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| SHORT ARTICLE |
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| Year : 2021 | Volume
: 6
| Issue : 2 | Page : 228-232 |
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Impact of the COVID-19 pandemic on the transfusion practice: Experience of a tertiary healthcare hospital from Sousse, Tunisia
Salma Riahi1, Lamia Ifa1, Sihem Boukadida1, Meriem Heni1, Nihel Haddad2, Mahdi Smida1, Amina Bouatay1
1 Department of Haematology and Transfusion Medicine, Hematology and Blood Bank, Sahloul University Hospital of Sousse, Sousse, Tunisia
2 Department of Preventive and Community Medicine, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| Date of Submission | 09-Jun-2021 |
| Date of Decision | 30-Oct-2021 |
| Date of Acceptance | 19-Oct-2021 |
| Date of Web Publication | 30-Nov-2021 |
Correspondence Address:
Dr. Salma Riahi
Department of Haematology and Transfusion Medicine, Hematology and Blood Bank, Sahloul University Hospital of Sousse, Sousse
Tunisia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/gjtm.gjtm_63_21
Background and Objectives: The COVID-19 pandemic created a global health crisis with a multisector disruption, particularly in blood transfusion services where restrictive measures unsettled the blood supply. In this context, we have reported our experience during this crisis by evaluating the transfusion activity before and during the pandemic as well as the measures undertaken. Methods: This was a retrospective descriptive study conducted at the blood bank of a tertiary healthcare hospital from Sousse, Tunisia, during the years 2019 and 2020. The analysis focused on the monthly comparison of data of the blood bank including the number of donations recorded and the number of labile blood products produced and distributed during the 2 years of the study. Results: The total number of annual donations in 2020 decreased by 14% compared to 2019. The number of monthly donations decreased significantly, especially during the two epidemic peaks in Tunisia (in April and October 2020). The production of packed red blood cells has decreased by 17% (up to 53% reduction during the first wave). The production as well as the distribution of fresh frozen plasma and platelet concentrates decreased significantly with an annual reduction of 12.3% and 25%, respectively, with a stable rate for the apheresis platelet concentrates. Conclusion: The COVID-19 pandemic constitutes a universal threat on all levels and, in particular, on the safety of transfusion practice. The development of an appropriate management plan would be necessary to surpass this crisis.
Keywords: Blood banks, blood donation, blood transfusion, COVID-19
How to cite this article:
Riahi S, Ifa L, Boukadida S, Heni M, Haddad N, Smida M, Bouatay A. Impact of the COVID-19 pandemic on the transfusion practice: Experience of a tertiary healthcare hospital from Sousse, Tunisia. Glob J Transfus Med 2021;6:228-32 |
How to cite this URL:
Riahi S, Ifa L, Boukadida S, Heni M, Haddad N, Smida M, Bouatay A. Impact of the COVID-19 pandemic on the transfusion practice: Experience of a tertiary healthcare hospital from Sousse, Tunisia. Glob J Transfus Med [serial online] 2021 [cited 2022 May 26];6:228-32. Available from: https://www.gjtmonline.com/text.asp?2021/6/2/228/331616 |
| Introduction | |  |
The emergence of the first cases of the new coronavirus in Wuhan in the late 2019 was the event that triggered the severe acute respiratory syndrome coronavirus 1 (SARS-CoV-2) epidemic. This epidemic had rapidly spread internationally, creating a global health crisis.
The SARS-CoV-19 pandemic was declared as a disruptive element in transfusion activities on multiple levels.[1]
The major impact of this pandemic on blood services was the emergence of significant shortages in the supply of labile blood products (LBPs), due to donors' fear of exposure to the virus in medical facilities, general disruption of lifestyle due to the lockdown, and other restrictive measures.[2] The cancellation of many community and mobile blood donation campaigns, as well as the prohibition of gatherings due to social distancing, quarantine, and other containment measures, exacerbated the situation.
In Tunisia, after the discovery of the first cases in March 2020, the COVID-19 outbreak counts to date (December 31, 2020) 245,923 infected people (2098.32/100,000 inhabitants) with 4199 deaths.[3],[4]
As elsewhere in the world, the shortages encountered in the blood supply during this pandemic had the transfusion centers and blood banks in our country concerned.
In this context, the objective of this study was to compare the transfusion practice before and during this pandemic, to document the problems encountered, and to report the palliative measures deployed.
| Materials and Methods | | |
This was a retrospective descriptive study conducted at the blood bank of a tertiary healthcare hospital, located in the city of Sousse in Tunisia.
The resources of the blood bank were ensured by donations from apt people according to the regulations, in two forms: either in the form of compensation donations or in the form of voluntary donations.
The bank ensures the supply of blood to surgical departments and operating rooms, emergency and intensive care units, as well as medical departments.
Our facility produces more than 12,000 units/year, including the production of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelet concentrates (PCs), and apheresis PCs (APCs).
The study was divided into two phases:
- Phase I: Corresponded to the year of the COVID-19 epidemic, which includes the two epidemic peaks in Tunisia, spanning from January 2020 to December 2020
- Phase II: Corresponded to the previous year 2019.
The study focused on the monthly comparison of data from the bank and included the number of donations recorded, the total number of LBP produced, and the number of LBP distributed during the two phases of the study.
Blood was collected from donors according to current laws on double or triple bags. Data were obtained from donor registries and from the preparation, production, and distribution documents of the LBP (PRBC, FFP, PC, and APC).
Frequencies and percentages were calculated for qualitative variables, and averages, standard deviations, and range of extreme values were calculated for quantitative variables.
The relative reduction risk rate was calculated according to the following formula:
Relative reduction risk rate = ([2019 value ‒ 2020 value]/2019 value) ×100. If the rate was positive, it was considered as a reduction.
If the rate was negative, it was considered as an increase.
The utilization rate (UR) was calculated according to the following formula:
UR = (LBP distributed/LBP produced) ×100
| Results | | |
The total number of annual donations decreased and it went from 11,948 donations in 2019 to 10,237 donations in 2020 which represented a reduction of 14%.
In 2020, the average of monthly donations was 853 with a minimum of 366 and a maximum of 1256 compared to 2019 when the same average was 996 with a minimum of 808 and a maximum of 1088.
The number of monthly donations decreased significantly especially during the two epidemic peaks in Tunisia (in April and October 2020) [Figure 1]. | Figure 1: Number of monthly donations in the blood bank of a tertiary healthcare hospital from Sousse, Tunisia, during 2019 and 2020
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In the postepidemic peaks, we noted an increase in voluntary donations due to our strategy to overcome the periods of extreme shortages.
The production of PRBC decreased by 17% compared to the previous year, especially during the epidemic peaks; for instance, in April, the reduction in the number of PRBC was 53% compared to the same month of the previous year [Figure 2]. | Figure 2: Number of packed red blood cells produced per month in the blood bank of a tertiary healthcare hospital from Sousse, Tunisia, during 2019 and 2020
Click here to view |
Likewise, the production and distribution of FFP has decreased significantly, especially during critical epidemiological periods. However, due to the strategy implemented in our department to counteract this shortage, we were able to compensate for this decrease to have an annual reduction rate of only 12.3% for FFP.
The production of PC also decreased with an annual reduction of 25%. For the APC, the disruption was mainly during epidemic peaks with a stable annual balance [Figure 3]. | Figure 3: Annual number of fresh frozen plasma, platelet concentrates, and apheresis platelet concentrates produced in the blood bank of a tertiary healthcare hospital from Sousse, Tunisia, during 2019 and 2020
Click here to view |
The number of LBP distributed also decreased, especially during epidemic peaks, with a statistically significant annual reduction for PRBC and PC. The monthly figures were variable depending on the epidemic situation [Table 1] and [Table 2]. | Table 1: Annual number of labile blood products distributed in the blood bank of a tertiary healthcare hospital from Sousse, Tunisia, during 2019 and 2020
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 | Table 2: Monthly number of packed red blood cells distributed by the blood bank of a tertiary health-care hospital from Sousse, Tunisia, during 2019 and 2020
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The overall UR was 45.5% in 2019 and 39% in 2020.
The decrease in distribution affected all specialties. Surgical departments were the most consuming departments of LBP with 57% of consumption in 2019 and 60% in 2020 [Figure 4]. | Figure 4: Annual number of labile blood products distributed in the blood bank of a tertiary healthcare hospital from Sousse, Tunisia, during 2019 and 2020 according to different departments
Click here to view |
| Discussion | | |
In our study, we noted an overall significant decrease in transfusion activity in both supply and distribution.
In the early January 2020, a virus was identified from bronchoalveolar fluid samples and was found to be a beta-coronavirus named SARS-CoV-2 that spread rapidly around the world.[5]
In Tunisia, the first case of SARS-CoV-2 was reported on March 3, 2020, in Gafsa, with a first peak in April 2020 and a second peak in October 2020. Following the increase in the number of cases, the Tunisian government introduced restrictive measures, including a general and total lockdown on March 22, 2020.[3],[4]
The lockdown paralyzed directly the activity of the blood bank and the number of donors dropped significantly (14% reduction), in accordance with the literature where we found variable reduction ratios ranging from 10% for Franchini et al. to 67% for Wang et al.[1],[6],[7],[8]
The number of donations decreased by more than half, at the time of the epidemic peaks, as demonstrated by the study of Al-Riyami et al., who investigated the blood supply of several blood banks in the Eastern Mediterranean region, and found that most centers experienced a decrease in blood supply during the 1st month of the pandemic, ranging from 10% to 75%.[9]
This was due to various factors, including the decrease in in-hospital blood collections, the cancellation of outpatient blood collections, and the ban on travel during the first lockdown period.
Similarly, in our study, we noted a decrease in the annual production of PRBC and FFP of 17% and 12.3%, respectively, compared to the previous year, with monthly percentages reduction that sometimes exceeded 50%. This could be explained by the decrease in compensation donations due to the decrease in routine surgical activity and the cancellation of several elective surgical procedures. Similar to our study, Raturi and Kusum in a multidisciplinary medical center in Dehradun district in North India reported a reduction in both demand and distribution of blood products.[10]
The distribution of blood products has at times experienced periods of statistically significant increase that coincided with the resumption of surgical activity and the reducing of the sanitary measures undertaken.
To overcome this shortage, our institution implemented a multisector action plan by mobilizing all available resources.
First of all, we tried to secure the donations by applying sanitary measures of distancing, measuring the temperature at the entrance, and eliminating the cases suspected of having contracted COVID-19 by an adapted questionnaire while following the recommendations of the WHO.[11]
During the first lockdown period, we tried to send out passes through e-mails and phone messages to organize donations and allow donors to reach hospitals safely, as did an Indian team in a multidisciplinary center in Kerala who tried to invite donors by telephone and through media platforms.[12]
Our team mobilized civil society through social networks and the media to raise awareness, reassure people, and encourage them to donate blood so that the number of volunteer donors increased by more than 60% in April. Various nonprofit associations responded to our call and organized internal blood drives. We even solicited the healthcare staff of the hospital to donate blood and feed the bank.
| Conclusion | | |
According to the WHO, COVID-19 has caused 93 million cases and over 2 million deaths through January 2021.
The COVID-19 pandemic is a universal threat to the safety of blood transfusion practices. The development of an effective strategy, improved communication to recruit and motivate donors, and collaboration among blood facilities would be essential to manage the crisis.
Informed consent was obtained from all donors before blood donation according to our institution's reglementation.
Ethical approval
All procedures involving human participants were in accordance with the ethical standards of the institutional ethics committee.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 3. | ONME. Situations épidémiologiques 2019 en Tunisie. ONMNE; 2021. Available from: https://www.aturea.org/blog-details.php?id=122. [Last accessed on 2021 May 28]. |
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| 6. | Wang Y, Han W, Pan L, Wang C, Liu Y, Hu W, et al. Impact of COVID-19 on blood centres in Zhejiang province China. Vox Sang 2020;115:502-6. |
| 7. | Franchini M, Farrugia A, Velati C, Zanetti A, Romanò L, Grazzini G, et al. The impact of the SARS-CoV-2 outbreak on the safety and availability of blood transfusions in Italy. Vox Sang 2020;115:603-5. |
| 8. | Pagano MB, Hess JR, Tsang HC, Staley E, Gernsheimer T, Sen N, et al. Prepare to adapt: Blood supply and transfusion support during the first 2 weeks of the 2019 novel coronavirus (COVID-19) pandemic affecting Washington State. Transfusion 2020;60:908-11. |
| 9. | Al-Riyami AZ, Abdella YE, Badawi MA, Panchatcharam SM, Ghaleb Y, Maghsudlu M, et al. The impact of COVID-19 pandemic on blood supplies and transfusion services in Eastern Mediterranean Region. Transfus Clin Biol J Soc Francaise Transfus Sang 2021;28:16-24. |
| 10. | Raturi M, Kusum A. The blood supply management amid the COVID-19 outbreak. Transfus Clin Biol J Soc Francaise Transfus Sang 2020;27:147-51. |
| 11. | Guidance on Maintaining a Safe and Adequate Blood Supply during the Coronavirus Disease 2019 (COVID-19) Pandemic and on the Collection of COVID-19 Convalescent Plasma. Interim guidance, 10 July 2020. World Health Organization. License: CC BY-NC-SA 3.0 IGO https://apps.who.int/iris/handle/10665/333182. /last accessed on 08/11/21. |
| 12. | Rajendran V, Sanooja P. Impact of COVID-19 outbreak in blood transfusion services in India: Experience from tertiary care blood centres in Kerala: A short review. Glob J Transfus Med 2020;5:215-7. [Full text] |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]
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