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May 2020

Hospital Blood Component Inventory Issues During the COVID-19 Pandemic

Dr. Allison Collins and Wendy Owens ART, BCom
Ontario Regional Blood Coordinating Network

Fortunately, the COVID-19 pandemic has not yet resulted in a blood shortage in Canada. However, hospital transfusion services are encouraged to promote best practices in transfusion therapy, as described in the Ontario Transfusion Quality Improvement Plan (www.transfusionontario.org ). The components most likely to become in short supply are platelets, due to their short shelf life, so particular care should be taken to ensure that orders are appropriate.  The Canadian Blood Services (CBS) component production methods allow for either cryoprecipitate or platelet production, but not both from the same donation.  While CBS continues to produce some cryoprecipitate, there may be need in the future to decrease or discontinue its production if CBS must prioritize platelet production. Cryoprecipitate and fibrinogen concentrate (FC) can both be used for fibrinogen replacement in bleeding patients. Hospitals that have not yet developed policies and procedures for substituting FC for cryoprecipitate are now required to do so.

CBS issued a Green Phase Advisory to hospitals on March 17, 2020. This Advisory encompassed all blood components and products. At that time, donor cancellations were high and many mobile clinics had to be cancelled due to the increasing restrictions related to workplace closures and social distancing, and there was growing concern around sustainability of supply. There was a wide appeal for blood donation to ensure the blood supply could continue to support the needs of patients, and donors responded generously.

At the same time, most provincial Ministries of Health announced that, to prepare for possible increased activity related to COVID-19 patients, hospitals should reduce elective surgeries. This resulted in a significant drop in the demand for, primarily, red cells (25-30%) and, to a lesser extent, platelets.  This sudden drop in demand meant that many hospitals soon found their red cell inventory aging on their shelves and outdating. Hospitals were encouraged to reduce their target red cell inventory by 10-20% to reduce their stock in response to the lower demand.

Arguably, having excess red cell inventory during an event such as COVID-19 is better than facing a shortage as it ensures hospitals are able to continue to provide for those patients whose surgeries are urgent and whose treatment needs continue despite all the focus on COVID-19.

This situation we are all facing currently underlines the importance of being prepared to respond in situations when many uncertainties surround us but the need to maintain blood inventory to support patients’ needs continues.  As restrictions start to ease and hospitals begin to ramp up elective procedures again, it will be critical to monitor blood inventory to ensure supply can keep pace with the increase in demand. Hospital transfusion medicine laboratories will need to bring inventory targets back up to their Green phase levels slowly to meet these needs in order to ensure the supply at Canadian Blood Services can support the move towards normal operation.

Convalescent Plasma as a Treatment for COVID-19

Dr. Allison Collins and Wendy Owens
Ontario Regional Blood Coordinating Network

Convalescent plasma, from patients who have recovered from COVID-19, is being investigated as a potential treatment for patients with the acute illness. Although convalescent plasma has been used in the treatment of other viral illness, such as influenza and SARS, evidence for its efficacy and safety in COVID-19 is scant, with no randomised controlled trials.  A large Canadian trial is being planned to provide evidence of its usefulness. This trial, called the Convalescent Plasma for COVID-19 Research (CONCOR-1) is a collaborative effort of ten research teams, more than fifty hospitals, Canadian Blood Services, and Héma-Québec.

The plasma will be collected by Canadian Blood Services (CBS) and Héma-Québec, and an on-line registry for potential donors has been set up (https://blood.ca/en/convalescentplasma#dana).  Donors will have to meet certain criteria (younger than 67 years old, laboratory-confirmed COVID-19 infection, fully recovered and free of symptoms for at least 28 days, and otherwise eligible as a plasma donor).  More details of the trial, which is awaiting Health Canada approval at the time of writing, can be found at the link above.  The National Advisory Committee on Blood and Blood Products (NAC) has also published information about the use of convalescent plasma. (https://www.nacblood.ca/COVID%20QA_NAC%20March%2031%202020_FINAL.pdf).

Ontario Immunoglobulin Treatment Program

Dr. Juthaporn Cowan MD, PhD, FRCPC Associate Scientist, Ottawa Hospital Research Institute

ONIT is a recent Ministry approved initiative to improve the healthcare of patients with immunodeficiencies requiring immunoglobulin replacement therapy (IGRT). This clinical program is set out to support IGRT through home, self-administered subcutaneous immunoglobulin (SCIG) infusion. Although the mandate is to provide support for SCIG, we care for and manage primary and secondary immunodeficiency patients who need IGRT regardless the route of administration. That support is provided through hospital-based outpatient clinics, with nursing coordination, education, and follow-up, with medical oversight in all areas including dosage titration, health outcomes and optimization of therapy. Evaluation of treatments, and of the program will be possible through a consented case registry. The main objectives of the program are to provide consistent, standardised diagnosis and management of immunodeficiencies requiring IGRT, for best health outcomes, maximal patient autonomy and satisfaction, and reduced hospital utilization. The program welcomes consultation requests for patients with immunodeficiency.

There are currently three centers: The Ottawa Hospital, St. Michael’s Hospital and Hamilton Health Sciences with the hope to expand to other centers across Ontario.  This program started in 2019. We aim to fully implement the program by the second quarter of 2020 in all three centers. Stay tuned!