Guidance on Blood Conservation Strategies
As we continue to respond to the COVID-19 pandemic, UMMS is identifying and developing new guidelines and policies to guide our daily operations across the System. One of the many detrimental impacts of this crisis has been a drastic decline in the number of people who are presenting each day to donate blood.
On April 17, 2020 UMMS issued guidance on Blood Conservation Strategies to provide direction for clinical staff on:
- Massive Transfusion Event (MTE) coolers
- Transfusion guidelines
- Protocols for non-urgent requests; see the reference guide linked as an appendix at the bottom of the policy for direction on how to handle non-emergency adult transfusion needs
- Considerations for postponement of non-urgent bone marrow transplantation
- Monitoring procedures for massively transfused patients
- Strategies to decrease blood supply wastage of red blood cells, thawed plasma, and platelets
Several modifications have been made to this guidance, calling for the release of an updated version of the policy, effective July 16, 2020. Major changes include:
- Clarification on the scope of responsibility required by the Medical Director (or designee) and the Transfusion Medicine team, as they work together to facilitate orders for blood products (red blood cells, thawed plasma, and platelets) and maintain sufficient inventories during massive transfusion events (MTE).
- Direction on prophylactic transfusions for outpatients, to be capped at one red cell and one platelet unless the patient is symptomatic but regardless of post-transfusion values, per event/order.
- Emphasis on the need for close monitoring of blood product inventories following a MTE of 50 or more units, due to the fact that the blood supply may not be replenished as quickly as normal.
We value and appreciate your willingness to adapt to revised guidelines and protocols as our COVID-19 response continues to evolve.
Click here to view the Guidance on Blood Conservation Strategies.
FAQs
Has there been a decrease in blood donations due to the COVID-19 outbreak?
Yes. Less people have been presenting to donate blood since March, and the impact on patients who require blood transfusions is significant. As blood product inventories decline, and are slow to replenish, we must make blood conservation strategies a priority across our health care System.
What is UMMS doing to try to improve the situation?
We continue to hold blood drives in compliance with all necessary COVID-19 precautions and we encourage those who are able to schedule an appointment to donate blood, to ensure all patients who require lifesaving blood transfusions are able to receive them.
What is a massive transfusion event (MTE)?
Massive transfusion events (MTEs) are those that require a significant amount of blood products (red blood cells, thawed plasma, and platelets) for transfusion. At this time, UMMS is closely monitoring blood inventories following MTEs that require 50 or more units of blood. This is important, as we work to ensure our blood supply remains sufficient to meet the needs of all patients who rely on us for care.
Are non-emergency blood transfusions continuing?
Non-emergency transfusions may continue under the guidance of the Adult Non-Emergency Transfusion Guidelines. Additional communication will be issued to clinical leaders if further prioritization protocols are needed, in light of blood supply shortages.
What about non-urgent bone marrow transplantation?
We still recommend that these cases be deferred if possible, as these patients are immunosuppressed and thus at a higher risk for contracting COVID-19.
What are some ways we are working to decrease blood wastage?
Two strategies have been implemented:
- Rotation of red blood cells (RBC) and platelet units from sister UMMS hospitals as their expiration dates approach.
- Adjustment of daily blood orders to suppliers according to specific patient needs. For example, we evaluate the operating room schedule and determine what supply is needed for the day, rather than continuing with stat orders.