key: cord-0713844-nh3wouo7 authors: Tan, Pei Pei; Chang, Chee Tao; Mohd Noor, Sabariah title: Blood supply management during the Covid-19 pandemic: Experience in a tertiary referral hospital in Malaysia date: 2020-10-30 journal: Transfus Apher Sci DOI: 10.1016/j.transci.2020.102982 sha: 4972c03e3256e294e0bdcff038684d7613e90a5f doc_id: 713844 cord_uid: nh3wouo7 nan The COVID-19 outbreak, caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was declared as a pandemic by the World Health Organization on March 11, 2020 [1] . As of 5th of October 2020, there were more than 35 million of confirmed Covid-19 cases worldwide and 12,813 cumulative confirmed cases reported in Malaysia [2] . To combat the Covid-19 transmission in the community, the Malaysian government had implemented the Movement Control Order (MCO) on the 18th of March 2020. This article described the management, challenges, and steps taken by the Hospital Raja Permaisuri Bainun (HRPB) Transfusion Medicine Department to ensure adequate and safe blood supply during the Covid-19 pandemic outbreak. The blood supply in the Malaysian health system relies mainly on voluntary, non-remunerated blood donors [3] . After the enforcement of movement control order (MCO), blood supply at the National Blood Centre and other blood banks in the country reported a prominent 40 % reduction in comparison with previous year, from 111,328 bags (Mac-May 2018) to 67,135 bags (Mac-May 2020) [4] . Relaxation measures were implemented to replace the MCO in May 2020 (Conditional MCO) and June 2020 (Recovery MCO). Subsequently, there was a rise in blood demand, as elective operations began to resume and motor-vehicle accidents raised [4] . The challenge in blood procurement during the Covid-19 outbreak is not primarily due to the SARS-CoV-2 itself, but secondary to the movement restrictions order and social distancing rules. Similar with other settings, the Raja Permaisuri Bainun Hospital transfusion medicine department faced several challenges in maintaining optimum level of blood inventory. The amount of blood bags collected from March to August in 2019 was 14,486, whilst there was only 11,895 bags collected over the same period in 2020, similar to an 18 % reduction. While bloodbank based collections had a slight increment of 1.6 %, blood collections through mobile drive had markedly reduced by 23 % [2019: blood bankbased: 1763 units, mobile blood drives: 12,723 units; 2020: blood bankbased: 2097 units, mobile blood drives: 9798 units]. Nevertheless, the total amount of blood usage had reduced over the same period of time, from 9936 units in 2019 to 7888 units in 2020 as a result of reduced elective cases and trauma-related transfusion. Upon closure of educational and employment venues, the number of blood donation drives had also decreased markedly. Cancellation of mobile drive have led to more than 30 percent drop in the blood inventories as reported in India and the United States, which are among the most populous countries in the world [5, 6] . While the blood demand had been declined during the MCO, there were patients who required routine and emergency transfusion, including the Thalassemia and maternity patients. To mitigate the impact of reduced blood donors and to meet the blood demand, we organized mobile blood drives at the Perak state Indera Mulia Stadium and shopping complexes adjacent to our hospital blood bank. Areas with vast spaces are suitable for blood donations, as the donor's bed can be spaced at least 1 m apart and adequate physical distancing can be practiced at the donors' waiting area [7] . A recent study found that short message service (SMS) and telephone calls on inactive blood donors can effectively increase re-donation. While SMS was found to be more cost-effective, we employed both active calling and SMS to maximize donor return, to cater for the in-hospital blood demand [8] . In consistence with previous study, the national blood bank team had also made public radio and television station appearance to increase the public intention to donate [9] . We also used social media such as Facebook and Telegram to disseminate mobile blood drive information, which may serve as a more effective method among the younger donors. Several measures were implemented to ensure blood donors and staff safety during the donation. Additional blood donor screening questionnaire was administered in our setting [10] to identify donors with high-risk of Covid-19 exposure. The following deferral steps were made at both blood-bank based and mobile blood drives: i) Deferral of donors returning from any national or international territory for 14 days; ii) deferral of donors who had been in close contact with confirmed Covid-19 cases; iii) deferral of donors who had Covid-19 symptoms; iv) deferral of donors with a body temperature of 37.5 • C. This was supplemented by the MySejahtera mobile application, an application developed by the Malaysian Government for contact tracing and stratify user's risk against Covid-19 [11] . All blood donors were required to scan the registered QR code using the designated mobile apps or write their contact details manually before entering the donation area. All staff and donors worn a facemask throughout the donation process. The staff were also equipped with personal protective equipment and the donors' bed and donor's area were routinely disinfected based on national guidelines [12] . During the initial stage of the MCO, the blood donors faced difficulties in travelling to the mobile sites and blood bank. To maintain blood inventories, it is important for the authorities to recognize blood donation as a permitted activity during lockdown [13] . After communication between the Ministry of Health with the National Security Council and the Inspector-General of Police, on the 27th of April, donors were allowed to travel within the state to donate. This was a mitigation strategy implemented to ensure adequate blood supply during the Ramadhan fasting month (23rd April-23rd May 2020) [14] . In our setting, we practiced both appointment and walk-in system to increase donor recruitment. Donors who preferred an appointment were required to fill up their details in a Google Form, and a travelling slip were [15] . For walk-in donors, they were given an official letter as a proof that they had donated after donation. Despite facing several challenges in blood donors' recruitment, the HRPB blood bank was able to sustain blood usage throughout the MCO. Fortunately, there was no Covid-19 cases reported among the donors and recipient, as a result of our preventive measures. Apart from the aforementioned measures, other actions can be considered in any event of inadequate blood supply. The patient blood management principle is an effective, evidence-based, multidisciplinary approach to reduce unindicated transfusion during the Covid-19 pandemic. By optimizing the patient's red cell mass, reducing peri-operative blood loss and enhancing anaemia tolerance, patients' outcome can be improved at a lower healthcare cost [10] . Active involvement of the transfusion medicine specialist in evaluating the patients' need for transfusion and effective communication with clinicians on recommendations for blood component support and blood conservation strategies is warranted in future clinical practice [16] . Any blood bank staff who performed cross-matching of suspected Covid-19 specimens should use a certified class II Biosafety cabinet or Plexiglass splash guard with adequate PPE to reduce the risk of infection [17] . Improvisation of a disaster and infectious disease outbreak response team led by a transfusion medicine specialist is important to promptly develop mitigation guidelines and policy [18] . Less common measures available in other countries such as blood collection at donor's home, establishment of rare donors' registry, loosening donor's eligibility criteria, extended donation hours, sharing of blood inventories with neighboring hospitals, could be considered in time of blood supply crisis [13, 19] . The transfusion medicine team plays extremely important role in maintaining the balance between blood supply and demand during the Covid-19 pandemic. While ensuring adequate procurement, the safety of donors, staff and blood products should not be compromised. A multifaceted approach, including promotion via social media, calls, SMS, an online appointment system, applying patient blood management principles and active involvement of the transfusion specialist is important to ensure sustainability of blood supply. This study did not receive external source of funding. All authors contributed equally to this paper. The authors declared no conflict of interest WHO. WHO characterizes COVID-19 as a pandemic. 2020. Date: March 11, 2020. Date accessed: 06 Oct Current situation of COVID-19 in Malaysia Overcoming blood supply challenges in multi-ethnic donor and patient populations: the Malaysia experience Health DG urges public to donate blood due to shortage at blood centres. 2020. Date: 20 Potential challenges faced by blood bank services during COVID-19 pandemic and their mitigative measures: the Indian scenario Balancing supply and demand for blood during the covid-19 pandemic Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis Effective methods for reactivating inactive blood donors: a stratified randomised controlled study Motivational factors for blood donation, potential barriers, and knowledge about blood donation in first-time and repeat blood donors Patient blood management during the COVID-19 pandemic: a narrative review Malaysian government Cleaning and Disinfection Procedures in Public Places. Ministry of health Effects of the COVID-19 pandemic on supply and use of blood for transfusion The Star. Why allow blood donations during MCO? MOH says shortage happens every Ramadan. 2020. Date: 27 Apr 2020. Date accessed: 06 Oct Raja permaisuri bainun hospital appeals for blood donation to replenish stock The role of the transfusion medicine consultant Infection control for handling blood specimens from suspected ebola patients. 2020. Date accessed Disaster preparedness in the blood bank Management of blood supply and demand during the covid-19 pandemic in king abdullah hospital, bisha, saudi arabia We would like to thanks the Director General of Health Malaysia for his permission to publish this article.