Use of blood products during the first months of COVID-19 pandemic period: A single center report

Abstract

The novel coronavirus (SARS-CoV-2) outbreak exerted a serious effect on healthcare. Between 1st of January and May 31, 2020 due to the special regulations in Hungary, the number of reported COVID-19 infections were relatively low (3876 cases). The inpatient and outpatient care and the blood supply were significantly affected by the implemented regulations. The aim of this study was to evaluate the use of blood products amid the first five months of the pandemic situation. This investigation has observed a significant reduction of hospitalizations (37.35%). Analyzing individually the included units, pre-transfusion hemoglobin concentrations of transfused patients presented slight modifications, which were not statistically significant. The special regulations resulted major changes in the frequency of diagnoses at admissions in case of the Department of Surgery, while in case of the other specialities (Division of Hematology and Department of Anesthesiology and Intensive Therapy), there were no major changes compared to pre-pandemic period. Considering each department separately, transfused red blood cell concentrates (RBC) per patient, and the proportion of transfused patients did not change significantly. However, the combination of these modifications resulted in the significant decrease in RBC transfusions (p < 0.0001) compared to the pre-pandemic baseline. With regard to platelet and fresh frozen plasma (FFP), their usage was significantly reduced (44.40% platelet concentrates and 34.27% FFP). Our results indicate that the pandemic had an important effect on the blood product usage at the included departments by introducing different patient care policies and the temporary deferral of the elective surgical interventions. Despite the challenging circumstances of blood collection and blood product supply, the hospitalized patients received adequate care.

Keywords: Blood components; COVID-19 and blood product usage; Patient blood management; Pre-transfusion hemoglobin; Restrictive transfusion policy.

Fig. 1

Weekly usage of packed red cell concentrates. Summative weekly representation of the red blood cell concentrates' usage suggests that the Division of Hematology has been the clinic with the highest use of this blood product type followed by the Department of Anesthesiology and Intensive Care and Department of Surgery. The red blood cell concentrate usage has been significantly lower in the second time interval, especially in the first weeks of this period. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Boxplots of measured hemoglobin concentrations before red blood cell transfusions by clinics and combined (X-mean marker). Our data suggests that there were slight differences regarding pretransfusion hemoglobin concentrations comparing the two time intervals. Overall, mean pretransfusion hemoglobin concentrations have been significantly decreased, showing a wider range of distribution. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Weekly usage of thrombocyte concentrates. The represented data suggests a marked decrease of platelet concentrate usage in the first weeks of the second interval, after which thrombocyte concentrate usage is gradually increasing by the end of the analyzed period. The highest demand has been registered at the Division of Hematology. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Weekly usage of fresh frozen plasma during the tested period. The Division of Hematology also includes apheresis as a therapeutic option, therefore the FFP usage is significantly related to the activity of the apheresis team. We can observe that on weeks 8, 9, 16, 17 and 22 a very high number of FFP has been administrated at the Division of Hematology, which occurred on those weeks, when therapeutic apheresis has been performed on different patients that needed the intervention. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 5

Occurrence of the most frequent diagnoses at the evaluated clinics during the tested time intervals. The columns represent the rate of the diagnoses in ascending order by clinics and time intervals. Further data regarding the frequency of diagnoses by clinics is represented in the supplementary material provided. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)