key: cord-1017113-tml7aquk
authors: Quaglietta, Anna; Nicolucci, Antonio; Posata, Raffaella; Frattari, Antonella; Parruti, Giustino; Accorsi, Patrizia
title: Impact of Covid‐19 epidemic on the activities of a blood centre, transfusion support for infected patients and clinical outcomes
date: 2020-12-02
journal: Transfus Med
DOI: 10.1111/tme.12742
sha: 194308b4b60d938dc1be13b2c4af4d70e9b2e731
doc_id: 1017113
cord_uid: tml7aquk

OBJECTIVES: We evaluated how the Severe Acute Respiratory disease from Coronavirus 2 (SARS‐CoV‐2) epidemic impacted transfusion services, transfusion support required by Covid‐19 patients and their clinical outcome. BACKGROUND: In Italy, the first confirmed case of SARS‐CoV‐2 infection was registered on 21 February 2020. As of 20 April, about 250 000 cases were registered, 1143 of which were in the province of Pescara. METHODS: We compared transfusion services provided by the blood centre of Pescara between 1 March and 20 April 2019 and between 1 March and 20 April 2020. We assessed the number and type of blood components donated, those transfused in the various hospital departments and those transfused to Covid‐19 patients. RESULTS: Compared to 2019, we documented a decrease of 32% in the number of donations. The number of transfusions increased by 139% in the infectious diseases department (IDD), dedicated to Covid‐19 patients, and by 76% in the intensive care unit (ICU), whereas it markedly decreased in the other departments. Of 299 patients with Covid‐19, 60 were transfused (20.1%). Transfused patients in the ICU were significantly younger than those in IDD and had a lower number of lymphocytes, lower post‐transfusion increment of haemoglobin levels and higher D‐dimer and C reactive protein values. Mortality rate was 60.7% among transfused patients in the ICU and 39.0% among those in the IDD (p = 0.02). CONCLUSION: The Covid‐19 epidemic had a profound impact on transfusion activities. The important blood demand for Covid‐19 patients was satisfied because of the reduction in activities in other hospital wards. Covid‐19‐positive transfused patients showed a very poor prognosis.

Transfused patients admitted to the ICU were significantly younger than those admitted to the IDD, were more frequently of male gender, showed slightly higher pre-transfusion haemoglobin levels and a lower number of lymphocytes and had a significantly lower post-transfusion increment of haemoglobin levels (Table 3 ). (Table 3) . We documented a high mortality rate among Covid-19-positive, transfused patients. About 60% of patients admitted to the ICU and one in three of those admitted to the IDD died during their hospital stay. Patients who died did not differ from those who survived in terms of age and gender distribution; however, markers of inflammatory activity, particularly PCT levels, were markedly higher in patients who died than in survivors, together with a more severe lymphopenia.

Based on the available current evidence, restrictive RBC transfusions are associated with decreased morbidity and mortality, 8, 9 and a transfusion trigger of 7 g/L is clinically acceptable for most nonacutely bleeding critically ill patients. In certain groups of critically ill patients, such as those with septic shock, acute respiratory failure, severe or acute ischemic heart disease and brain injury, who may be at increased risk of the adverse effects related to anaemia, a trigger of 

Several reports have described the impact of Covid-19 on transfusion services 1,10-13 ; however, to our knowledge, this is the first report showing the impact of the Covid-19 pandemic not only on transfusion practices but also on outcomes. As such, it offers important information, particularly regarding the measures needed to face the increasing demand for transfusion support. The major limitation of our study is the origin of the data from a single, large hospital. Additional experiences will help to better define the burden posed by Covid-19 to transfusion services and the strategies that should be implemented to meet the needs of all patients.

The Covid-19 epidemic has had a profound impact on transfusion activities. During the emergency phase, the important blood demand for Covid-19-positive patients was satisfied, despite the reduction in donations, because of the reduction in activities in the other hospital wards. However, in recent weeks, specific structures have been gradually created for people with Covid-19, freeing hospitals from caring for these patients. This has important implications in light of the new outbreak of the epidemic. In fact, in these circumstances, the request for transfusion support for Covid-19 patients would add to the routine requests of hospitals that would resume their usual care activities.

All this could create a dramatic shortage of transfusion products, which could be at least partially remedied by increasing the stocks of frozen blood cells, optimising PBM and promoting donor awareness campaigns.

The impact of the SARS-CoV-2 outbreak on the safety and availability of blood transfusions in Italy

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and transfusion medicine: reflections from Italy

Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis

Patient blood management during the COVID-19 pandemic: a narrative review

International Foundation of Patient Blood Management (IFPBM) and Society for the Advancement of Blood Management (SABM) Work GroupThe essential role of patient blood management in a pandemic: a call for action

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group

Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

Blood supply and transfusion support in southern Italy: findings during the first four weeks of the SARS-CoV-2 pandemic

Impact of the COVID-19 -a regional blood centre's perspective

Impact of COVID-19 on blood centres in Zhejiang province China

Prepare to adapt: blood supply and transfusion support during the first 2 weeks of the 2019 novel coronavirus (COVID-19) pandemic affecting Washington State

Impact of Covid-19 epidemic on the activities of a blood centre, transfusion support for infected patients and clinical outcomes

The authors have no competing interests. 

https://orcid.org/0000-0002-3157-0132