Essential Role of Patient Blood Management in a Pandemic: A Call for Action

Abstract

The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Global health care now faces unprecedented challenges with widespread and rapid human-to-human transmission of SARS-CoV-2 and high morbidity and mortality with COVID-19 worldwide. Across the world, medical care is hampered by a critical shortage of not only hand sanitizers, personal protective equipment, ventilators, and hospital beds, but also impediments to the blood supply. Blood donation centers in many areas around the globe have mostly closed. Donors, practicing social distancing, some either with illness or undergoing self-quarantine, are quickly diminishing. Drastic public health initiatives have focused on containment and “flattening the curve” while invaluable resources are being depleted. In some countries, the point has been reached at which the demand for such resources, including donor blood, outstrips the supply. Questions as to the safety of blood persist. Although it does not appear very likely that the virus can be transmitted through allogeneic blood transfusion, this still remains to be fully determined. As options dwindle, we must enact regional and national shortage plans worldwide and more vitally disseminate the knowledge of and immediately implement patient blood management (PBM). PBM is an evidence-based bundle of care to optimize medical and surgical patient outcomes by clinically managing and preserving a patient’s own blood. This multinational and diverse group of authors issue this “Call to Action” underscoring “The Essential Role of Patient Blood Management in the Management of Pandemics” and urging all stakeholders and providers to implement the practical and commonsense principles of PBM and its multiprofessional and multimodality approaches.

COVID‐19 and thalassaemia: A position statement of the Thalassaemia International Federation

“…The optimization of blood use will help safeguard blood supplies during the pandemic 21 . In this context, adoption of a patient blood management (PBM) system, based on three pillars, optimization of patient's own blood volume, minimization of blood loss and harnessing the physiological anaemia reserve, reduces the need for transfusions, improves patient outcomes and reduces length of hospital stay and costs 27 . One particular aspect of optimizing blood usage could be to the use of erythropoiesis stimulants, with a view to reducing transfusion requirements.…”

“…Similarly, the COVID‐19 pandemic has already led to reduced blood supplies due to the cancellation of numerous community‐based and mobile blood donation drives, as well as a marked reduction in donors arriving for scheduled appointments 31 . In the US, nearly 4000 American Red Cross blood drives, that account for more than 80% of its blood collects, have been cancelled across the country, 33 while cancellation of hospital‐based collections resulted in 130 000 fewer donations in only a few weeks 27 …”

Blood transfusion utilization in hospitalized COVID‐19 patients

“…10 Hospitals and blood centers proactively implemented blood conservation strategies as well as efforts to maintain blood donations. 11 However, no studies to date have provided detailed blood usage in COVID-19 patients. Better understanding of this aspect of COVID-19 care can aid planning and preparation during the pandemic.…”

Evidence-based management of COVID-19 in cancer patients: Guideline by the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

“…Transfusion strategies should be as restrictive as recommended per guidelines and iron, folic acid, vitamin B12 or erythropoietin should be supplemented rigorously as indicated (BIII). 88 , 89 , 90 Clinic visits for surveillance might be postponed or be substituted by telephone or video calls. 91 …”