Impact of COVID-19 and lockdown regarding blood transfusion

Abstract

Background: The outbreak of a SARS-CoV-2 resulted in a massive afflux of patients in hospital and intensive care units with many challenges. Blood transfusion was one of them regarding both blood banks (safety, collection, and stocks) and consumption (usual care and unknown specific demand of COVID-19 patients). The risk of mismatch was sufficient to plan blood transfusion restrictions if stocks became limited.

Study design and methods: Analyses of blood transfusion in a tertiary hospital and blood collection in the referring blood bank between February 24 and May 31, 2020.

Results: Withdrawal of elective surgery and non-urgent care and admission of 2291 COVID-19 patients reduced global activity by 33% but transfusion by 17% only. Only 237 (10.3) % of COVID-19 patients required blood transfusion, including 45 (2.0%) with acute bleeding. Lockdown and cancellation of mobile collection resulted in an 11% reduction in blood donation compared to 2019. The ratio of reduction in blood transfusion to blood donation remained positive and stocks were slightly enhanced.

Discussion: Reduction of admissions due to SARS-CoV-2 pandemic results only in a moderate decrease of blood transfusion. Incompressible blood transfusions concern urgent surgery, acute bleeding (including some patients with COVID-19, especially under high anticoagulation), or are supportive for chemotherapy-induced aplasia or chronic anemia. Lockdown results in a decrease of blood donation by cancellation of mobile donation but with little impact on a short period by mobilization of usual donors. No mismatch between demand and donation was evidenced and no planned restriction to blood transfusion was necessary.

Keywords: COVID-19; blood donation; lockdown; transfusion.

FIGURE 1

Mean activity per day for 2019 and 2020. Hospital activity is expressed as mean per day for (A) full hospitalization and (B) for day hospitalization for each subperiod A (24 Feb to 15 Mar), B (16 Mar to 13 Apr), and C (14 Apr to 31 May). (C) Mean number of surgical intervention per day. A&E, accident and emergency department; MICUs, medical ICUs, RRT: renal replacement therapy unit; SICUs, surgical ICUs [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Mean transfusion activity per day for 2019 and 2020. Transfusion of (A) Red blood cell packs, (B) platelet concentrates and (C) fresh frozen plasma. A&E, accident and emergency department; MICUs, medical ICUs; SICUs, surgical ICUs [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Transfusion in non‐COVID‐19 and COVID‐19 patients (16 March to 31 May, 2019 and 2020). Transfusion of (A) red blood cell packs, (B) platelet concentrates and (C) fresh frozen plasma in 2019 (red) and in 2020 (non‐COVID‐19 patients in dark blue and COVID‐19 patients in light blue). A&E, accident and emergency department; MICUs, medical ICUs; SICUs, surgical ICUs [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

Transfusion in transfused COVID‐19 patients. (A) Scatter plot with median and interquartile of large‐volume (left) and non‐large‐volume (right) transfused products: red blood cell packs in red, platelet concentrates in orange and fresh frozen plasma in blue and (B) whisker boxes (horizontal line inside box median, upper and lower box limits 25–75 percentiles and T‐bars 10–90 percentiles respectively) of number of transfusion per patients during all the stay (LV, large‐volume; nLV, non‐volume transfused patients) [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 5

Blood bank (EFS grand‐Est) activity. Results are given by weeks for 2019 and in 2020 by sub‐period A (weeks 9–11), B (weeks 12–15), and C (weeks 16–22). (A) delivery and (B) regional stock of Monday of each week [Color figure can be viewed at wileyonlinelibrary.com]