Patient blood management and the Covid-19 Pandemic: An institutional study

Abstract

Introduction: The COVID-19 pandemic in India is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19). Despite no convincing evidence that this virus can be transfusion-transmitted, the absolute disruption we have seen in everyday life has dramatically reduced the amount of blood donations. Applying the Patient Blood Management (PBM) method is very useful. It is the scientific use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding to improve patient outcomes. PBM conserves a precious community resource, reduces unnecessary hospital and patient care costs, improves patient safety by minimizing exposure to blood, can reduce the risk of hospital-acquired complications and infections, and increases the consumer interest in safety. Efforts to correct anemia in the general population, as well as the imple­mentation of safe blood drive protocols, must be in place to mitigate the risk of viral exposure. This study aimed to assess the indications and requirements of blood and blood products in Covid-19 cases and to develop safe transfusion practices concerning PBM during the Covid-19 pandemic. Methods: This observational study was done in the Blood Bank RLJ Hospital Department of Pathology attached to Sri Devaraj Urs Medical College & Hospital. The records of all COVID-19 positive patient's including their history, blood and blood component utilization from the medical record section, as well as the blood bank and requisition forms sent to a laboratory for investigation and collected over a duration of 6 months (March 2020 to August 2020). Results: Out of 200 COVID-19 positive cases analyzed, only 70 (35%) patients received a blood transfusion, in which 64.28 % (45) patients received single unit PRBCs because of severe anemia and pregnancy-related anemia. Additionally, 25.7% (18) patients received a platelet transfusion because of underlying comorbidities, and 10% (7) received FFP. In all COVID-19 positive patients, we observed a raised ESR. A few patients had raised PT and APTT levels. Patients with mild and moderate anemia presented with microcytic hypochromic anemia and normocytic normochromic anemia. We adopted the Cleveland clinic blood management for low hemoglobin to avoid unnecessary blood transfusions. Conclusion: PBM was found to be an important interventional tool to meet the shortage of blood during the COVID-19 pandemic successfully. An evidence-based emergency blood management plan and flexible regulatory policy should be ready to deal with any disaster and to respond quickly in the case of a blood shortage. While pandemics may reduce the blood supply, our study demonstrated that hospitalized COVID-19 patients had a low level of blood usage. Future studies examining the impact of patient factors may help to further elucidate the mechanisms affecting blood utilization in hospitalized COVID-19 populations.