The coronavirus disease 2019 (COVID-19) pandemic has led to a reduction in both blood donations and the demand for blood transfusions. However, because patterns in demands are uncertain, it is important for institutions to plan for reductions, according to a review published in The Lancet Haematology.
Simon J. Stranworth, FRCP, of NHS Blood and Transplant, John Radcliffe Hospital in the United Kingdom, and colleagues conducted a systematic search of studies that addressed the transfusion process (from donor, to collection and processing, to patient treatment) to compile a synthesis of published literature on COVID-19 and expert guidance on transfusion practices during potential and actual blood shortages.
More than 9000 citations were identified from March 23, 2020, to April 30, 2020, and 414 citations were included in the final list. The researchers noticed a steady increase in the number of citations in April, and the proportion of topics pertaining to transfusion processes from donor to patient. Finally, they identified 1255 references on emergency planning and chose 121 relevant citations in the analysis. Using the relevant citations, the investigators narrowed down their findings into 5 themes.
Theme 1: SARS-CoV-2 Infection Characteristics That Affect Patient Transfusion Needs
To address possible mismatches between blood supply and demand, the authors noted that it is important to understand features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On admission, anemia is uncommon and severe anemia is uncommon among patients admitted to intensive care during the first 3 days of admission.
When presenting with thrombocytopenia, severity appears to be a marker for poor outcomes; however, citations indicated that many patients with COVID-19 do not need transfusion.
“Higher transfusion requirements are expected in patients who have extracorporeal membrane oxygenation than in those who do not, but this outcome is relevant to only a small number of patients,” the authors noted.
Elevated D-dimer concentrations, a distinct coagulation disturbance, was also reported as a poor prognostic marker. No data has been available on the benefits of red blood cell transfusion to maintain hemoglobin concentrations (>70 g/L) for patients with SARS-CoV-2 infection with significant respiratory symptoms.