Transfusion medicine

Blood 2021: Pandemic challenged but failed to interrupt blood supply

The COVID-19 pandemic has raised numerous issues for a safe and secure blood supply but Australian systems have worked well and there has been no significant disruption to supply to date.

There has also been no need to activate the National Blood Supply Contingency Plan (NBSCP), an ANZSBT session at Blood 2021 was told.

Ms Sandra Cochrane, Executive Director Fresh Blood, Data & Clinical Development at the National Blood Authority, told the Congress that demand for fresh blood products was down and supply was up in 2020 when elective surgery was first cancelled.

That situation has now flipped in 2021 with demand for red cells at a 10-year high.

Ms Cochrane said the intermittent resumption of previously delayed elective surgery, higher demand from oncology and obstetrics, and more emergency presentations were some of the likely drivers for increasing demand in 2021.

She said platelet demand had also increased in 2021 by about 5% over 2019-2020.

Ms Cochrane said total days cover for red blood cells had dropped nationally from 8.4 days to 6.9 days but was being closely monitored.

Continuing efforts at optimising blood management principles were important on the demand side as was ongoing recruitment of donors on the supply side.

“Donating blood is an essential continuing activity and is explicitly supported by governments as an exemption to restrictions on movement and travel,” she said.

Vaccination’s impact on blood supply

Speaking in the same session, Australian Red Cross Lifeblood’s Chief Medical Officer Dr Joanne Pink said COVID-19 vaccination had brought fresh challenges in 2021.

She said while donors need to wait until 7 days after their vaccination before they can donate, this was for donor health reasons not the recipients.

“… because the vaccine may cause minor side effects such as fever. Donors who donate when they are not feeling 100%, are at increased risk of experiencing an adverse reaction such as fainting during or after their donation.”

She said donated blood is not labeled with the vaccination status of the donor.

“We do not routinely ask whether they have been vaccinated and we are not able to meet requests for blood sourced only from unvaccinated donors. Millions of units of blood from vaccinated people have been used worldwide and there are no concerning safety signals to date.”

She said anti-platelet factor 4 (anti-PF4) antibodies associated with the AstraZeneca vaccine complication VITT were not necessarily pathological.

“They are present in about 4-6% of the normal population. It may be that in the asymptomatic people, the antibody is circulating unbound to whatever the unknown cofactor is in VITT.”

Similarly concerns about the transfer of lymphocytes which produce anti-PF4 could be allayed given red blood cells products were leucodepleted and also irradiated in patients with significant immunosuppression.

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