Hospitals across the country are delaying surgeries while peaks in blood use.
There has been at least a 10% increase in blood transfusions since patients received care they deferred during the COVID-19 pandemic, many of whom are more ill, according to Vizient, the organization’s acquisition of the group that helps source for more than half of U.S. health systems. Donations have also dropped, which they have has delayed some non-urgent procedures.
It’s a perfect storm, said Akiva Faerber, a senior director at Vizient. Utilization is increasing and supply is falling, which has compromised not only patient care but also inflated prices, he said. The price of O positive and O negative red blood cells has increased by 30% per unit in the last 12 months, Vizient said.
More than a third of community blood centers across the country said they had a supply of a day or less, according to America’s Blood Centers ’ daily update from 59 community blood centers.
“That’s the worst thing I’ve seen in my 47 years in this business,” Faerber said. “And it’s going to get better very soon.”
There is a severe shortage of either positive and O-negative blood, which is worrisome because summer is typically when non-urgent surgery volumes and trauma cases increase, said Meg Femino, vice president for emergency management at Beth. Israel Lahey Health.
Beth Israel Lahey hospitals sort out operating room cases every day and can delay elective cases when appropriate, he said.
“We have recommended guidelines for hospital maintenance in all of our lines of medical surgical services that are high blood users,” Femino said, adding that BILH operates blood units in its hospitals.
Hospitals consider reducing non-urgent surgeries or adjusting blood transfusion limits to preserve supplies. But clinicians were already concerned that preventive and elective care delayed or skipped during the pandemic could have significant impacts on health outcomes. It could also stress patients and providers, who had already reported higher levels of burnout and anxiety.
Meanwhile, vacant offices and schools have launched blood donations. Blood suppliers also have problems with staff.
The Cleveland Clinic said he is facing a blood shortage like the rest of the country, but has yet to stop any service. The University of Utah Health said it has had to deal with intermittent blood deficiency, but has not been affected by the recent outage.
“There have been some low periods in the past, but I would have to go back a few years to see such short supply for an extended period of time,” said Dr. Glenn Ramsey, president of the Transfusion College of American Pathologists ’, apheresis, and cell therapy committee practicing in Northwestern Medicine. “It’s definitely been a national problem for about two weeks.”
Liver transplants are some of the most intensive blood tests, Ramsey said. Providers may be able to limit the number of outpatient transfusion units for chronically anemic and chemotherapeutic patients. But these are complicated scenarios, he said.
Providers cannot plan around for gunshot wounds, obstetric hemorrhages or other emergencies.
“A common theme we’ve heard from blood providers is that hospitals are seeing increased use; some are also recovering from deferred care because of COVID,” Ramsey said, adding that recent coverage gains through of the Medicaid expansion or the Affordable Care Act can also be straining provisions.
There has also been a lack of blue-cap tests used to test for blood clotting, even though supplies are refilled, experts said. The blue-capped tubes have the anticoagulant sodium citrate, which is lacking, according to the Food and Drug Administration.
In mid-June, Becton Dickinson and Greiner manufactured and shipped blue top tubes, but continued to be assigned while processing subsequent orders, said Scott Grubenhoff, senior director of contract services for Vizient. Becton Dickinson, who is the market leader for blue top test tubes, expects to have completed his subsequent orders by the end of October; Greiner said in late July.
The lack has affected almost every aspect of a health system, from the emergency room to trauma and acute elective cases to outpatient facilities that monitor patients in blood thinners.
Some doctors routinely perform hemoglobin tests before non-urgent surgeries. Adapting these practices with safe reduction in the frequency of blood tests for certain patients could save supplies, experts said. They emphasized cohesive messaging in all departments of the health system.
According to the College of American Pathologists, the shortage of blue upper tubes persists until 2021. Without these supplies, doctors will be able to predict a patient’s risk of excessive bleeding or developing clots, which can be life-threatening.
IN CAP recommended reduction of routine coagulation tests for low-risk surgeries when clinically appropriate. Limit standing orders for tests, especially for patients stable in long-term blood thinners.
Nurses and phlebotomists should avoid using sodium citrate tubes as discard tubes and design only blue top tubes when tests are ordered. Clinical laboratories should obtain sodium citrate tubes from alternative suppliers, but only if there are written procedures and the manufacturers are validated.
Laboratories should avoid 3.8% of tubes instead of 3.2% of tubes and use only expired tubes as a last resort, the CAP said.