Open letter to the U.S. health care community

Sunday, March 15

Dear Transfusion Service Partner,

Already, the American Red Cross is experiencing the adverse effects of the coronavirus pandemic (COVID-19) on our blood collection operations. With a rapidly increasing number of blood drive cancellations across the country, the impact to the national blood supply is inevitable. We are steadfast in our efforts to recruit and collect blood despite these ongoing challenges; however, the volatility of the situation requires that we act now to safeguard the anticipated limited supplies.

We are taking several precautionary measures to manage declining supplies. Beginning this week, we will reduce order fulfillment on scheduled and ad hoc orders for red blood cells (RBCs). We have also established a STAT blood product volume threshold and will start reviewing all STAT orders for need before release. Both these actions are designed to secure products for immediate patient needs and limit the routine stocking of products during short supply. To maximize product stewardship, where necessary, we are discontinuing stock rotations.

Although we have not had to make any change to our distribution model yet, we are prepared to take additional action to consolidate inventories into strategic sites across the country should supplies become severely constrained. From these larger sites, we would deploy a direct shipment delivery model that would allow the Red Cross to manage limited inventories more effectively and reduce lost transit time. Should we need to make these changes, you will be notified in advance.

As your hospital prepares to implement its contingency plans, we strongly recommend you consider the following steps to ensure continued access to blood to those most in need:

• Update all clinical staff that the current COVID-19 pandemic has put tremendous strain on the blood supply.
  • Establish formal and routine status alerts to medical staff and nursing leadership on the need for vigilance.
  • Prioritize coordination with the operating room, emergency department, and floor staff to avoid wastage due to temperature limits/time out of the blood bank.
• Implement a prospective review of all blood product ordering before release from the blood bank. Specifically,
  • Verify that the transfusion is expected within the next 8 hours. Cancel orders where the clinical need has changed.
  • Lower transfusion triggers for RBCs and platelet transfusions.
  • For stable non-emergent patients, review orders > 2 RBC units at one time (give one then reassess). Limit the use of O negative RBCs to women of child-bearing age and pediatric females. Use O positive RBCs for emergent transfusion of males and post-menopausal women.
  • As soon as possible, switch from O RBCs to type-specific RBC transfusions in emergent transfusions or massive transfusions.
  • Use group A plasma for emergent transfusions and massive transfusions.
  • Set goal to reduce blood product utilization by 25%.
• Carefully monitor your inventory to minimize product expiration. Place short-dates in the front so staff can easily access them. Set an outdate target of zero.
  • Readily move products between hospitals in your community to limit outdating.
• Determine the minimum required inventory held at your hospital. Do not stock blood products on your shelf for “just-in-case” scenarios. The blood supply cannot support stocking orders at this time.
• Increase flexibility when placing product orders with your blood provider:
  • Order platelets of any blood group by choosing “Any Type” in Connect.
  • Accept PAS and 100% plasma platelets interchangeably
  • Limit attribute specificity to allow for greater fulfillment options.
• Implement less aggressive targets for routine red cell exchange transfusions whenever possible.
• Utilize one unit (rather than two unit) platelet transfusion strategies for non-bleeding adult oncology outpatients (Gehrie et al. Vox Sang 2019; 114:517-22).

Another immediate action you can take to protect the blood supply is to actively promote blood donations within your hospital and your community. Ongoing blood drives are imperative to ensuring a readily available supply. When possible avoid canceling scheduled blood drives within your hospital, and please help us raise public awareness on the critical need for healthy, eligible donors to donate blood now.

With the closure of schools, colleges and universities throughout the nation, blood collectors lose an active and vital donor base. We expect the impact to be broad and inventories to deteriorate quickly. Given the rapidly changing nature of this situation, we will provide frequent updates on our status so that you may keep your teams informed. Continue to communicate with your Red Cross account manager regarding any changes within your hospital that may impact our service, primarily as it pertains to deliveries to the blood bank. Additionally, our medical directors are readily available to guide you on managing blood product shortages.

Sincerely,

Pampee P. Young, M.D., Ph.D.
Chief Medical Officer
American Red Cross