancellation of a number of mobile blood camps owing to the locked educational, industrial, commercial and occupational premises. This significant decline in blood reserve was partly compensated by the decline in blood requests due to the temporary cessation of elective surgeries during the pandemic.
Other steps to maintain adequate blood supply and overcome the hurdles were taken such as the use of social media to encourage and motivate people for blood donation, organising mobile blood camps, active participation of our hospital transfusion committee to monitor emergency blood supply and careful handling of available blood and proper patient blood management (PBM). The practice PBM includes judicious use of available blood, treatment of anaemia and coagulopathy with pharmacological agents, use of the latest minimally invasive surgical techniques, rescheduling of non-compulsory surgery and intraoperative and post-operative cell salvage. Thus, the practice of PBM helped us to conserve precious blood during the crisis.[27,28] Our analysis showed that the ongoing COVID-19 pandemic had a detrimental effect on donor participation and blood inventory. To make sure a safe as well as sufficient blood supplies, hospitals face several obstacles, as seen in earlier epidemics.[8,29–32] To make sure a safe and sufficient blood supplies, several steps should be enforced towards the resolution of these difficulties. To make sure that requested blood is used in crisis and serious situations, blood centre specialists must communicate with clinicians. The plans of hospitals to maintain adequate BTSs in a pandemic must consist of the protection of both the workforce and blood donors. A well-structured recruitment as well as encouragement plan to be made to encourage non-remunerated volunteer blood donors to donate regularly until the crisis has stopped. The maintenance of sufficient stocks of laboratory reagents and consumables is also very important. Thus, during pandemics, careful monitoring and appropriate planning to manage blood component supply are of utmost importance. If a blood shortage still persists despite these precautions, the deficit can be resolved by transporting blood reserves from adjacent hospitals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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