The American Red Cross made headlines in January when it declared the United States’ first-ever blood crisis amid the COVID-19 pandemic’s omicron surge. But that announcement came as no surprise to the nation’s blood banking experts and laboratory professionals. “I started working as a medical technologist in the blood bank in 1991 and I have never seen the available donated blood plummet to these levels,” says Kimberly W. Sanford, MD, MASCP, MT(ASCP), Immediate Past President of ASCP, and Medical Director of the Laboratory at Virginia Commonwealth University’s (VCU) Stony Point Medical Center, Richmond, VA. “September 11, 2001, was the only thing that came close, and that was a specific, finite event.”
For Dr. Sanford, what sets apart the current crisis is its extended time frame and widespread pandemic-related fatigue and malaise. “It’s been the perfect storm: Healthcare workers are fatigued, the public is fatigued, and resilience is low,” she says, noting that VCU has treated an increased number of gun violence victims during the pandemic, further taxing their already stretched blood supply.
COVID-19 has affected the blood supply in other ways, too. For example, the pandemic has meant that the usual sites for blood drives have been off limits and many donors have stayed away due to concerns about COVID-19 exposure. Blood drives have not been exempt from the staffing challenges found throughout healthcare these days, either; many healthcare workers have been sick with COVID-19, while others have left the field altogether.
Tell the right story
Stephanie Whitehead, MBA, MPH, CLS(ASCP), Executive Director of Pathology Services at University Health in San Antonio, Texas, is not about to sugarcoat the blood shortage. But she also believes that laboratory professionals are well-positioned to bring about positive change in their institution’s blood policy and supplies. “Nobody outside the lab really understands our laboratory world,” she says. “It’s all about how you tell the story. You can make the blood shortage real for people and make them care and want to help.”
For Mrs. Whitehead, that means being willing to step out of one’s communication comfort zone when necessary. “As laboratory professionals, it’s easy to be introverted but we have to push ourselves past that narrative and build relationships to provide guidance about blood management,” she says.
Take a leadership role with clinicians
Establishing trust with your institution’s clinical leaders via regular communication is crucial. Refining both the lines of communication and your institution’s blood-related clinical decision-making is a strategic imperative, especially given that the blood shortage is likely to continue indefinitely.
Mrs. Whitehead serves on a multidisciplinary committee that includes hospitalists and OB-GYN and emergency physicians that provides her the opportunity to keep communication lines open and flowing, whether blood-related or not. “We talk about the utilization of specific lab tests and order sets,” she says. “Are the order sets updated to follow all ASCP guidelines? We want to make sure of that.”
Dr. Sanford speaks with VCU’s perioperative leadership, transplant, and trauma teams daily to anticipate their needs. “I also engaged our ethics committee and assembled an on-call group to be ready if we had multiple trauma patients where we didn't have enough resources to support all of these individuals,” she says.
The pandemic also pushed VCU to develop a blood emergency management policy that includes an algorithm that addresses the distribution of emergency-use blood in the hospital based on inventory status. This effort included the creation of a blood bank availability dashboard that sets criteria for green, yellow, amber, and red status levels.
Don’t be afraid to gatekeep when needed
While relationship-building with your institution’s clinical leaders is important, being an effective gatekeeper when appropriate can also help decrease the effects of the blood shortage on your institution.
For example, when VCU’s blood management dashboard reaches amber status, the system automatically notifies all providers. “At that point, we’ll screen every unit that leaves the blood bank,” Dr. Sanford says. “We’ll discuss with clinicians the need to fully assess each patient, and not just transfuse to the numbers. We’ll ask if patients are truly symptomatic and get clinicians to consider whether their patient can wait to receive blood or if it’s a truly lifesaving situation.”
At University Health, Mrs. Whitehead has worked with clinicians to refine their blood management program. “As a team, we looked at our hemoglobin trigger to discuss whether it could be higher or lower based on our population, and then whether we could start with one unit of red blood cells instead of starting with two as we’ve always done,” she says. “Our lab also refined the notion of ordering 5 a.m. CBCs on all patients, which can potentially make that patient anemic and lead to a blood transfusion, further contributing to the overall blood shortage.”
Partner with suppliers and peers
Building strong relationships with your blood supplier and nearby institutions can also help buffer your institution from the worst of the blood shortage. “Treat your supplier as the partner they are,” Mrs. Whitehead advises. “Our blood bank team talks with ours daily to keep close tabs on when our units will expire and whether we can or should switch out some units for those with longer expirations. Our supplier is happy to send those units to another facility that can use them before they expire.”
Establishing and keeping communications open with your nearby peers can enable you to do your own swaps when needed. In Virginia, Dr. Sanford was able to create an informal phone tree for cooperative blood management between medical centers when needed.
Mrs. Whitehead also looks for positive patient stories to share with her blood supplier.
“Sometimes they don't have enough of those feel-good stories to use in their marketing to promote blood donations, but we always hear them from our care team,” she says. “We’ll be sure to tell them when, for example, we had a pre-eclamptic mother come in who received blood that saved her life.”
Work with the broader community
Finally, look for ways to promote blood donation among patients and members of the public. Create a constant flow of subtle but positive messages that get the point across: community members can and should roll up their sleeves whenever possible.
At VCU, Dr. Sanford has arranged to display donation-positive messages on every hospital computer screen, where they can be seen by both patients and staff members. “I want to remind people that the need is not just during the pandemic surges,” she says. “We need that blood on the shelf at all times to do our lifesaving work.”
In San Antonio, Mrs. Whitehead and her team have worked with her marketing department to create materials that emphasize the importance of donation: “Regular reminders that blood can’t be manufactured like other drugs are helpful to the public. Blood products are only available in adequate supply through generous and regular donations from the community,” she says.
Additionally, University Health has placed tactful blood donation messages in hospital areas and electronic systems that are viable to the patient. “During times of crisis, many people want to do something positive to help, but they don’t think of donating blood as a way to help save lives unless we plant the seed,” Mrs. Whitehead says. “We try to make the process easy for our donors.”
Finally, Dr. Sanford suggests looking for opportunities to get back on campus for blood drives. “High school and college blood drives are where we find a lot of first-time donors and make lasting connections with them,” she says. “The fact that we’ve missed two years of on-campus blood drives means that two graduating classes have missed that introduction. We’ve got a lot of catching up to do in terms of developing new lifetime donors.”
The common thread through all these suggestions is, of course, communication and leadership from laboratory professionals with clinicians, suppliers, and the community. “This is not always easy for laboratory professionals, but we absolutely must engage,” Dr. Sanford says. “We can’t solve the blood shortage alone, but we can help.”