|Year : 2021 | Volume
| Issue : 1 | Page : 49-53
Impact of COVID-19 Pandemic and Subsequent Lockdown on Blood Transfusion Service in a Tertiary Healthcare Institute of South India – A Learning Experience
Parmatma Prasad Tripathi1, Vijay Kumawat1, Gopal Kumar Patidar2
1 Department of Transfusion Medicine and Haematology, NIMHANS, Bengaluru, Karnataka, India
2 Department of Transfusion Medicine, AIIMS, New Delhi, India
|Date of Submission||21-Jan-2021|
|Date of Decision||25-Feb-2021|
|Date of Acceptance||19-Mar-2021|
|Date of Web Publication||29-May-2021|
Dr. Vijay Kumawat
Department of Transfusion Medicine and Haematology, NIMHANS, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background and Objectives: Coronavirus disease-19 (COVID-19) pandemic has affected people all over the world and poses challenges to health-care services. Lockdown was first response strategy implemented by governments including India to prevent spread of coronavirus 2. The lockdown and anxiety among public had severely affected transfusion services. This paper analyses the impact of COVID-19 pandemic and lockdown on blood transfusion services. Methods: A retrospective analysis of the transfusion services for 5 months was carried out. The data regarding blood collections, blood donation camps, blood issued, and therapeutic plasma exchange (TPE) performed were collected and analyzed during 3 phases of the study period, i.e., phase 1 (pre-lockdown, 84 days), phase 2 (complete lockdown, 40 days), and phase 3 (partial lockdown, 28 days), and compared. Results: A significant drop (P = 0.010) was observed in blood donation from phase 1 to phase 2 but slight nonsignificant improvement was found from phase 2 to phase 3. The issue of blood was significantly reduced from phase 1 to phase 2 (P < 0.0001) and improved from phase 2 to phase 3 (P < 0.0049). There was a significant reduction (P < 0.00001 and 0.002) in patients referred for TPE during two phases of LD. Conclusion: There is significant decrease in blood supply and utilization due to pandemic and lockdown. An emergency blood management plan is required which can include donor education focusing to alleviate donor hesitation, relaxation to donor selection criteria, blood drive planning with inventory management and ensuring staff and product safety.
Keywords: Blood components, blood donation camps, lockdown, therapeutic plasma exchange
|How to cite this article:|
Tripathi PP, Kumawat V, Patidar GK. Impact of COVID-19 Pandemic and Subsequent Lockdown on Blood Transfusion Service in a Tertiary Healthcare Institute of South India – A Learning Experience. Glob J Transfus Med 2021;6:49-53
|How to cite this URL:|
Tripathi PP, Kumawat V, Patidar GK. Impact of COVID-19 Pandemic and Subsequent Lockdown on Blood Transfusion Service in a Tertiary Healthcare Institute of South India – A Learning Experience. Glob J Transfus Med [serial online] 2021 [cited 2021 Jun 25];6:49-53. Available from: https://www.gjtmonline.com/text.asp?2021/6/1/49/317117
| Introduction|| |
Coronavirus disease-19 (COVID-19) pandemic originated during December 2019 as an outbreak in Hubei province (China). The World Health Organization (WHO) on January 07, 2020 reported cluster of unknown pneumonia patients in Wuhan, China, due to a new severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), a member of the coronavirus family. WHO announced the COVID-19 outbreak as a public health emergency of international concern and declared it as a pandemic disease on January 31, 2020. At the end of June 2020, this pandemic affected almost 10 million people worldwide. This rapid progression of the SARS-CoV-2 virus completely changed the lives of people as well as it has increased the burden on health-care services. The health-care services worldwide were fighting with this pandemic resulting in patients with other diseases neglected. The first case of COVID-19 was reported on January 30, 2020, in Kerala and subsequently it spread to other states of the India. Many countries restricted the movement of people by implementing complete lockdown measures to prevent the community spread of the virus. The COVID-19 pandemic and subsequent lockdown had also affected the blood transfusion services. The effect of pandemic on blood transfusion services had been reported in various countries previously.,, The Government of India response was also prompt to impose a complete lockdown in the country from March 25, 2020 with approximately 650 COVID-19 patients at that time and extended gradually over the next 3 periods till May 31, 2020. The lockdown was graded from full restriction of all people movements except emergency services (complete lockdown) to relaxation allowing limited movement of people to resume financial activities (partial lockdown). The lockdown affected blood transfusion services significantly due to the restriction of blood donor movements. The outpatient department services and scheduled elective surgeries were also deferred in response to COVID-19 preparedness at our institute and lockdown guidelines of Government of India.,,
Objectives of the study
We analyzed the impact of lockdown on blood transfusion services offered by the department including blood collection, issue of blood components and therapeutic plasma exchange (TPE) as clinical service for various neurological disorders.
| Materials and Methods|| |
This retrospective observational study was conducted at a tertiary health-care center in southern part of India from January 01, 2020, to May 31, 2020. This 5-month period was divided into three phases. Phase 1 period of 84 days from January 01, 2020, to March 24, 2020 corresponding to the prelockdown period, phase 2 period for 40 days from March 25, 2020, to May 3, 2020, representing the lockdown period 1 and 2 (complete lockdown), while 3rd phase from May 3, 2020, to May 31, 2020 corresponding to the 3rd and 4th lockdown period (partial lockdown).
For all three phases, the data were collected for total blood collections, voluntary blood donation camps (VBDC), blood donor recruitment by the different methods of donor recruitment, total blood/blood component issued to patients and number of TPE performed by the department. The TPE, patients were categorized based on indication as per the American Society for Apheresis 2019 guidelines. The data were collected from blood bank records.
All the data were analyzed using Microsoft excel-2016 (Microsoft corporation, Redmond, WA, USA). Paired t-test (two tailed) and Chi-square test were performed for inter-group comparison and P < 0.05 was considered as statistically significant.
This study was approved by Institute Ethics Committee (NIMHANS/IEC/2020-21 dated 30-06-2020). An ethical waiver was granted for retrospective study of deidentified records.
| Results|| |
Results were analyzed in three categories total blood donation, total blood units transfused and TPE procedures performed.
Whole blood donations
A statistically significant drop (P = 0.010) was observed in blood donation from phase 1 to phase 2 but slight nonsignificant improvement was found from phase 2 to phase 3 [Figure 1]. A total of 16 VBDC were organized during phase 1 while only 1VBDC in phase 2 and 2 VBDC in phase 3 were conducted. The contribution through VBDC to total collection also significantly (P < 0.0001) dropped by more than 90% from phase 1 to phase 2, while it increased significantly (P = 0.002) from phase 2 to phase 3 [Figure 2]. The decline in inhouse voluntary blood donation was also around 90% from phase 1 to phase 2 while it increased by 60% from phase 2 to phase 3. There was more than 50% decline in blood donors who were mobilized by nongovernment organizations from phase 1 to phase 2 and 100% reduction was observed in phase 3. It is noteworthy that the medical fraternity of our institute and their family members responded by donating blood accounting for 29.06% of total collection during phase 2 and 15.88% during phase 3. However, the recruitment through social media accounted for only 2.87% of total donors during lockdown [Figure 2].
Issue of blood/blood components
The blood stock of packed red blood cell (PRBC), FFP and platelet concentrates were 261, 902 and 9 units, respectively in the beginning of phase 1 of the study. The stock of PRBC and PC were higher (300 units) and similar (9 units) at the starting of phase 2 of the study, while the FFP stock was reduced to 387 units. The stock of all three components was significantly reduced in the beginning of phase 3 but it improved at the end of phase 3 [Figure 1].
The issue of blood components was reduced from phase 1 to phase 2 (P < 0.0001) and improved during phase 3 compared to phase 2 (P < 0.0049) [Figure 1].
PRBC issued in phase 1, 2, and 3 of the study were 1424, 344, and 294 units respectively. FFP and platelet utilization was 1551, 256, 275 and 372, 48, 52 in the all three phases of the study respectively [Figure 1].
Therapeutic plasma exchange
There was a statistically significant reduction (P < 0.00001 and 0.002) in patients referred to our department form phase 1 to phase 2 and phase 3 of the study, respectively. The number of TPE procedures performed during different phases of study varied significantly. Maximum number of TPE procedures were performed for category I indication patients in all three phases of the study, especially in second phase of the study (85.45%). In third phase of the study, number of category I and category III patients were almost similar [see [Table 1]].
|Table 1: Number of therapeutic plasma exchange referrals and procedure performed as per the American Society for Apheresis category during the study|
Click here to view
| Discussion|| |
COVID-19 affected almost all the nations and the inflexible measures like lockdown have a role to slow the spread of coronavirus but application of lockdown also had a deep impact on the health-care system. While the negative impact was that the normal health services and transfusion services were badly affected, the positive impact was that it brought in new donors to the blood center especially many from the medical fraternity. The clinical services inclusive of transfusion services, blood donation, and blood component supply was also affected.
In the initial 84 days of prelockdown period, departmental services were fully functional and running smoothly. The almost 90% blood donation was from VBDC but during phase 2 of the study (40 days) when all nonessential services were restricted, only one blood donation camp was conducted. The Government of India issued an advisory note for holding all voluntary donation camps as a part of the “curtailment strategy” to avoid mass gatherings during early period of lockdown. The fear in the minds of the public with respect to COVID-19 kept them away from hospitals/blood centers causing shortage of blood supply. Previous epidemics such as SARS and Influenza have also caused dramatic reduction in blood supply., Raturi et al. from India also reported 64% drop in blood donors during COVID-19 pandemic recently. The social media motivation through WhatsApp (Facebook, Menlo park CA, USA) and Facebook (Facebook, Menlo park CA, USA) was initiated and donors who showed their willingness to donate blood were issued movement pass or vehicle passes to facilitate their movement in hospital vehicle. The previous studies have showed a higher response using social media. A recent study by Waheed et al. showed 31.65% donors responded to the WhatsApp message and donated blood in their country during COVID-19. However, social media failed because people did not take the risk of venturing out during an official lock down period. During the third phase of the study, government eased off many restrictions and movement of people started which subsequently resulted in increase of voluntary blood donation and VBDCs were organized. Still, the donations were not the same as prelockdown because major voluntary organizations and institutes were yet to open, and voluntary donors were still scared of contracting infection while visiting hospital and blood donation centers.
The blood stocks were also significantly reduced in 2nd and 3rd phase of the study as compared to first phase due to limited blood donations. After implementation of the complete lockdown (second phase of the study), outpatients services and routine surgeries of our hospital were deferred. Consequently, the utilization of the blood and blood components also reduced significantly. The utilization of FFP was almost 85% reduced from phase 1 to phase 2 of the study due to less issue for TPE procedures and it improved in phase 3 of the study. The utilization of PRBCs also reduced by 75% in phase 2 due to limited inhouse admitted patients and only emergency surgical procedures being performed by clinicians. A study by Fan et al. also reported a decrease usage of 16%, 21.2%, and 15.7% of PRBCs, FFP, and platelets, respectively, during COVID-19 pandemic. To reduce the wastage of blood components due to under-utilization, first in first out policy followed strictly and we also transferred near expiry blood components to near-by blood centers as and when demanded.
The TPE procedures were performed for three categories of indications (category I to III) with category I contributing to 72% cases initially but in phase 2 of the study 90% of the patients were from category I indications, mainly due to shutdown of the outpatient's services and only emergency/critical patients were being admitted to hospital. Previous studies in different specialties also reported decline in workload during COVID-19 pandemic like endoscopies, gastrointestinal and hepatobiliary surgeries, vascular surgeries, and routine minor surgeries. The category II and category III patients started rising during phase 3, as clinicians started consulting less critical cases also.
| Conclusion|| |
Dealing with effects of COVID-19 pandemic on various health services is still in learning phase and evolving. The restriction on movement of people to contain COVID-19 spread essentially had a negative impact on normal health and blood transfusion services. The healthcare workers emerged as frontline workers not only for treating patient but also in donating blood to tide over the crisis. The blood wastage was minimized by transfer of blood components to other blood banks or health-care facility. A proper emergency blood management plan required to fight with pandemics like SARS-CoV-2 as described by Stanworth et al. including donor education and recruitment are essential with special focus on alleviation of donor hesitation anxiety and fear. Possible relaxation to donor selection criteria, appropriate blood drive planning and inventory management and ensuring staff protection along with product safety are essential during pandemics.
For the future, every country must consider drafting their own policies for disaster management during such pandemics and lock downs.
Limitations of study
This was a retrospective analysis with limited sample size of blood collection and issues during study period.
We acknowledge guidance and encouragement provided by Prof. Vani Santosh (HOD). We also acknowledge support received from Mr. Shivanna N, Mr. Vivekananda, and Mr. Erraiah for helping to retrieve data.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]