The UCI Transfusion Medicine Service is issuing this Service Brief to alert UCI Health providers to reductions in regional blood supply anticipated during the current COVID-19 outbreak. Thus, strict blood and platelet inventory management is required, and participation by all providers at UCI Health is necessary to minimize impact on patient care.
Background
Annually, the nation transfuses over 10 million RBCs, 2.3 million units of plasma, 1.9 million PLT units, and 1.1 million units of cryoprecipitate [1]. The nation’s blood supply depends upon the generosity of altruistic blood and platelet donors. Currently, there is no evidence to suggest that COVID-19 is transfusion transmissible [2].
The American Red Cross, a primary blood supplier for the UC system, will begin implementing precautionary measures this week to manage the declining supply [3]. These measures include reduced fulfillment of both standing and ad-hoc blood orders and active approval process for all STAT blood orders.
We are working to finalize a secondary vendor relationship with Houchin Community Blood Bank and will continue to operate the UCI Blood Donor Service. We anticipate, however, that all blood centers and hospital transfusion services will be impacted equally by current events.
Effective date: Immediately
References: Click here for references
Measures to Minimize Impact to Patients
- Clinicians are asked to carefully review the clinical urgency of EVERY transfusion order.
- Transfusion orders are often placed in anticipation for procedures. Instead, transfuse only at the time of a procedure to avoid the scenario where a transfusion is completed but then the procedure is either delayed, cancelled, or rescheduled.
- For non-bleeding oncology patients, consider a single-unit platelet transfusion strategy [4].
- Re-evaluate platelet transfusion strategy in patients with poor post-transfusion increments; the Transfusion Medicine Service is available to assist with such scenarios.
- For non-bleeding patients with anemia, adhere to a restrictive pre-transfusion threshold (Hb <7 g/dL in most patients). Modern transfusion practice is to proceed with single-unit red cell transfusions in non-exsanguinating patients [5,6].
- Re-evaluate pre-procedural platelet transfusion practices; arbitrary pre-procedural platelet count thresholds may not be attainable in all patients (particularly those with cirrhosis and splenic sequestration).
- For Trauma patients or those requiring massive transfusion support, we ask that efforts be re-doubled to provide initial and type-check specimens to the blood bank. This allows us to convert to type-specific red cells as soon as possible, thereby conserving group O red cell units.
- The Transfusion Medicine Service will be carefully screening blood product orders with ordering providers/services.
Cooperation from all clinical teams will be crucial as orders are triaged in order to ensure the patients with the most urgent needs receive the products they need.
Sincerely,
Minh-Ha Tran, DO
Director
Division of Transfusion Medicine
Edwin S. Monuki, MD, PhD
Chair
Department of Pathology & Laboratory Medicine
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