Journal Club�23 Feb 2021

Background

• Maintaining an adequate and safe blood supply is one of the primary aims of blood centers across the globe.
• Three main factors which govern the blood supply include
• the availability of blood donors
• the usage of blood and blood components
• the availability of critical supplies required for collection and testing of blood.
• Blood transfusion services in India are decentralized with around 3108 licensed blood banks collecting around 122 million units against an estimated clinical demand of 146 million units of blood.
• Most of the blood centers are hospital based, mainly dependent on replacement donors or blood collected from donors at voluntary blood donation drives.

• The 2019-20 corona virus (SARS-CoV-2) pandemic has challenged the blood centres across the world to maintain a balance between blood supply and demand in an unprecedented way.
• During the past three months since the first case of SARS-CoV-2 was reported in India on 29 January 2020, blood centers have adopted a number of strategies to tide over this crisis.
• The purpose of the present study is to share experiences and the effect of various policies adopted by author’s blood centre from time to time and the lessons learned from it for future pandemics.

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Material and methods

• Study setting
• Conducted in Main Blood Bank, Department of Transfusion Medicine, AIIMS, New Delhi (a tertiary research institute and received referral for complex cases)
• Stock data from 29^th Jan 2020 till 14^th April 2020
• Study time periods
• Time Period A (29^th Jan- 26^th Feb 2020)
• Supply and demand were unchanged and not affected by the pandemic (One case Covid-19 reported)
• Red cell stock for 1 week with FIFO policy

• Time Period B (27^th Feb- 21 Mar 2020)
• Implemented steps to increase the buffer stock (safety stock) of red cells to approximately 2 weeks
• Higher number of blood donation drives conducted
• Time Period C (22^nd Mar-14^th April 2020)
• Start of the pan-country lockdown till the intended period of closure of the first lockdown
• Various strategies to maintain an adequate and safe blood supply
• Changes in the existing disaster management plans
• FIFO policy was implemented strictly

• Data collection and analysis
• Data were collected using blood bank management software reports for each day of operation
• Blood collection, blood issue and stock were calculated and represented as median (interquartile range, IQR), and a comparative analysis of these parameters was done for the three time periods
• The effect of implementing different strategies during the third time period was also studied

Result

RDP: WB or Random-derived PLT

Discussion

• Maintaining an adequate blood inventory is a dynamic process and involved on various aspects of blood inventory management.
• Low inventory exposes to an acute shortage during times of disaster whereas an overfilled inventory may lead to expiry of the blood components.
• COVID-19 outbreak resulted in disruption of various aspects of the blood supply dynamics
• reduced the availability of the blood donors/restrictions on public gathering.
• fear of acquiring infection during donation
• cancellation of the already planned blood donation

• An adequate buffer stock equivalent to 1–2 weeks requirement of red cells helped
• maintaining emergent transfusions despite sharp decrease in blood supply
• provided enough time to plan activities and mobilize voluntary blood donors
• There was no increase in discard of blood due to outdating despite reduction in the requirement

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• The platelet inventory which pose a major challenge due to a limited shelf life of 5 days, So;
• maintained a stock which was sufficient for a single day use and platelet inventory strictly to therapeutic use in bleeding patients as well as prophylactically when the platelet counts were <10 000/μl.
• voluntary donors from the staff were motivated to donate Single Donor Platelet (SDP) to be used in case RDPs were not available.

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• The present study demonstrates that maintaining a buffer stock of blood and blood components, strict adherence to the transfusion triggers, good coordination with the clinical staff and a prospective review of blood transfusion requests to ensure rational blood transfusion
• Importance of maintaining a registry of voluntary blood donors from around the neighboring areas of blood centre.

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How About PDN?

Weekly Red Cells In and Out

Safe level

New safe level

CMO 1

Raya

RMCO

Unit

Weekly Red Cells In and Out

CMCO KL/SEL

Unit

Safe level

Monthly red cell supplied 2019 and 2020

Unit

Monthly PLT supplied 2019 and 2020

Unit

�Still demand blood?

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• Existing and Ongoing (predictable)
• Patient with Hematological malignancy or other malignancy
• Transfusion dependent Thalassaemia /Coagulation disorders
• Emergency (not predictable)
• Trauma with bleeding
• Emergency operations
• Organ transplantation
• Others
• e.g. Pregnancy related (PPH), severe premature neonatal anemia, exchange transfusion, massive hemorrhage, DIVC

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• Balancing the demand and supply
• Initial phase of MCO (18 Mar 2020- May 2020): Decrease in demand (eg. postponement of major elective surgeries, ICU beds for severe Covid-19 cases)
• Later phase (Jun 2020)-the increases in blood supply as more hospitals slowly back to routine services.
• Mid Oct 2020: 3^rd Wave of Covid-19 with CMCO in Klang Valley
• Blood availability vs. wastages

Action Plan: Implementation on Blood Demand, Supply and Usage

• Communication with all stakeholders and hospitals
• Official letter regarding the blood supply (focus more on emergency needs, alternative treatments and patient blood management)
• To set the minimal blood stock supply per hospital
• Blood Stock Forecasting and Management
• Blood Action Team (virtual discussion)
• Set the new red cells safe and critical stock level (safe: 3500->2000 units, critical : 1500->1200 units)
• Blood supply adjustment based on hospitals requirement:

1) Strict blood supply controlled by on call team

2) Stock request screened and approved by assigned medical officer

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• Request and Supply monitoring
• Daily and weekly blood request and supply analysis (~ RC weekly supply 2200-2500 units during 1^st MCO )
• Adequate blood components preparation (Platelet, Plasma Components)
• National Blood Stock Information
• Malaysian Blood Stock System (MyBSS)
• Data entry of the weekly blood collection & supply by Hospitals/state
• Stock coordination and mobilisation
• To affected collection centers

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Summary (Year 2020)

• Red cell (RC) stock is > 2000 unit all time
• Percentages of RC supply is 83.6%
• Reduction of RC supply of 13.4% vs year 2019
• RC expiry 0.05% (KPI <0.2%)
• Balanced platelets preparation vs demand/issue with rate of expiry 2.0 % (KPI < 3%)
• Blood Stock Management
• Blood Forecast
• Established good collaboration and coordination among all division in PDN (BAT)
• Constant communication with hospitals/ Customers (Judicious use of blood/PBM)
• Coordination and blood shipment/mobilisation to affected hospital

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