Cleveland Clinic Provides Blood Management Strategy Innovation during COVID-19

It goes without saying that the ongoing coronavirus 2019 (COVID-19) pandemic has taken a great toll on healthcare systems and services around the US. While social distancing measures have remained in place, a shortage of blood supply products has pushed healthcare providers to respond, innovate, and strategize so that they can meet the needs of patients while keeping safe both caregivers and patients.

In a recent article published by Deborah Tolich, DNP, MSN, RN, and colleagues at the Cleveland Clinic, they describe strategies implemented in the face of blood supply chain disruptions and donations due to the pandemic.

Such efforts include increasing blood collection, aligning efforts among transfusion medicine departments, effectively triaging blood products to ensure proper allocation, and increasing education of patient blood management (PBM) practices.

Although PBM practices have long existed, there has been no motion to fully integrate them as a universal standard of care.

“The COVID-19 pandemic highlighted the need for PBM guidelines to be mainstream practice,” Tolich and colleagues wrote. “First, there is the immediate risk that blood shortages impose on acutely ill patients. Second, there is the surge of need for innovation in delivery of PBM services given new opportunities to optimize patients such as after cancellation of elective surgeries.”

In response to these needs, Cleveland Clinic’s transfusion medicine department established guidelines for issuing all Rh D-negative—in addition to O-negative—red blood cell units, as well as Rh D-negative platelets. Additionally, department personnel informed institutes to potential blood shortages and plans to minimize blood use.

The patient blood management department implemented guidelines for red blood cell use and anemia management to ensure consistency in blood management strategy.

PBM personnel also ensured patients with preoperative iron deficiency had access to intravenous and oral iron formulations, the latter being recommended for administration every other day in a single nighttime dose.

Furthermore, PBM established an anemia management workflow for cancelled high blood loss surgical cases. This would ensure the best possible approach to continue anemia care.

Despite efforts to minimize blood transfusions while optimizing treatment, it nonetheless remains necessary to continue collection of blood from donors.

With the burden COVID-19 has placed on blood donations, the collaborative efforts of hospitals and blood centers have pushed for blood drives to be held in larger spaces—so as to promote social distancing and ensure maximization of collections. 

And yet, clinicians cannot overly rely on consistent blood supply. As the authors noted, innovations in healthcare strategies are propelled by pandemics and far-reaching active crises.

“Blood management also is affected as it plays a crucial role for enhanced patient optimization, especially before surgical intervention,” they concluded. “Clinicians must balance the need to optimize anemia while minimizing the risk for patient blood loss in order to mitigate the need for blood transfusion.”

These strategies ring especially true for patients who depend on frequent blood transfusions, such as individuals with sickle cell disease. Recent therapeutic options have emerged that have reduced the need for transfusions in sickle cell patients.

Such new, innovative options underscore the hurdles that are continuously being overcome as clinicians and researchers alike are attempting to provide optimal care to patients in a pandemic that seemingly sees no end.

The advisory, “Blood management during the COVID-19 pandemic,” was published online in Cleveland Clinic Journal of Medicine.