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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 60-64

Management of safe and adequate blood supply in covid-19 pandemic amid national lockdown: Experience of a standalone blood center in India


1 Department of Quality Management, Life Blood Centre, Rajkot, India
2 Life Blood Centre, Rajkot, India
3 Department of Blood Donation
4 Department of Red Cell Serology

Date of Submission25-Jan-2022
Date of Decision15-Feb-2022
Date of Acceptance21-Feb-2022
Date of Web Publication29-Apr-2022

Correspondence Address:
Dr. Nishith Ashvinbhai Vachhani
Department of Quality Management, Life Blood Centre
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/gjtm.gjtm_8_21

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  Abstract 


Background and Objectives: Blood centers around the globe are dependent on voluntary blood donation from healthy individuals to meet their blood supplies. The severe acute respiratory syndrome coronavirus-2 pandemic has become one of the most critical global health emergencies of modern times. Blood transfusion service (BTS) in India faced numerous challenges during the COVID-19 outbreak and the following imposed country lockdown. We aim to identify the challenges faced by a standalone blood center and explore the mitigation strategies implemented during the COVID-19 pandemic and subsequent lockdown. Methods: A cross-sectional study conducted at a standalone blood center done over a time period of 05 months including the nationwide lockdown phase. Personal invitation of donors, social media awareness, and in-house donation drives were implemented to improve donor inflow. Restricted donor entry, stringent donor selection, and adequate sanitization strategies were the key steps adopted to ensure the safety of donors and staffs. Results: After a declaration of nationwide lockdown in India, blood donation showed a drop of 13.36% and blood demand was also reduced by 25.70% in our study. Conclusions: The COVID-19 pandemic affected blood donation process and blood supply and adversely affected BTSs. BTS should always be vigilant to adopt new practices even before guidelines are set by regulatory authorities in adverse situations. Restrictive blood transfusion strategies need to be emphasized in the country.

Keywords: COVID-19 pandemic, national lockdown, standalone blood center


How to cite this article:
Vachhani NA, Nandani SL, Domadiya YS, Bhatt JP. Management of safe and adequate blood supply in covid-19 pandemic amid national lockdown: Experience of a standalone blood center in India. Glob J Transfus Med 2022;7:60-4

How to cite this URL:
Vachhani NA, Nandani SL, Domadiya YS, Bhatt JP. Management of safe and adequate blood supply in covid-19 pandemic amid national lockdown: Experience of a standalone blood center in India. Glob J Transfus Med [serial online] 2022 [cited 2022 Jun 26];7:60-4. Available from: https://www.gjtmonline.com/text.asp?2022/7/1/60/344340




  Introduction Top


A pneumonia of unknown cause detected in Wuhan, China, was first reported to the WHO Country Office in China on December 31, 2019. A novel CoV distinct from the previously known CoVs was recognized as the causative agent, which quickly spread to more than 215 countries, sufficient enough to be called a pandemic. The WHO labeled the outbreak as a Public Health Emergency of International Concern on January 30, 2020.[1] This new virus has now been officially called severe acute respiratory syndrome-CoV 2 (SARS-CoV-2), because of its similarity to SARS-CoV of 2003, and the disease caused by it has been termed CoV disease or COVID-19 a pandemic on March 11, 2020. The first case of COVID-19 in India was reported on January 30, 2020, from Kerala state and first case of Gujarat state was reported on March 19, 2020, from Rajkot where the blood center is situated.[2],[3]

In India, the count of infected persons and deaths was rising gradually, and to prevent the community spread of the SARS-CoV-2 virus, on March 22, 2020, the Prime Minister of India requested a 14-h voluntary public curfew followed by an essential national lockdown for 21 days till April 14, 2020, starting from March 25, 2020, and extended up to May 31, 2020, to prevent the community spread by chain break. In accordance with this, all the hospitals in India have closed their outpatient department services (OPD) and cancelled routine surgeries, and only emergency services are functional. Similarly, in view of this pandemic and national lockdown, the apex body of blood transfusion services (BTSs) in India, the National Blood Transfusion Council (NBTC), released guidelines on March 25, 2020, regarding implications on BTSs and recommendation for the exclusion of at-risk donors. In the entire country, there are more than 3200 blood centers. The major challenges to BTSs are recruitment of healthy blood donors, follow-up of donors and patients, inventory management, staff safety and adequacy for emergency work, and consumable management. BTSs also participate in the treatment of COVID-19 patients by convalescent plasma collection from recovered patients.[4]

The transmission of SARS-CoV through blood transfusion has not been reported, and the Food and Drug Administration does not recommend testing donors or donated blood for SARS-CoV-2. However, blood banks should take precautionary measures to minimize any chance for transmitting SARS-CoV-2 between the blood bank staff and donors and between donors themselves because there is still a rare possibility of blood transmitting SARS-CoV-2. These precautions include appropriate personal protective equipment, physical distancing between the donors, checking donor body temperature, public health measures, and standard laboratory biosafety practices.[5]

During community transmission, demand for blood and components may decrease as the health-care system shifts toward treating increasing numbers of COVID-19 patients and elective surgeries and nonurgent clinical interventions are deferred. Blood transfusions will still be necessary for emergency situations such as trauma, postpartum hemorrhage, severe infant anemia, blood dyscrasias, and urgent surgeries requiring availability of blood. Good patient blood management (PBM) will help safeguard blood stocks.[6]

Aims and objectives

The goal of this research was to calculate donor participation and blood demand to help identify successful ways to handle blood supply during the COVID-19 pandemic and similar public health crises in the future.


  Materials and Methods Top


A cross-sectional study was conducted at a standalone blood center in India. Data were retrospectively collected from in-house donor registration, blood donation at outdoor blood donation drives, and blood inventory records for a period of 5 months inclusive of pre-per-post lockdown period of India (between January 17, 2020, and March 24, 2020, pre national lockdown period, between March 25, 2020, and May 31, 2020, nationwide lockdown period in four phases) to assess the impact of COVID-19 on donor attendance, blood donation, and the management of blood supply and demand.

Ethical clearance

This study has been done maintaining patient confidentiality as per declaration of Helsinki in line with institutional ethical guidelines.

Statistics

Data were analyzed using Microsoft Excel spreadsheet for Windows version 10.0 (Microsoft Corp., Washington, U.S.A.).

There was a fear in healthy population that they might get infected while visiting moderate-risk areas like blood centers or during transportation. After the essential national lockdown, it became very difficult to reach the blood centers; hence, only a few came forward to donate. Blood centers were also reluctant to conduct voluntary blood donation camps in view of risk of community spread of the virus and prohibition of mass gatherings by the Government of India.

Blood centers had to plan to maintain or increase the inventory of blood components, which were sustained with public appeals to donate and by ensuring that blood donation is regarded as a permitted activity during lockdown and safety of staff members as well. Corona preparedness team focused on various areas of blood centers [Figure 1].
Figure 1: Standalone blood centre challenges during the national lockdown in Covid-19 pandemic

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Protecting blood supply

Donor recruitment: Information campaigns were started to raise awareness with key message of “it is safe to donate blood in COVID-19 pandemic.” Regular repeat voluntary blood donors are usually safer and more faithful than first-time donors, so approaching them to donate was of prime focus. The safety of the donation process was ensured by appropriate protective measures while assuring proper flow of work. In-house blood donation activity was initiated on a more targeted basis through focused (including blood group specific) retention and recall of healthy repeat donors. Social media platforms like WhatsApp, Facebook, Instagram, and simple jargon-free language importer-exporter code (IEC) materials were used to connect with all the potential donors. To reduce mass gathering, an appointment system was established, and donors were given a specific time for blood donation. Blood donors were encouraged for self-deferral in case of doubt of symptoms or history of contact with infected persons with the help of an interview and by IEC materials. A dedicated vehicle was made available for donors' transportation from their residence. To support unhindered movement of blood donors during the national lockdown, special movement request passes were issued to donors online, so that they can easily reach blood center. In fact, regular repeat blood donors helped in recruiting new donors from their surroundings on behalf of our blood center.

Donor eligibilities: Potential donors were educated about the need to self-defer based on risk factors for COVID-19 or feeling unwell. All donors were informed of reporting immediately to the blood center regarding any COVID-19-related illness within 14 days after donation.

Outside blood donation camps

Containment strategies limited the ability of donors to attend donation camps and prevent blood collection teams from visiting areas where public health restrictions were in place. Mobile blood donation drives and group donations were reduced due to closure of workplaces, educational institutions, and social gathering. Strategies to overcome this situation included rapid switching of sites for blood collections, providing transportation for group of donors were implemented. In some circumstances, an outbreak was geographically restricted to a small identified area like a village or society., resulted in temporarily cessation of blood collection. Loss of donations from such area was supplemented by increased recruitment for blood donors and collections in nonaffected areas and in-house donations.

Protection of blood donors and staff

Use of personal protective equipment for donors and staff members of blood center; practice physical distancing; and elevated temperature before entering facilities and donation sites was started to gain their confidence to continue donating blood and providing safe place for working to staff.

Special education programs including on-site training and webinars were initiated for staff to educate and keep them updated about COVID-19. Standard laboratory biosafety practices, based on national and international guidelines, were followed in all circumstances. For staff safety, best to function with minimal numbers, less number of duty changeovers, and providing quarantine leave were executed. Staffs were divided into two groups and a weekly rotation of each group was practiced. Staff members were advised not to come to work if they feel ill or may have been exposed. Samples from patients suspected or confirmed with COVID-19 handled in accordance with additional biomedical safety guidelines for COVID-19.

Infection prevention and control measures

Distance between donor chairs, increased frequency of environment cleaning, frequent disinfection of high touch areas, availability of alcohol-based hand rub at all departments, change of bed sheets and disinfection of donor chair after every donation, cleaning and disinfection of donor screening room, donor screening tools and refreshment area, restrooms, sanitization of vehicle before start of blood drive or donor transportation, and placement of posters in waiting area indicating basic infection control guidelines executed [Figure 2].
Figure 2: Precautionary measures at stand-alone blood centre in Covid-19 pandemic

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Inventory management

Blood stock never last long. To maintain the stock and reduce the wastage, clinicians were motivated to use nonidentical but compatible blood group components in place of identical groups. We also insisted single-donor apheresis platelets to fulfil the shortage in whole blood-derived platelets. Clinicians were made aware of the scarcity of blood during a pandemic and are sensitized regarding PBM policies like restrictive transfusion and use of transfusion alternatives that is albumin, intravenous immunoglobulin, factor VIII, iron, and erythropoietin.

Stock management system for consumable material storage of minimum 3 months proved its importance in this pandemic situation because the nationwide lockdown and banning of international flights during the pandemic lead to a cut in supply of all essential consumables required in the blood centers. Increased use of sanitizing agents, disinfection solutions, and medical masks and gloves by staff indirectly indicated well established infection prevention and control measures.


  Results Top


Data of donated blood and supplied blood components are maintained and monitored on monthly basis. After a declaration of nationwide lockdown of 68 days in India, blood donation showed a drop of 13.36%. On the other hand, blood demand during the same period was also reduced by 25.70%. In-house blood donation facility at a standalone blood center increased by 79.22% satisfying the shortage due to the less number of outdoor blood donation camps and blood collections [Table 1]. Out of total 2102 blood donations during national lockdown time, 2082 (99%) were male donors and 20 (1%) were female donors [Table 2]. Young donors 768 (36.54%) from the age group of 28–37 years and 668 (31.78%) from the age group of 18–27 years responded well and donated blood more frequently than other age groups [Table 3]. Total 2929 units of whole blood and various blood products have been issued among 1250 patients including 787 (62.96%) males and 463 (37.04%) females during this lockdown time period [Table 4]. Maximum blood products supplied to treat anemia (34.14%), thalassemia major patients (13.45%), cancer patients (7.78%), and patients of cardiac surgeries (4.68%). The total blood discard rate was 6.50% before lockdown period, which decreased to 5.50% during lockdown period because of proper inventory management.
Table 1: The volume and sources of blood collection and supply

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Table 2: The source of blood collection and gender-wise distribution

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Table 3: Age-wise distribution of blood donors

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Table 4: Whole blood and blood component supply details

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  Discussion Top


Stand-alone blood centers face many challenges in maintaining stable and adequate blood supply, as shown in current condition of COVID-19 pandemic. Blood and blood components are an essential part of emergency preparedness, and neither can be produced nor stored for long periods. Hence, continuous replacement of the blood supply is crucial. Proper planning of blood supply management is essential during pandemics.

The drop in blood supply in this study may be explained by cancellation of many mobile blood drives due to the closed educational institutions, offices, and manufacturing units.[7] Fortunately, this drop in blood supply was balanced by the reduction in blood demand, communication with regular voluntary donors through telecommunication and social media platform encouraging them to donate at the blood center, and organization of mobile blood drives at donors' homes after coordination with the donors and application of all COVID-19 safety precautions.

Many measures should be implemented to overcome these challenges to ensure a stable and adequate blood supply. These measures may include using public media to educate and motivate people for blood donation and to reassure donors about the availability of safe and accessible options for blood donation through an appointment system, mobile blood drives at donors' homes, monitoring of emergency blood supplies, proper management of the available blood, postponement of elective surgeries where that would not lead to more complex and urgent medical situations, utilization of blood only for emergency conditions, and using effective blood conservation methods such as PBM.[8],[9]

Cooperation among hospitals and blood centers to monitor inventories and to redistribute blood components to prevent wastage may help balance local supplies and demands.


  Conclusions Top


In the battle against the COVID-19 infection, it is of utmost importance that the supply of blood and its products needs to be continually maintained. Effective and accurate data-driven risk assessment is necessary to determine the most appropriate and proportionate action.

A clear, proactive, and consistent communication strategy is key to addressing and overcoming donor anxiety and fears which often stem from lack of awareness or misinformation. Effective public awareness campaigns on the importance of maintaining an adequate national blood supply, need for blood donors, and safety of the donation process should be disseminated continuously, using different communication platforms to reach all segments of the population.

Identifying crucial areas, proactive planning, coordinated strategies, and their timely implication is essential for transfusion services to face current situation of COVID-19 pandemic.

Limitations of the study

Less availability of comparative research articles to compare the present study.

Future considerations

Effective blood conservation methods like PBM should be adopted during pandemic situations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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World Health Organization. WHO Director-General´s Opening Remarks at the Media Briefing on COVID-19; 2020.  Back to cited text no. 1
    
2.
Bhatia R, Abraham P. Lessons learnt during the first 100 days of COVID-19 pandemic in India. Indian J Med Res 2020;151:387-91.  Back to cited text no. 2
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Chandrashekar S. The story of the emerging coronavirus: SARS-CoV-2/COVID19: Challenges posed and lessons Learnt. Glob J Transfus Med 2020;5:1.  Back to cited text no. 3
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Dhiman Y, Patidar GK, Arora S. COVID-19 pandemic-response to challenges by blood transfusion services in India: A review report. ISBT Sci Ser 2020;15:365-73.  Back to cited text no. 4
    
5.
Yahia AI. Management of blood supply and demand during the COVID-19 pandemic in King Abdullah Hospital, Bisha, Saudi Arabia. Transfus Apher Sci 2020;59:102836.  Back to cited text no. 5
    
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World Health Organization. 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; 2020. Available from: https://WHO/2019-nCoV/BloodSupply/2020.2. [Last accessed on 2020 Dec 25].  Back to cited text no. 6
    
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Shander A, Goobie SM, Warner MA, Aapro M, Bisbe E, Perez-Calatayud AA, et al. Essential role of patient blood management in a pandemic: A call for action. Anesth Analg 2020;131:74-85.  Back to cited text no. 7
    
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Sadana D, Pratzer A, Scher LJ, Saag HS, Adler N, Volpicelli FM, et al. Promoting high-value practice by reducing unnecessary transfusions with a patient blood management program. JAMA Intern Med 2018;178:116-22.  Back to cited text no. 8
    
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Hofmann A, Farmer S, Shander A. Five drivers shifting the paradigm from product-focused transfusion practice to patient blood management. Oncologist 2011;16 Suppl 3:3-11.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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