Theme 4: Prioritizing Patient Blood Use in Predicted Shortage Event

For red blood cell shortages, a possible action is to review the threshold of red blood cell transfusions for stable and low-risk patients.

In the event of platelet shortages, platelets used as prophylaxis should only be for patients with hypoproliferative thrombocytopenia without clinical bleeding. This includes autologous transplantation. Local policies should be reviewed on blood shortages for patients with bleeding. 

At times of blood shortage, emphasizing the use of alternatives to transfusion may be required.


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Theme 5: Convalescent Plasma and Immunoglobulin Use

There is a considerable interest in the use of immunotherapies and convalescent plasma from patients who have recovered from COVID-19 infections, with many randomized trials recently registered and ongoing. There are variations in protocol design between these trials, therefore, several organizational challenges must be addressed to support and deliver a convalescent plasma program.

The authors also suggested passive immunization as another treatment option, which would require the collection of plasma to extract hyperimmune immunoglobulins; however, large amounts of plasma would need to be collected to implement this option.

“Recommendations have not been provided for each theme, although many of the actions described could be considered as best practice suggestions,” the investigators wrote.

The authors noted that a limitation of the analysis was that only 1 researcher conducted the initial screening. In addition, the quality of many of the publications was insufficient and several of the searches were observational.

Contrastingly, the investigators noted that they identified a large number of ongoing randomized trials that addressed topics that were relevant to practice.

“Recommendations for transfusion should conform to general messages of restrictive use of blood. In collaboration with public health agencies, blood services are well placed to contribute to epidemiological studies and biobanks evaluating the serology, features, and course of the COVID-19 pandemic,” the researchers noted.

Reference

Stanworth SJ, New HV, Apelseth TO, et al. Effects of the COVID-19 pandemic on supply and use of blood for transfusion [published online July 3, 2020]. Lancet Haematol. doi: 10.1016/ S2352-3026(20)30186-1