Blood transfusion is an important part of health services and is lifesaving in many conditions. SARS-CoV-2 (also known as COVID-19) has been an unprecedented challenge in many parts of the medical field with blood banking being no exception.
Blood services must be prepared to move quickly in response to changes in the pandemic situation. A national approach, rather than a sub-national or local approach, should be adopted for coherence and coordination, but taking into account any specific localised factors or needs.
The World Health Organization (WHO) has issued early during the pandemic a guidance for blood services entitled “Maintaining a safe and adequate blood supply and collecting Convalescent plasma in the context of COVID-19 pandemic” to give directions and support to blood services in taking required action considering: mitigating the risk of staff and donor exposure to SARS-CoV-2 , managing the demand for blood and blood products , preventing disruption in supplies of critical material, temporary deferral of donors, mitigating the impact of reduced availability of blood donors, and equipment. The guidance was so important and useful to blood services.
During the pandemic, blood donation centres adopted additional eligibility criteria to ensure safety of blood donors and patients receiving blood. Such criteria have been continuously updated according to the information received from the WHO, Food & Drug Administration (FDA) and local health authorities in different countries.
The WHO has provided no recommendations about screening the donors for SARS-CoV-2 by RT-PCR or immunoassays, however, it recommends temporary deferral for 28 days if any symptoms (cough, fever, flu) are present, or if they are exposed to a confirmed COVID-19 patient or have travelled to an epidemic area. It also recommends that the potential donors inform the blood donation centre if they develop symptoms within 28 days of donation. On March 2020, the American Association of Blood Banks (AABB) issued a toolkit and further recommending on eligibility criteria and deferral guidelines. The International Society of Blood Transfusion (ISBT) has afforded a wide range of scientific material to guide blood services during this critical time, through availability of guidance, educational sessions and live webinars through its website available for blood transfusion professionals.
The emergency and disaster authorities in almost all countries had implemented many guidelines to limit the spread of the infection and to ensure the safety of the population. The blood services faced a big challenge in maintaining its services that starts by availability of eligible blood donors. In most countries there was movement restriction for certain period of time, lockdowns and closures of many offices that was replaced by working from home. All of the previously mentioned factors have affected the organisation of blood donation campaigns and drives which is in most blood services the major source for blood donors.
The availability of a comprehensive and well-structured business continuity plan is an important part of any important facility planning to act during such a pandemic. To ensure donors safety during donation and staff safety in keeping social distance, blood services have adopted many measures such as giving appointments for donors to avoid crowds, extending or changing working hours, and in case their existing space for collection was small then finding temporarily bigger halls to carry out blood collection. Placing thermal cameras to check employee and donors body temperature at entry point to blood centre, frequent cleaning, social distancing in seating the donors and, of course, the usage of personal protective equipment as required by local health authorities. Ensuring the availability of the required number of donors was a big challenge that has been well managed in blood centres that have an updated data base for blood donors, including their contact telephone or emails. Contacting the donors by telephones, SMS, emails or calling public through social media posts has played a very important role in keeping the flow of blood donors to visit the blood centres.
Different countries have implemented different precautionary measures to avoid the transmission of COVID-19 among their populations. In many countries, lockdown strategies and social distancing is mandatory to reduce person-to-person transmission. Accordingly, the prevalence of asymptomatic cases has varied in different countries, and this has been reflected in blood donors.
In the absence of evidence-based guidelines, the international community has adopted conservative measures to ensure the safety of blood products at the level of blood donation. The recommendations suggest the education of donors on self-deferring in exposed or symptomatic patients and informing the blood centre if they develop COVID-19-related symptoms within 28 days of donation. Patients who had or were exposed to COVID-19 had to self-defer for at least 28 days. It was also recommended to quarantine the blood products until the donor is considered safe defined by the ‘absence of a reported subsequent illness’ and recall the blood components if the donor became symptomatic or reported contact with a certified case within 14–28 days of donation.
The prescription of blood products has been impacted by the decision of the medical community to defer elective surgeries and requested treating physicians to prioritise their blood and components requests. Priority was given to thalassaemic patients, oncology and critically ill patients. A good network between blood donation centres and ordering physicians is also very important.
The lessons learned from COVID -19 pandemic includes but not limited to the following:
- The need to continuously be updated with the changes of the pandemic situation locally and at international levels by appropriate information from local health authorities and WHO.
- Having an updated data base for registered blood donors to contact them during emergencies.
- Social media’s role is an essential and important tool to educate the public about the need for blood donation, measures taken by blood facilities to ensure their safety during donation and working hours.
- Having a well-structured business continuity plan, emergency and disaster plan and appropriate patient blood management policies and procedures.
- Participation in conferences, workshops, working parties at national, regional and international levels has helped blood services a lot to learn from each other by sharing knowledge and experience.
Dr. May Raouf
This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.