Blood banks around the world depend on three types of donation of blood and blood products: voluntary unpaid donations, replacement blood (for example, you may donate blood if an acquaintance who is in hospital needs it), and paid donations.

These donations have suffered over the last few months. Not only has an extended lockdown in the country since 25 March restricted the movement of people, but many medical services around the country have also had to be curtailed during the COVID-19 pandemic. One of the fallouts of this is a growing shortage of blood and blood components in blood banks.

Reports of thalassemia patients being unable to avail blood transfusion at a Lucknow hospital, and news from other parts of the country, have highlighted this rising concern amid the COVID-19 crisis, which has crippled many departments within the medical world. Despite assurances from the Ministry of Health and Family Welfare that hospitals continue blood transfusion and blood donation drives, the shortage has been amplified by the national lockdown which was extended for a third time in the month of May.

Read more: 12 things people want to know about thalassemia

According to the World Health Organization (WHO), "if 1% to 3% of a country's population donates blood, it would be sufficient for the country's needs". India does not meet even the lower limit of 1% of this recommendation, falling short by 1.9 million units per year in 2018.

The National Blood Transfusion Council on 25 March - the first day of the national lockdown - had issued a list of guidelines for the continuation of blood transfusion services in the country to maintain the supply of blood samples for critically ill patients, as well as for patients who depend on blood transfusions as a life-saving measure, like people with thalassemia (a blood disorder).

  1. Exclusion of at-risk donors to maintain safety
  2. Management of blood collection to ensure adequacy
  3. Blood collection
  4. Donor education and communication
  5. Role of voluntary blood donor organisations
  6. Post donation care
  7. Sharing and transfer of screened or otherwise low risk blood and blood components
  8. Guidelines on appropriate clinical use of blood and blood components
  9. Haemovigilance
Doctors for Blood transfusion during the COVID-19 pandemic

If a blood donor has been exposed to the COVID-19 infection based on their history of travel or coming into contact with an infected person, the criteria for deferring their donation is as follows:

  • Travel history: Donors should be deferred from donating blood 28 days after the date of departure from a country with COVID-19 transmission in the community and in areas as notified by the Ministry of Health and Family Welfare.
  • Contact history: If a donor has had a possible contact exposure to an individual who is a confirmed/suspected case of COVID-19, then he/she shall be deferred from donating blood for 28 days from date of contact.
  • Confirmed case: If a donor has been infected with COVID-19, donation will only be possible 28 days after recovering from the infection, including getting radiological and virological clearances.

Maintaining safe blood supplies must continue while adhering to the rules of physical and social distancing put in place by the Ministry of Health and Family Welfare. In-house blood donation as well as outdoor blood donation activities can be continued as long as rules of social distancing, infection control guidelines and biomedical waste disposal rules are followed. 

  • Social distancing measures should be followed at the blood donation site: Concerned authorities must remind individuals to maintain a one-metre distance from everyone else, refrain from physical contact like shaking hands or hugging, following basic hand hygiene protocols and maintain proper cleanliness of the equipment used during blood donation.
    Measures must be taken to reduce overcrowding of the facility and managing the waiting areas properly so that social/physical distancing protocols are met.
  • Infection control measures: All such measures must be consistent with national and state communicable disease control guidelines for COVID-19 for communities. General measures must be undertaken by both healthcare workers as well as the donors present at the blood donation site. Organisers of the camp must educate the staff and donors about the safety measures and provide facilities such as running water, soap, hand sanitizers, PPEs as well as colour-coded dustbins. Following are the measures to be taken at the blood donation site:
    • Hand hygiene: Washing hands regularly with soap and water, or rubbing alcohol-based hand sanitizer must be followed at the site to maintain hand hygiene and avoid touching infected surfaces. (Read more: Tips to maintain hygiene and social distancing)
    • Cough etiquette: Covering the mouth with the elbow or with tissue paper and disposing it properly must be followed to avoid any kind of transmission of infection. 
    • Avoid close contact with confirmed or suspected case of COVID-19.
    • Remain at home or defer your visit to the donation site or camp if the staff or donor is unwell or may have come in contact with someone confirmed or suspected of COVID-19.
    • Safe disposal of items such as masks, gloves, caps or other materials used during blood donation.

In order to maintain a sufficient supply of blood to the blood banks, organisers and sites for collection must ensure the recruitment of healthy individuals as donors. Regular and repeat voluntary donors must be encouraged to come in for donation at sites that are convenient to them. Blood donation camps must be organised after taking all the precautionary measures.

Donation sites must call donors in a staggered manner to avoid crowding and mass gathering of people at the site and avoid chances of infection, and follow the norms of social distancing put in place by various national and state authorities. Blood donation teams can also be deployed by blood centres for collection.

In the case of an outbreak, blood collection drive must be suspended from the affected geographical location.

In the case of loss of donation due to suspension of the activity, recruitment of donors must be increased from areas that are not affected by an outbreak. Campaigns to encourage people to donate blood in non-affected areas must be organised to continue the drive.

In the case of an outbreak such as COVID-19, which has caused a disruption in daily life in cities and villages alike, blood donors must be informed about changes to the blood donation drive, screening or selection processes. Blood centres can then review their donation drive and revise their strategy according to the changes put in place.

Information pertaining to donor education including instructions for deferring or avoiding donation if they have come in contact with infected persons must be displayed at the site. Medical officers at the blood donation site must adhere to all the recommended measures to keep the area safe.

Voluntary blood donor organisations play a vital role in ensuring sufficient blood supply. These blood donor organisations must stay in contact with local blood centres to periodically evaluate the need for donors, and work with health authorities to circulate necessary guidelines for blood donation during an outbreak like COVID-19.

Authorities should notify these voluntary blood donor organisations about their role in transfusion services during the outbreak of infectious diseases, in accordance with the rules and regulations on mass gatherings and social distancing measures.

Steps must be taken to ensure post blood donation care for donors at all blood centre and outdoor camps, in accordance with the standard operating procedures. However, the following contexts must be taken into account:

  • Blood donor-related information: In case a donor reports back to the blood donation centre within 14 days of donating blood with the following conditions:
  1. Post donation illness, which is suspected to be COVID-19
  2. Been confirmed positive for COVID-19, or
  3. A close contact being confirmed positive for COVID-19

If such a case is brought to light, the blood centre's medical officer must ascertain if clinical intervention is needed for the donor, and must be appropriately referred for further management as per the guidelines. All details pertaining to the diagnosis and treatment of COVID-19 must be made available to all blood centres by state governments in their respective states.

  • Blood and blood component related: If any of the donors falls under any of the above mentioned criteria, their unutilized blood or specific components must be recalled and discarded.

Drugs & Cosmetics Act and the National Blood Transfusion Council (NBTC) guidelines on blood and blood components allow for the sharing and transfer of screened or otherwise low-risk samples. It is done as a potential solution, to avoid supply hurdles due to reduced donation activities in an outbreak. These provisions can be exercised by licensed blood centres to make up for the scarcity of supply in the affected regions of the country.

Although a matter of routine and practice, these guidelines must be built into all clinical training and practice. Giving blood and blood components - when absolutely necessary - must be conducted when blood supply or normal sufficiency is compromised. This can help safeguard supplies and protect the recipients from exposure to a potentially infectious clinical product.

Hospital transfusion committees should be empowered to implement necessary measures to make the right decision with respect to blood transfusion and issue guidelines to the treating medical staff of the hospital for the appropriate clinical use of blood and blood components during an outbreak like COVID-19.

The National Institute of Biologicals which runs the National Haemovigilance Programme should continue to analyse adverse events and outbreaks that can affect blood transfusion practices, including post donation instances of COVID-19.

Dr. Arun R

Dr. Arun R

Infectious Disease
5 Years of Experience

Dr. Neha Gupta

Dr. Neha Gupta

Infectious Disease
16 Years of Experience

Dr. Lalit Shishara

Dr. Lalit Shishara

Infectious Disease
8 Years of Experience

Dr. Alok Mishra

Dr. Alok Mishra

Infectious Disease
5 Years of Experience


Medicines / Products that contain Blood transfusion during the COVID-19 pandemic

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References

  1. Ministry of Health and Family Welfare: Government of India. [Internet] New Delhi, India. Guidelines in the context of blood transfusion services during COVID-19 pandemic
  2. World Health Organization [Internet]. Geneva (SUI): World Health Organization; National Standards For Blood Transfusion Service
  3. Koeckerling D et al. Blood transfusion strategies and ECMO during the COVID-19 pandemic The Lancet Respiratory Medicine. 2020 Apr; 8(5): 40.
  4. American Red Cross [Internet]. Washington DC, USA. American Red Cross Faces Severe Blood Shortage As Coronavirus Outbreak Threatens Availability of Nation’s Supply
  5. Thalassemia International Federation. [Internet] Nicosia, Cyprus. The Covid–19 Pandemic And Haemoglobin Disorders
  6. Cai X et al. Blood transfusion during the COVID-19 outbreak. Blood Transfusion. 2020 Mar;18(2):79-82. PMID: 32267830.