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Pál S, Réger B, Alizadeh H, Szomor Á, Vereczkei A, Kiss T, Miseta A, Solymár M, Faust Z. Use of blood products during the first months of COVID-19 pandemic period: A single center report. Heliyon 2023; 9:e14391. [PMID: 36919084 PMCID: PMC9995388 DOI: 10.1016/j.heliyon.2023.e14391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023] Open
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.
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Affiliation(s)
- Sándor Pál
- University of Pécs, Medical School, Department of Laboratory Medicine, Department of Transfusion Medicine, Hungary
| | - Barbara Réger
- University of Pécs, Medical School, Department of Laboratory Medicine, Hungary
- Corresponding author.
| | - Hussain Alizadeh
- University of Pécs, Medical School, 1st Department of Internal Medicine, Division of Hematology, Hungary
| | - Árpád Szomor
- University of Pécs, Medical School, 1st Department of Internal Medicine, Division of Hematology, Hungary
| | - András Vereczkei
- University of Pécs, Medical School, Department of Surgery, Hungary
| | - Tamás Kiss
- University of Pécs, Medical School, Department of Anesthesiology and Intensive Therapy, Hungary
| | - Attila Miseta
- University of Pécs, Medical School, Department of Laboratory Medicine, Hungary
| | - Margit Solymár
- University of Pécs, Medical School, Department of Laboratory Medicine, Department of Transfusion Medicine, Hungary
| | - Zsuzsanna Faust
- University of Pécs, Medical School, Department of Laboratory Medicine, Department of Transfusion Medicine, Hungary
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Jacobs JW, Karafin MS, Allen ES, Abels E, Park YA, Stephens LD, Ward DC, Woo JS, Gehrie EA, Booth GS, Adkins BD. Blood conservation strategies at United States hospitals during the COVID‐19 pandemic: Findings from a multi‐institutional analysis. Transfusion 2022; 62:2271-2281. [PMID: 36093583 PMCID: PMC9538724 DOI: 10.1111/trf.17116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
Background Due to the coronavirus disease 2019 (COVID‐19) pandemic, the transfusion medicine community has experienced unprecedented blood supply shortages since March 2020. As such, numerous changes to everyday practice have occurred with a specific emphasis on blood conservation. We sought to determine the strategies used to mitigate blood shortages and promote blood conservation during the pandemic. Methods An anonymous, 37‐question survey was developed using Research Electronic Data Capture and distributed via e‐mail to transfusion medicine specialists across the US obtained via publicly available databases. Results Amongst surveyed [41.1% response rate (51/124 institutions)], 98.0% experienced a product shortage, with the greatest number reporting red blood cell (RBC) shortages (92.0%). This led to 35.3% of institutions altering the composition and/or number of blood product suppliers, including a 100% increase in the number of institutions acquiring blood from organizations that connect hospital transfusion services with blood collection centers (e.g., Blood Buy) compared to before March 2020. Prospective triaging of blood products was the most common blood conservation strategy (68.1%), though 35.4% altered their RBC exchange or transfusion program for patients receiving chronic RBC transfusion/exchange. As a result of these changes, 78.6% of institutions reported that these changes resulted in a reduction in blood product usage, and 38.1% reported a decrease in product wastage. Conclusions Most hospitals experienced the effects of the supply shortage, and many of them implemented blood conserving measures. Conservation strategies were associated with decreased blood utilization and waste, and future studies could evaluate whether these changes persist.
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Affiliation(s)
- Jeremy W. Jacobs
- Department of Laboratory Medicine, Division of Transfusion Medicine Yale School of Medicine New Haven CT USA
| | - Matthew S. Karafin
- Department of Pathology and Laboratory Medicine University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Elizabeth S. Allen
- Department of Pathology University of California San Diego La Jolla CA USA
| | | | - Yara A. Park
- Department of Pathology and Laboratory Medicine University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Laura D. Stephens
- Department of Pathology University of California San Diego La Jolla CA USA
| | - Dawn C. Ward
- Wing‐Kwai and Alice Lee‐Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine David Geffen School of Medicine at UCLA Los Angeles CA USA
| | - Jennifer S. Woo
- Department of Pathology City of Hope National Medical Center Duarte CA USA
| | - Eric A. Gehrie
- American Red Cross, National Headquarters Washington DC USA
| | - Garrett S. Booth
- Department of Pathology, Microbiology and Immunology Vanderbilt University Medical Center Nashville TN USA
| | - Brian D. Adkins
- Department of Pathology, Division of Transfusion Medicine and Hemostasis University of Texas Southwestern Dallas TX USA
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Murphy C, Silva de Leonardi N. Better than 'normal': Describing the distribution of and outliers in RBC usage. Transfusion 2022; 62:817-825. [PMID: 35170040 DOI: 10.1111/trf.16831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND/CASE STUDIES Optimizing a hospital blood inventory requires understanding the distribution of blood usage at the institution. Standard methods for describing red blood cell (RBC) usage like mean and standard deviation assume a normal distribution. Other distributions may fit the distribution of daily RBC usage better and provide more accurate insights into blood usage and in6ventory management. STUDY DESIGN/METHODS RBC usage data from 2014 through 2020 were queried from the laboratory information system. Theoretical distributions were fit against this empirical distribution of daily RBC usage. Goodness-of-fit was assessed visually using Pearson/Cullen and Frey plots as well as quantitatively using Kolomogorov-Smirnov (K-S) distance and the Akaike Information Criterion (AIC). RESULTS/FINDINGS 241,957 units of RBCs were transfused over 2557 days in the study period. The log-normal and gamma distributions had superior K-S distances and AICs for daily RBC usage. The top percentile of days for RBC usage was significantly more likely to have at least one ultramassively transfused patient (p < .001, Fisher's Exact Test). CONCLUSIONS The log-normal and gamma distributions better describe the right-skewed and entirely positive empirical distribution of daily RBC usage as compared to the normal distribution. This should broadly inform inventory management efforts and future descriptions of RBC usage at the institutional level.
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Affiliation(s)
- Colin Murphy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, United States
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Boroumand-Noughabi S, Rahmati A, Morovatdar N, Keramati M. Significant decrease in the transfusion rates during the COVID-19 pandemic in the North East of Iran. Transfus Clin Biol 2021; 29:181-182. [PMID: 34973462 PMCID: PMC8714607 DOI: 10.1016/j.tracli.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/14/2021] [Accepted: 12/26/2021] [Indexed: 11/13/2022]
Affiliation(s)
- S Boroumand-Noughabi
- Department of Hematology and Blood Banking, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - A Rahmati
- Department of Hematology and Blood Banking, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - N Morovatdar
- Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - M Keramati
- Department of Hematology and Blood Banking, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Jacobs JW, Booth GS. Blood shortages and changes to massive transfusion protocols: Survey of hospital practices during the COVID-19 pandemic. Transfus Apher Sci 2021; 61:103297. [PMID: 34690073 PMCID: PMC8530788 DOI: 10.1016/j.transci.2021.103297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/29/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
Introduction The COVID-19 pandemic has resulted in severe ongoing blood shortages across the US, despite employment of numerous blood-conservation measures. Massive transfusion protocols (MTP) are one resource-intensive practice that utilize significant amounts of blood products. Alterations to the composition of MTP parameters to conserve scarce biologic resources have hitherto not been examined during the pandemic. Methods An anonymous 18-question survey was administered to 115 hospitals with valid email contact information. Survey questions addressed whether institutions have altered their MTPs due to the COVID-19 pandemic and blood shortages, and if so, what adjustments they have made. Additional details concerning potential differences in the number and cycles of MTPs and blood product wastage during the COVID-19 pandemic compared to the year prior were assessed. Results 50 responses were received (43 % response rate). 10 % (5/50) of institutions altered their MTPs utilizing a variety of approaches in attempt to conserve blood during the COVID-19 pandemic. Four additional institutions intend to alter them if it becomes necessary. Following onset of the COVID-19 pandemic, 24 % of institutions (12/50) reported an increase in monthly MTP activations, while 16 % (8/50) reported decreased activations compared to prior to the pandemic. 22 % (11/50) of institutions experienced increased blood wastage, whereas 16 % (8/50) reported decreased waste compared to pre-pandemic. Discussion The results of this survey highlight a variety of mechanisms by which institutions have attempted to conserve blood via altering MTPs. Whether an institution adjusted their MTP does not correlate with changes in blood product wastage compared to pre-pandemic.
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Affiliation(s)
- Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, 330 Cedar Street, New Haven, CT, 06520, USA.
| | - Garrett S Booth
- Department of Pathology, Microbiology & Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Rajbhandary S, Shmookler A, Cohn CS, Nunes E, Karafin MS, Stubbs J, Pagano MB. Hospital transfusion service operations during the SARS-CoV-2 pandemic: Lessons learned from the AABB hospital survey in preparation for the next infectious disease outbreak. Transfusion 2021; 61:3129-3138. [PMID: 34469010 PMCID: PMC8661942 DOI: 10.1111/trf.16643] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 01/28/2023]
Abstract
Background The SARS‐CoV‐2 pandemic disrupted hospital operations, affected the blood supply, and challenged the health care system to develop new therapeutic options, including convalescent plasma (CCP). The aim of this study is to describe and analyze blood supply fluctuations and the use of convalescent plasma in 2020. Methods AABB distributed a weekly and biweekly questionnaire through email to hospital‐based members (HBM). Results The survey was sent to 887 HBM with 479 unique respondents, most of the hospitals served pediatric and adult patients, and all states of the country participated, except Idaho and Vermont. Fifty four percent of HBM reported increased wastage in the early phase of the pandemic (May), which decreased to 4% by the end of June and throughout the rest of the year. The majority of HBM reported receiving alerts from their blood suppliers reporting blood shortages throughout the year. During March and April, only 12% of HBM were performing elective surgical procedures. The top reasons to delay procedures were: bed availability (28%); COVID‐19 caseload (23%; and blood availability (19%). By mid‐April, 42% HBM had transfused CCP and reported >24 h delay in getting the units; the vast majority obtained CCP using the Expanded Access Protocol, and later, the Emergency Use Authorization. HBM consistently prioritized the most severe patients to receive CCP, but the proportion of severely ill recipients fell from 52% to 37% between May and October, with an increase from 5% to 21% of HBM providing CCP transfusion early in the course of the disease. Discussion Blood utilization and availability fluctuated during the pandemic. The fluctuations appeared to be related to the number of COVID‐19 in the community. The use and regulatory landscape of CCP rapidly evolved over the first 8 months of the pandemic.
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Affiliation(s)
| | - Aaron Shmookler
- WVU, Pathology, Anatomy and Laboratory Medicine, Morgantown, West Virginia, USA
| | - Claudia S Cohn
- Lab Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | | | - Matthew S Karafin
- University of North Carolina System, Chapel Hill, North Carolina, USA
| | - James Stubbs
- Mayo Clinic Rochester, Transfusion Medicine, Rochester, Minnesota, USA
| | - Monica B Pagano
- Department of Laboratory Medicine, The University of Washington, Seattle, Washington, USA
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