Blood management during the COVID-19 pandemic

5 Jan 2021


COVID-19 highlighted the need for patient blood management (PBM) guidelines to be mainstream practice.

The worldwide COVID-19 pandemic has required healthcare systems to implement strategies for effective healthcare delivery while managing blood supply chain disruptions and shortages created by infection-limiting practices that have reduced blood donations. At Cleveland Clinic, we have made multiple synchronous efforts: a call for increased blood collection, alignment of efforts among transfusion medicine departments (blood banks), enhanced monitoring and triage of blood product use, and increased education on patient blood management practices regarding blood utilization and anemia management. In addition, we created an algorithm to assess anemia risks in patients whose elective surgery was cancelled to optimize preoperative hemoglobin levels.

Introduction

.The worldwide COVID-19 pandemic has created a need for healthcare providers to respond, innovate, and adapt quickly to address the continued demand for emergency care and necessary healthcare services amid this pandemic. Thus, healthcare systems have had to determine how best to care for patients, keep caregivers safe, and manage supply chain disruptions and shortages, including shortages in blood products.

In March 2020, states began issuing social distancing guidelines and escalated school and business closures. In response, healthcare facilities cancelled all elective surgical procedures and nonessential care. These measures also caused cancellation of blood drives and reduced the number of blood donors who could be at a collection site, which severely affected the availability of blood products. Blood centers and hospitals have had to collaborate to ensure continued blood collections.

At the start of the COVID-19 pandemic in Ohio, blood suppliers for the Cleveland Clinic informed us of the potential for blood shortages and a possible 25% cutback of standard inventory orders, creating a need to adjust inventory and blood utilization. Blood utilization services include transfusion medicine (blood bank) and patient blood management (PBM) departments. Plans were instituted to actively monitor and triage blood product orders. Electronic health record blood orders were modified to enhance and facilitate triaging efforts. PBM amplified its educational efforts regarding restrictive blood utilization and anemia management. In addition, PBM took a proactive approach in reviewing cancelled elective surgical cases to identify opportunities for preoperative hemoglobin optimization once these surgeries were restarted.

Background on patient blood management

PBM practices have existed for decades, but have not been fully integrated as a universal standard of care. PBM is defined as an evidence-based medical and surgical approach to minimize the need for and use of blood transfusion in patients as a means to improve their clinical outcomes. It encompasses a comprehensive integration of a patient-centric, multidisciplinary standard of care centralized on blood health, which involves all functions of maintaining blood volume, anemia management, coagulation management, and surgical technique, not just blood transfusion therapy.

To achieve optimal patient outcomes, PBM implements a variety of treatment strategies to minimize or reduce the use of blood products as well as decrease overall healthcare costs. The practice and standards of PBM are universal across specialties as well as inpatient, outpatient, surgical, and medical disciplines.

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Source: Omnia Health