U.S. blood supply steadier but still short

Anne Paxton

August 2022—Blood is a precious resource and shouldn’t be treated as a commodity. That’s the consensus in the blood banking community, in line with a longstanding conviction that volunteer donations should remain at the blood system’s core. But as the worst of the pandemic appears to have passed, discussion of blood shortages has increasingly drawn on the vocabulary of commerce, and the warnings about the blood supply have been rife with references to supply chain problems that go beyond the need for more donations.

Crises in the blood supply are nothing new, and while the health care system strives to stay prepared, the pandemic threw novel commercial and logistical factors into the mix, in some ways jumbling the expected order of a crisis for blood services. Hospitals scrambled to cope with a surge of COVID-19 patients while the spread of infection caused thousands of blood drives to be canceled, so there was a steep drop in supply of blood products, says Pampee Young, MD, PhD, chief medical officer, biomedical services, American Red Cross.

“What saved us was the concurrent order from government and state legislatures to cancel all elective surgeries,” Dr. Young says. That COVID-19 itself did not require a lot of blood brought a concurrent drop in demand. “That prevented an absolutely major crisis,” she says.

So for the blood supply, the initial phases of the pandemic may have been the easier part. Pandemic recovery, however, has brought a more intense set of pressures and threats. At the beginning of this year, reopening the economy amid spread of the omicron variant may have been foremost on people’s minds. But the blood supply had dropped to historic lows.

“In January 2022, we had the most severe blood shortage we’ve had in two decades,” says Alyssa Ziman, MD, medical director for UCLA clinical laboratories and medical director of transfusion medicine at Ronald Reagan UCLA Medical Center. Triaging patients based on availability of blood, negotiating with physicians on whether surgeries could wait, moving blood between hospitals—all were measures the medical center took to manage the critical shortage.

“I think what helped us get through, in hindsight, was that the surgery schedule was curtailed because of the pandemic’s impact on patients and staffing. I also think that people’s behavior must have changed, as our hospital did not have to treat as many severe trauma patients as we have typically seen in December and January. So we managed to get through the severe shortage without a major trauma that required transfusion of 50 or 100 units of blood.”

While shortages have eased to a degree, blood experts interviewed by CAP TODAY describe the ongoing impact of the pandemic on the blood supply and some of the serious challenges that remain.

Before the pandemic, blood banks were comfortable if they had five to seven days of inventory on the shelves, says Claudia Cohn, MD, PhD, chief medical officer of the Association for the Advancement of Blood and Biotherapies (AABB). If they dropped below five days, that’s when they became worried, and at three days “they would issue an emergency alert” to recruit donors.

The cancellation of elective surgeries in 2020 meant that at a number of hospitals there was a 30 percent reduction in the amount of blood they needed. “So we went from a shortage [at the start of the pandemic] to actually a bit of a surplus because people who were willing to donate were donating and suddenly we had more than we needed. And, of course, because blood has a short shelf life, that meant that some blood units expired.” Unfortunately, because the National Blood Collection and Utilization Survey conducted by the Centers for Disease Control and Prevention is released three years after the data are collected, “no one knew it. We don’t keep good data on how blood is used.”

“We then sort of stabilized with maybe two or three days’ worth of blood on the shelves but very few patients. So we were okay,” says Dr. Cohn, who is professor of laboratory medicine and pathology, director of the blood bank laboratory, and associate director of clinical laboratories, University of Minnesota.

Two- or three-day supplies of blood became common. “We stayed there for a while,” she says. “But then the shortage of workers began to have an effect, as it has on every segment of the workforce. Some blood centers took measures to make sure their employees were happy and offered raises, better work hours, and things like that, but other blood centers did not. And so we saw problems with blood collections across the country, and that is still somewhat the case. So we’re still in this chronic shortage, but it has gotten better.”

The worst-case scenario, Dr. Cohn adds, “happened when we were at a one-day supply of blood at many, many centers, and there was a news report that at least one emergency trauma center closed for a few hours because they simply didn’t have the blood on their shelves to accept new patients.” Blood shortages causing delays in care occurred at a lot of hospitals, she says, but nearly all were unwilling to talk about it publicly. “They didn’t want to scare patients and have patients who had a choice go to a different hospital.”

Recovering from pandemic mode also didn’t mean the country started stepping up again to donate. “I suspect it’s probably not the first thing on your mind to come and donate blood for strangers, to get stuck with a needle,” says Kamille West-Mitchell, MD, chief of the Blood Services Section of the National Institutes of Health Clinical Center Department of Transfusion Medicine.

The workforce is a part of the blood system that people don’t often think about, Dr. West-Mitchell says. “They just think the blood magically comes out. But you need dedicated people to screen and recruit donors, test donations, and manufacture components. The workforce is a major element that I don’t think was anticipated in the beginning as part of the shortage.”

Demand also took many hospitals by surprise, Dr. West-Mitchell says. “Demand absolutely went up. It came back before the supply really did. People who had major interventions postponed for a year led to hospitals doing tons of transplants all in one month.” Suddenly there is a situation in which many patients need blood, she says, at a time when blood donation levels are far from recovered.

The pandemic has not exactly made haste to leave. “I’m not sure we’re done with the pandemic, because the pandemic is multiple things going on, not just one thing,” says Patricia Kopko, MD, professor of pathology and director of transfusion medicine, University of California San Diego Medical Center. “First of all, hospitals and blood suppliers in general are experiencing the same supply chain issues that the rest of the world is experiencing.

“Think about it,” she continues. “If you run a big blood center and you have hundreds of vehicles, how many do you have to replace a year? Have you tried to buy a car lately? It’s the same supply chain issues for everything, from not being able to buy blood sample tubes to little things like one of your TVs breaks and your donors like to come in and watch baseball games and you don’t have a TV for them to do that. It’s everything that goes into the supply chain to do what blood centers do.”

On top of that, blood centers still have trouble getting employees. “There are millions of people who are not in the workforce because they’re either sick from COVID, taking care of somebody who’s sick from COVID, retired because they’re afraid of COVID, or they died, or they didn’t have enough money to pay for child care for their kids. A large percentage of people who work drawing blood are women, and many are young women with children not yet in school. So you can’t get employees. But the blood supply still needs to be there.”