The best approach to managing a blood shortage is comprehensive and incorporates four key components.
1). Increase Blood Donations: This includes both blood supplier marketing campaigns and hospital leadership and communications teams promoting blood donation to staff and the community.
2) Blood Product Inventory Management: Hospital transfusion services must closely communicate with clinical leadership to minimize the risk of blood product outdate and waste. This includes carefully measured blood product ordering with the blood supplier, identifying opportunities to share nearly expired blood products with other hospitals, and collaborating with nursing leadership to eliminate product wastage.
3) Optimize Transfusion Ordering Practices: Blood shortages are an important time for clinical leadership to regularly communicate the need for providers to carefully weigh each transfusion decision and dose. If shortages become severe, the Transfusion Service should implement a prospective audit of all transfusion orders and establish a policy for prioritizing blood product distribution if necessary.
4) Transfusion Mitigation Strategies: This component promotes Patient Blood Management and the ability to avoid transfusions with a proactive approach. Implement anemia management protocols for perioperative anemia, acute blood loss and anemia associated with chronic disease or iron deficiency. Implement measures to minimize blood loss. This includes developing guidelines for the use of antifibrinolytics, prothrombin complex concentrates and other medications to prevent or treat bleeding. Optimize use of perioperative autotransfusion in surgery, high risk obstetrics, and trauma. Reduce blood draw volume in ICU patients with smaller tubes and blood waste reinfusion devices for central line draws.
Whether as a result of COVID-19 or any of the other factors that create blood shortages, it is important to take a comprehensive approach. This requires multi-disciplinary collaboration and communication and ensures that our communities and patients get the best care possible.