Blood transfusion during the COVID-19 pandemic

July 3, 2020

The availability of safe blood is a key aspect of health services provision, much like drugs, vaccines and other medical supplies are. Unfortunately, blood cannot be made in the laboratory. It has a limited shelf life even in the best of storage facilities. For sustained blood supply, there must be willing unpaid donors. Since 2005, the World Health Assembly designated June 14th as the World Blood Donor Day. This day’s purpose is to appreciate and recognize the incredible contribution made by the donors and an opportunity to raise awareness around the need for sustained blood donation. Universal access to blood for those in need irrespective of where they are and when they need it, is critical in any functioning healthcare system.

This year, the World Blood Donor day came at a rather unusual time. The COVID-19 pandemic has been raging globally for almost six months. The emergency occasioned by COVID-19 means that prioritization of service delivery is inevitable. Consequently, some services are bound to be crowded out through reduced financing, human resource shortage due to task shifting, changes in priorities, and diversion of other resources to mitigate the effects of the pandemic. The fear of getting infected by the coronavirus influences decisions by potential users of blood donation services as well as blood donors. The effect of this is a likely reduction in new bloodstock and expiration of existing stock.

Safe blood supply in many developing countries, even before COVID-19, has been a challenge. Postpartum hemorrhage, severe anemia in children due to malaria and sickle cell disease are all health conditions that require a reliable blood supply. Taking Kenya, for example, the supply in 2019 was about one-third of the levels recommended by the World Health Organization (WHO). A national blood transfusion system requires investment in the infrastructure, equipment, supply chain, training, standardization, quality control, and a motivated public to keep donating blood regularly. The health facilities with blood transfusion services are limited as well as blood collection across the country. There are only six blood transfusion centers in Kenya and about 20 satellite centers all stationed in major towns. With more than half of the Kenya population living in rural areas, access to blood transfusion services is out of reach for many. Given that in many cases, the need for blood arises as an emergency with limited time to act, the risk of preventable death due to lack of safe blood is ever present. Access to blood and blood products is part and parcel of the essential services needed for countries to achieve universal health coverage. As we learn more about COVID-19, there is evidence on the value and a place for blood plasma from recovered COVID-19 patients in the treatment of COVID-19 itself, and this resource needs to be harnessed through blood transfusion services.

In Kenya, while provisions have been made to facilitate blood donation during the COVID-19 epidemic and associated restrictions, the gaps are glaring. Schools have traditionally been a good avenue for blood donation drives. However, these have been closed for the last three months. Due to the current restrictions on commuter vehicles’ capacity, accessing designated blood collection centers is a challenge, compounded by the reluctance of donors to venture out of their homes for fear of contracting the COVID-19 virus.

There is a need for innovation and engagement to sustain blood donation. It is crucial not only to keep pace with the current demand but also to prepare for an unknown urgency from time to time. One approach might involve organizing several but smaller blood donation events to avoid crowding and hence reduce the risk of COVID-19 transmission. This approach has the potential to encourage donors to come forward and donate blood. Appeals and proactively reaching out to donors for rare blood groups, particularly rhesus negative, may need to be a deliberate undertaking through contacts of known donors. Health education, mainly targeting individuals who regularly need blood is essential to ensure that arrangements to have the transfusion are not carried out in an emergency mode. It allows time to source blood without interrupting other pre-planned surgical procedures that require transfusion. Looking to the future, blood transfusion services need more support from all stakeholders. Increasing access nationally should be a priority. For example, the north and north eastern regions of Kenya may benefit from upgrading one of the satellite centers, such as Garissa, into a fully-fledged blood transfusion center with better capacity to serve the vast region.