Adaptations of transfusion systems to the COVID-19 pandemic in British Columbia, Canada: Early experiences of a large tertiary care center and survey of provincial activities

Abstract

Background: In March 2020, a state of emergency was declared to facilitate organized responses to the coronavirus disease 2019 (COVID-19) pandemic in British Columbia, Canada. Emergency blood management committees (EBMCs) were formed regionally and provincially to coordinate transfusion service activities and responses to possible national blood shortages.

Study design and methods: We describe the responses of transfusion services to COVID-19 in regional health authorities in British Columbia through a collaborative survey, contingency planning meeting minutes, and policy documents, including early trends observed in blood product usage.

Results: Early strategic response policies were developed locally in collaboration with members of the provincial EBMC and focused on three key areas: utilization management strategies, stakeholder engagement (collaboration with frequent users of the transfusion service, advance notification of potential inventory shortage plans, and development of blood triage guidance documents), and laboratory staffing and infection control procedures. Reductions in transfusion volumes were observed beginning in mid-March 2020 for red blood cells and platelets relative to the prepandemic baseline (27% and 26% from the preceding year, respectively). There was a slow gradual return toward baseline beginning one month later; no product shortage issues were experienced.

Conclusion: Provincial collaborative efforts facilitated the development of initiatives focused on minimizing potential COVID-19-related disruptions in transfusion services in British Columbia. While there have been no supply issues to date, the framework developed early in the pandemic should facilitate timely responses to possible disruptions in future waves of infection.

Keywords: blood center operations; blood management; transfusion service operations.

FIGURE 1

Interim framework for Vancouver Coastal Health blood triage scenarios (for appropriate allocation of blood product support in massive transfusion situations in the event of severe blood product shortage). EBMC, emergency blood management committee; MRP, most responsible physician; PLT, platelets. *Triage team case discussions require a minimum of three team members, including the blood triage leader and transfusion medicine physician

FIGURE 2

Strategies implemented by the authors' health authority (Vancouver Coastal Health [VCH]) and those reported to be in use in transfusion medicine services (TMS) represented in the provincial emergency blood management committee (EBMC) with regards to utilization management. G denotes Green Phase Advisory strategies (currently in use), A indicates strategies to be implemented with Amber Phase Advisory or above (insufficient inventory for routine transfusion practices), and R indicates strategies to be implemented in the event of Red Phase Advisory (critical inventory shortages) [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Protocol for disposition of products returned to the transfusion medicine laboratory in the authors' center. Products are distributed in sealed overwrap bags and integrity of the seal is evaluated on return to the laboratory. *Provided standard criteria for return to inventory are met

FIGURE 4

Strategies implemented by the authors' health authority (Vancouver Coastal Health [VCH]) and those reported to be in use in transfusion medicine services (TMS) represented in the provincial emergency blood management committee (EBMC) with regards to reduction of viral transmission in the transfusion laboratory and managing risks related to surface contamination of returned blood products. X indicates a strategy is in use

FIGURE 5

A. RBC and platelet utilization over time at Vancouver General Hospital. Solid lines indicate 14‐day rolling average rates and icons indicate daily rates (diamond: RBC; square: Platelet). The dashed vertical line indicates the date a provincial state of emergency was declared. The shaded area denotes the time period reviewed in panels (B‐D). B‐C, RBC (B) and platelet (C) transfusion rates by clinical service and overall at Vancouver General Hospital between 15 March‐31 May, 2019 and 2020. Relative changes in transfusion rates observed in 2020 relative to 2019 are indicated. BMT, bone marrow transplant; ICU, intensive care unit. D, Observed changes in RBC and platelet transfusion rates between 15 March‐31 May 2019 and 2020, as reported by members of the provincial emergency blood management committee for their local transfusion services. Decreases in RBC transfusion rates were most pronounced in emergency, trauma, and surgical areas in most centers. Reported increases in platelet transfusion were accounted for by unusually high use (4‐fold increase) in intensive care at one center and one patient requiring large numbers of transfusions for hypoproliferative thrombocytopenia at another. *Surgical transfusion data exclude intraoperative transfusions, which are not captured in the laboratory information system