Lockdown and our national supply of blood products

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CORRESPONDENCE
Published online ahead of print
Lockdown and our national supply
of blood products
To the Editor: Our generation finds itself in an unprecedented
situation, as coronavirus disease 2019 (COVID-19) causes wide-
spread changes to everyone’s lives. Our healthcare system has faced
adversity in various forms, but this current crisis brings new and
more difficult challenges.
An important aspect of medical treatment is the use of blood
products. The availability of these products is reliant on voluntary
donations and appropriate use by clinicians. A large proportion
of donations are made from the elderly, perhaps at greatest risk
from COVID-19, and educational institutions, now closed through
isolation polices. Data from other countries highlight social distancing
and self-isolation as important steps in slowing down transmission of
coronavirus.[1] However, these measures will drastically reduce the
number of blood donations, unless different collection strategies are
employed.
South Africa already has limited blood products, with the South
African National Blood Service (SANBS) and Western Cape Blood
Service (WCBS) needing to collect more than 3 500 units of blood
every day to maintain adequate stocks. Less than 1% of the population
regularly donate blood, and more than 30% of donors are under
25years of age, demonstrating the burden on blood collection when
schools and universities are closed. The high incidence of HIV, trauma
and chronic illness places tremendous demand on an already limited
supply, with several areas still having limited access to blood products –
all these problems will persist during the COVID-19 pandemic.
There are ongoing efforts to improve appropriate and responsible
use of these limited and life-saving blood products through patient
blood management (PBM) systems. There is now an even greater
need to implement and support these efforts.[2] In the light of
current events, we can expect a dramatic decrease in the number of
donations, and subsequently a mismatch in supply and demand. The
blood products available for our hospitals and clinics will therefore
rapidly decrease. This will continue for months, and we consider that
the following are important:
• Healthcare professionals should be aware of this pending problem
and implement PBM programmes, ensuring that blood products
are only used when necessary, through diagnosis and management
of anaemia, of which the most common and treatable pre-operative
cause remains iron deficiency.[2]
• Patients should generally only be transfused if alternative measures
have failed and they are symptomatic from anaemia, or in cases
of emergency. Single-unit transfusions should be used as far as
possible. Healthcare workers should be made aware of transfusion
threshold data showing that very few patients require blood
transfusions if their haemoglobin concentration is >7 g/dL.[3-5]
Hospital managers and transfusion committees must take proactive
roles in directing PBM activities in their hospitals.
• The public should be made aware of this problem and make
concerted efforts to donate blood out of their normal routine.
• The blood transfusion services should be supported by the
Department of Health and public forums to ensure continued
supply of products.
Addressing these issues will ensure that lives are saved and appropriate
care delivered in these difficult times. Failure to address these issues
timeously will result in a blood product supply crisis in which
patients will suffer with increased mortality.
R D Wise
Discipline of Anaesthesiology and Critical Care, School of Clinical
Medicine, University of KwaZulu-Natal, Durban, South Africa; and
Adult Intensive Care Unit, John Radclie Hospital, Oxford University
Hospitals Trust, Oxford, UK
robwiseicu@gmail.com
M W Gibbs
Department of Anaesthesiology and Perioperative Medicine,
Groote Schuur Hospital and Faculty of Health Sciences, University of
Cape Town, South Africa
V J Louw
Division of Clinical Haematology, Department of Medicine, Faculty of
Health Sciences, University of Cape Town, South Africa
Author contributions. All authors contributed equally to the writing of
this letter.
Funding.Not applicable.
Conicts of interest.RDW has provided training on behalf of the SANBS.
MWG declares no conicts of interest. VJL has received honoraria and/
or travel support and/or grant funding from the following: Acino, Austell,
Novartis Oncology, Pharmacosmos, Takeda. VJL serves as non-executive
director on the Board of the WCBS.
1. Jeerson T, Mar CBD, Dooley L, et al. Physical interventions to interrupt or reduce the spread of
respiratory viruses. Cochrane Database Syst Rev 2011, Issue 7. Art. No.: CD006207. https://doi.
org/10.1002/14651858.CD006207.pub4
2. omson J, Hofmann A, Barrett CA, et al. Patient blood management: A solution for South Africa. S
Afr Med J 2019;109(7):471-476. https://doi.org/10.7196/SAMJ.2019.v109i7.13859
3. Shehata N, Mistry N, da Costa B, et al. Restrictive compared with liberal red cell transfusion strategies
in cardiac surgery: A meta-analysis. Eur Heart J 2019;40(13):1081-1088. https://doi.org/10.1093/
eurheartj/ehy435
4. Holst L, Petersen M, Haase N, et al. Restrictive versus liberal transfusion strategy for red blood cell
transfusion: Systematic review of randomised trials with meta-analysis and trial sequential analysis.
BMJ 2015;350:h1354. https://doi.org/10.1136/bmj.h1354
5. Cable CA, Razavi SA, Roback JD, et al. RBC transfusion strategies in the ICU: A concise review. Crit
Care Med 2019;47(11):1637-1644. https://doi.org/10.1097/CCM.0000000000003985
S Afr Med J. Published online 2 April 2020. https://doi.org/10.7196/SAMJ.2020.
v110i5.14749
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