Planning for Blood Shortages in a Pandemic 

Dr. Claudia Cohn shares her insights as a CMO and Blood Lab Leader

Dr. Claudia Cohn got the bug for research early in her career and never lost it. She was drawn to pathology specific to transfusion medicine – the associated research questions, the patient situations, and the work itself. She subsequently became involved with the largest organization in the U.S. focused on blood management, AABB. This involvement evolved into an interest and further research on patient blood management in an effort to impact patient care. HPI connected with Dr. Cohn to discuss her experiences and learnings throughout the pandemic from the perspective of her roles as the Chief Medical Officer of the AABB and the Blood Bank Laboratory Director at the University of Minnesota.

AABB, Chief Medical Officer
I actually first became aware of the COVID-19 crisis in my role with the AABB. In late December I received an email from the head of the transfusion disease committee, Dr. Lou Katz. He noted that there was a new virus in China, inquiring if the committee thought we needed to worry about it. Several of us looked at the data and thought it was not transmitted through blood. We speculated on whether we really needed to worry about it, aside from making sure that the donor population was not impacted. We of course didn’t recognize how explosively the pandemic was going to affect everything throughout the world, including blood donations.

 
Dr. Cohn highlights the value of the AABB organization for us, noting that they support donor centers, blood collection centers, hospital transfusion services as part of their everyday work. Throughout the pandemic, they have expanded these efforts by creating guidelines to make it safer for donors to come into blood collection centers by scheduling appointments, screening donors before they come through the door while maintaining social distancing and cleaning all surfaces between donations. They also partnered with the media to help spread that blood donations were needed desperately, and people started to come out to donate again. They held huge webinars with hundreds of participants hungry for information. Thought leaders, like Dr. Steve Frank at Johns Hopkins, joined the conversation to explain the standard measures hospitals are taking to preserve the blood supply. These efforts no doubt helped get necessary education out into the market, as far and as quickly as possible.

University of Minnesota, Blood Bank Laboratory Director
Dr. Cohn notes two things that hit at the same time here: (1) the realization that the crisis was going to cause a shortage in blood and (2) that the crisis was going to cause a shortage in ICU beds, personal protective equipment and ventilators. Her first initiative in addressing the pandemic in her blood banking role was developing a plan for how to deal with a blood shortage.

The system was low on platelets and subsequently needed to delay some transfusions. Those that were bleeding got platelets right away but those who weren’t bleeding had to wait (even if just a few hours) for prophylactic transfusion of platelets. This was an entirely new sort of paradigm because it was going to potentially be a long-term shortage. We quickly shifted to using all the knowledge we’ve gained through patient blood management, immediately reducing the amount of blood used at the hospital. We were already doing a pretty good job, using a hemoglobin of 7 as a trigger for a transfusion in stable patient populations. We had already applied platelet triggers. We had already optimized the usage of iron and techniques in the surgical suites. We simply had to double down on all of it to make sure no patient leaked through the cracks.

In terms of the early cases of COVID, our hospital did a very nice job segregating infected patients. We had just expanded our hospital system by three, so we took one of those hospitals, stripped it down, transferred all patients out of its ICU and made it a COVID only ICU. We then began transferring other patients out of that hospital into other hospitals in the system, ultimately making more ICU beds available. We were also able to contain the spread amongst healthcare workers and other patients through these efforts. Our cases have now been down for a while, including reduced number of deaths. We had expanded from the one dedicated ICU to three but now we’re back just one hospital. I think our clinicians have learned how to handle cases better because there’s more testing available. Patients are coming in earlier, so they aren’t as sick. It may also be a possibility that, since early in the pandemic raged through with the institutions, these facilities are now filled with people who are immune so it may not affect them as much.

Moving Forward
Dr. Cohn shared her thoughts on how she sees the current landscape of progress in reference to blood use throughout the pandemic. Ironically, prior to the first case of COVID-19 hitting the U.S., there was an advisory committee for blood and tissue safety within U.S. Health and Human Services. The goal was to develop a report on the safety of the blood supply in case of a natural disaster or pandemic. Dr. Cohn was one of the members working on that when the pandemic hit.

We have found that there isn’t a lot of information nationwide about how much blood is collected and used. There are surveys that go out once every two years, but many hospitals have their own information about how much blood they use. Nationally, blood centers had no idea what the effect of of canceling elective surgeries was going to be. No one knew how much blood would not be needed when elective surgeries were cancelled or how much would be needed once they started ramping up again. What we’ve learned through these activities about how blood is used in the U.S. will help us respond to future threats to the blood supply much better.

Dr. Cohn believes that the medical and scientific community responded as quickly as it possibly could to a very difficult situation, demonstrating the best and worst of the U.S. health system. The U.S. health system is very innovative. It’s very driven by entrepreneurial activities. We saw multiple companies, universities and scientific centers come up with tests rapidly. But the worst of our system was buried in these activities as well. In the case of convalescent plasma in treatment of COVID, it’s hard to analyze data from different randomized control trials because each trial has used its own antibody testing to determine the level of antibody used in the convalescent plasma. It makes me wish that we had a more centralized authority that could organize efforts for future problems.

Dr. Cohn is clearly passionate about blood collection, transfusion, and management. She believes blood should be treated like a utility, like water or electricity, with even more regulation to maintain the flow of technology on patient safety. I will continue to do everything I possibly can to help further the blood industry and make blood safer for patients.

Thank you for your contributions and commitment Dr. Cohn. We can’t wait to see what where you profoundly impact healthcare next!

Dr. Claudia Cohn, MD, PhD

Dr. Claudia Cohn, MD, PhD

Associate Professor of Laboratory Medicine and Pathology, Director of Blood Bank Laboratory, Associate Director of Clinical Laboratories, University of Minnesota, Chief Medical Officer, AABB