Transfusion medicine during COVID-19 outbreak in the hotspot of Spain

Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients - Results from the prospective COVIP Study

AIMS

Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients.

METHODS

In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded.

RESULTS

In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality.

CONCLUSION

The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.

Predictors of Red Blood Cell Transfusion in Elderly COVID-19 Patients in Korea

Background

Patients who experience clinical deterioration from coronavirus disease (COVID-19) require blood transfusion support. We analyzed blood component usage in COVID-19 patients and identified the predictors of red blood cell (RBC) transfusion in elderly (≥65 years) patients.

Methods

Blood component usage in 882 COVID-19 patients hospitalized between January 24, 2020 and April 30, 2021 was analyzed. Elderly patients were categorized into transfused and non-transfused groups according to their RBC transfusion history; their demographic and clinical characteristics, disease severity, and outcomes were compared. Associations were determined using multiple logistic regression.

Results

The overall transfusion rate was 8.3% (73/882), and the transfusion rate was 2.7% (14/524) in patients aged <65 years and 16.5% (59/358) in those aged ≥65 years. Among the 358 elderly patients, 344 patients, including 50 who received transfusion and 294 who did not, were enrolled for the analysis. The prevalence of diabetes mellitus (DM), white blood cell count, absolute neutrophil count, and neutrophil-to-lymphocyte ratio (NLR) on admission were significantly higher in the transfused group, whereas Hb and platelet counts were significantly lower. Disease severity in the transfused group was relatively high on admission and increased thereafter. DM, intensive care unit entrance on admission, Hb, platelet count, and NLR on admission were independently associated with RBC transfusion.

Conclusions

This study presents transfusion rates in COVID-19 patients according to age groups and predictors of RBC transfusion in elderly patients. The results provide a basis for developing a strategy for the medical treatment of infectious diseases emerging during pandemics.

National level adjustments to the challenges of the SARS-CoV2 pandemic on blood banking operations

Background

SARS‐CoV2 causing coronavirus disease (COVID‐19) is responsible for an unprecedented worldwide pandemic severely affecting all activities of societies including blood banking. We aimed to systematically collect key indicators in a nationally centralized blood banking system and to perform comparisons between 2020 and 2019.

Methods

Count data for January–December 2020 and 2019 were extracted from the integrated informatics system of Hungarian National Blood Transfusion Service and analyzed by simple graphics, tabulations, and statistics.

Results

Whole blood donation activity showed a highly significant decline due to a sharp decrease in field donations by an average fall of 24% (range:17%–28%) during March–May 2020 compared to identical period of 2019. A second, more moderate decline accompanied the second wave in late fall. The simultaneous increase in institutional donations did not counterbalance this decline. Donor exclusion rates fell significantly by an average of 1,1% (range:0.9%–1.6%) in the three spring lockdown‐affected months. First‐time and repeat donors showed decreased turn‐out in larger proportions compared to highly repeat donors. Interestingly, among repeat and highly repeat donors, females showed less‐pronounced declines compared to males while this was not observed among first‐time donors. In June–September, a remarkable swing‐back was observed among highly repeat female donors. Product utilization fell most notably for RBC (mean:26.2%) but also for PLT (mean:19.8%) and FFP (mean:24.3%) and showed a full recovery in June–September followed by a second decline.

Conclusion

Trends and reaction patterns of blood banking reported by our study may be useful in future planning and adjustments of blood banking activities.