Blood has become the latest casualty in the ongoing battle against coronavirus.
Donations across Virginia dropped by 30 percent in the past few days as high schools, office buildings and college campuses — some of the biggest blood drive organizers — shut their doors. More than 4,000 blood drives have been canceled nationwide, leading to at least 100,000 fewer donations to the American Red Cross, said Jonathan McNamara, a spokesman for the nonprofit’s Virginia chapter.
“That’s a significant gap in the number of donors compared to demand,” he said in an interview on Wednesday. Three days earlier, the Red Cross sent a message to hospitals across the country, directing them to significantly reduce their blood usage.
“We learned we had a threatened blood supply and all had to reduce our blood usage by 25 percent,” said Dr. Kim Sanford, the medical director of transfusion services for VCU Health.
Shipments of blood to VCU Medical Center have dropped by 50 percent, forcing medical professionals to adopt new conservation policies. At VCU, stores have just dipped below what Sanford described as the “on-par threshold” — a two or three day supply. Other health systems, including HCA and Bon Secours, have seen blood shipments drop by two-thirds or more, Sanford said.
“None of us have really experienced anything like this,” she added. “My colleague has been in this industry for 30 years — she was an American Red Cross medical director before she came to VCU — and she said she’s never seen anything like it.”
It’s the latest shortage in an epidemic marked by ongoing concerns over testing supplies, medical equipment and available hospital beds. In this case, though, health experts worry that the impact will be spread across hospitals, from emergency departments to delivery rooms.
“We are all focused on the coronavirus epidemic, but car accidents or childbirth or surgeries don’t stop,” Virginia Gov. Ralph Northam said at a Wednesday briefing. “Our need for blood does not stop.”
VCU has adjusted its own policies when it comes to managing supplies, Sanford said. The health system announced Wednesday that elective surgeries and procedures will be postponed, likely for the next two to four weeks, while it responds to the coronavirus epidemic.
UVA Health and Carilion Clinic have also announced plans to postpone elective, or “nonessential,” surgeries for at least the next two weeks. Several Virginia hospitals have made “public appeals” requesting healthy residents to help restock dwindling supplies, wrote Julian Walker, the vice president of communications for the Virginia Hospital and Health Care Association, in an email on Wednesday.
The state is also folding the growing shortage into its larger messaging on the coronavirus pandemic. James Hatcher, CEO of Virginia’s Red Cross chapters, was one of the featured speakers at the governor’s latest daily press briefing. Later on Wednesday, Northam publicly donated blood to drive the point home.
— Ralph Northam (@GovernorVA) March 18, 2020
At VCU, Sanford emphasized that the policy wouldn’t extend to roughly 60 percent of patients with urgent surgical needs, including organ transplants. But operations including joint replacements, or interventional procedures such endoscopies and colonoscopies, will be rescheduled.
Those changes serve multiple purposes, she said. Even minor surgeries and procedures carry the risk of complications and possible blood transfusions, which makes their postponement a good way to conserve declining blood supplies. But limiting the number of patients who come into the hospital also reduces the risk of spreading COVID-19 and reserves bed space for a potential influx of emergency hospitalizations.
“It preserves personal protective equipment, it reduces risk of exposure — it works on multiple levels for the hospital,” Sanford said.
Doctors are taking additional steps to conserve blood use among existing patients. No one has been denied blood, Sanford added, but requests are screened based on risk factors such as hemoglobin levels or red cell counts. If a patient’s lab results don’t meet clinical blood transfusion guidelines, doctors may be asked why they’re requesting additional blood.
“We’re asking them to assess their patient and treat their patient,” Sanford said. “And if they’re hemodynamically stable, maybe rethink the request.”
In other words, if a patient has a stable blood pressure and heart rate, don’t ask for extra blood.
Sanford said hospitals across the state are concerned about running short on vital medical supplies, from ventilators to blood to personal protective equipment. Sentara Healthcare, which runs a network of 12 hospitals in Virginia and northeastern North Carolina, has also implemented new guidelines on which patients should receive blood transfusions and how many units should be supplied, Dr. Joel Bundy, the system’s chief quality and safety officer, said in an interview on Wednesday.
There are other ways for doctors to conserve blood while performing certain operations and procedures. Sanford said VCU surgeons performed a liver transplant on Wednesday using a cell saver machine, which collects blood lost during surgery and reinfuses it back into the patient.
But as closures continue, doctors worry that national blood stores will continue to decline. VCU has added three additional blood drives and will suspend new limits on visitation to allow Virginians to donate blood, Sanford said.
The American Red Cross is also taking additional measures to ensure patient safety at blood donation clinics. Beds will be spaced further apart, and both donors and providers will be screened for symptoms such as fever before being allowed on the floor.
“We’re taking measures to reduce risks and put donors at ease,” Sanford said. “But I can tell you this is a concern that every hospital is dealing with.”
If you’re healthy and can donate blood, you can make an appointment here.