Blood Bank usage by Covid19 Patients

[Kellimq 20]

Hi Everyone, 

I run a major hospital blood bank in Australia. Have any of you have experience with the demand for blood/blood products eg Albumin during the CoVid19 pandemic? Did you experience an increase in requests for group and hold serum from these patients? Are they using any particular type of product more than others or at all? Just trying to develop plans and stock levels. Good luck to everyone out there dealing with this and stay safe!. 

 

Kelli

[David Saikin 1,452]

Wish I could offer you some experience w these patients.  Currently we've only had one positive pt and that individual was not admitted.   We don't anticipate component usage for these folks but you never know.

[John C. Staley 1,206]

My best guess and it is nothing more than a guess, is that if these patient's require any support from the transfusion service it will be due to a preexisting condition and not the direct result of the corona virus.  I don't recall in all my years, of any patients with pneumonia requiring a transfusion due to having pneumonia and I understand that pneumonia is the primary reason for hospitalization here.  Now I may be way out there on this but only time and experience will tell.    

[Sonya Martinez 44]

I'm currently working on building the convalescent plasma product codes into our computer system in case it is needed/wanted.  But I'm in a children's only hospital so the only thing we're seeing right now is the normal stuff like urgent heart, spine, cranio and orthopedic surgeries plus our chronic transfusions for the rare anemia patients.  We are no longer doing non-urgent surgeries and I anticipate to slow down further but according to the news California had the first death of a child (person under 18 yo) with COVID-19 but I haven't see if that's why the patient died.  It would be nice if anyone knew lab personnel in Italy, Spain, etc but I think they may be a bit busy right now!!  Unfortunately for us the flu is still going strong and we have had HUS and CAHA cases from it.

[Kip Kuttner 87]

Really sick patients needing ECMO will use blood. I don’t have a way to gauge the utilization at this time though. 
All the best. 
 

[Symon Lockhart 2]

I believe that once ventilated, due to the risk of DIC, some COVID19 patients are requiring extensive platelet support. Thank fully not seeing this at present in Scotland, however numbers of patients testing positive are increasing daily.

 

[Neil Blumberg 246]

Transfusing platelets (and plasma)prophylactically to patients without serious bleeding, based solely upon laboratory abnormalities of hemostasis/platelet count,  is a serious clinical error in my opinion.  Platelets and plasma impair host defenses against viral and bacterial infection, promote inflammation and thrombosis, and likely increase the risk of multi-organ failure.  Thus I would reserve these products for situations where these serious toxicities are outweighed by the potential for treating life-threatening bleeding.  This opinion is shared by one of the world's experts on hemostasis and thrombosis, the London based hematologist Beverly Hunt, who has tweeted her recommendations for these patients.   See this link for her four pager on the subject.

https://twitter.com/bhwords?ref_src=twsrc^google|twcamp^serp|twgr^author

[AMcCord 1,302]

Blood shortages are a big problem in parts of the US. Donors are not presenting, drives are being cancelled. Those patients who normally need blood products will be affected by that. I can't speak to Covid19 patients specifically...yet. We have been asked to reduce our stock by 25% and cut usage by 25% so that blood products will be available for those who need it most.

[BldBnker 36]

Sonya Martinez,

Where are you going to get the COVID-19 convalescent plasma?  I had a physician inquire about that this morning.  I don't think our normal providers will have that as it is still considered "experimental."  

Thanks!

[Kip Kuttner 87]

You would need to research available studies or file your own eIND.  Approval can take as little as 4 hour I am told.  Then you would either collect it yourself, or work with you blood supplier to collect appropriate donors. Requires excellent communication.  You can only use it for your study.  It is not an off-the-shelf product.

[AMcCord 1,302]

I just got a memo from the ARC. They are working on convalescent plasma supplies. No details yet.

[Kip Kuttner 87]

Your institution will still need to file an eIND

 

[Baby Banker 86]

I asked the blood bank manager and director if I need to put these codes in our computer system; I have not heard back from them.

On 3/27/2020 at 1:16 PM, AMcCord said:

I just got a memo from the ARC. They are working on convalescent plasma supplies. No details yet.

 

[AMcCord 1,302]

3 hours ago, Baby Banker said:

I asked the blood bank manager and director if I need to put these codes in our computer system; I have not heard back from them.

 

I'm betting we will need to build something into our system, but we haven't received product code information. They probably haven't come up with the codes yet or decided on an existing code that will work.

[Baby Banker 86]

I think ICCBBA may release some information on 1 April.  They are, of course, operating under the same sort of constraints as the rest of us.

[Marianne 66]

Due to elective surgeries all being cancelled, blood usage has been way down and short dated units are now the problem.   Our sites are cancelling standing orders.

[Eagle Eye 203]

We have all codes in safetrace. 

1) anyone has thought about billing code?

2) also order service table: this will be same as FFP, right?

[Smarty pants 31]

Just to clarify... there were several webinars last week with AABB, ASFA and US FDA.
The collection of CCP (COVID Convalescent Plasma) is no different from the collection of ANY plasma.  So blood centers can collect it as they would like. It doesn't require anything special if you've been collecting plasma.
Most centers are collecting as much as they can once they get a donor (up to 1L) as a standard "dose" seems to be somewhere in the 300-400 mL range.
It is the TRANSFUSION of the product that requires the IND, and the FDA has promised that they will be approved in 4-8 hours.  They need to be submitted and approved on a per-patient basis.
Many blood centers are working now to locate recovered patients and collect plasma.  It can then be frozen and a standing inventory in place.
In Australia, if you want to start doing something now... I would start getting an inventory of CCP. 
In the US, because of HIPPA (patient privacy) blood centers are having to contact doctors to contact their patients to see if they would be willing to donate and those donors then need to call the blood center.  They are testing these "donors" for antibody titers and if it's been <28 days since the onset of symptoms, they are also testing to make sure the virus itself isn't present (so a negative RNA test).  Locating these donors and doing the required testing is taking some time.  Once found, it's pretty quick and easy process to get the plasma.  Then it's a normal process to get it to the hospitals.
It's looking like it's best to transfuse them earlier than later.  There is no standard of care... but I would suspect that the best results will be seen if they can be transfused as soon as they're admitted to the hospital (those not admitted may not be sick enough to need this?).
As for billing... your guess is as good as mine.

Edited April 6, 2020 by Smarty pants

[slsmith 71]

No we have not.

[Sonya Martinez 44]

San Diego Blood Bank (SDBB) is our primary blood vendor an they sent out information just this morning that they are working on their process and it will require an approved eIND number for each patient and each order or an approved organizational IND which will cover all CCP requests moving forward.  SDBB is starting with collections labeled with same product codes as frozen plasma products with a tie tag identifying them as CCP.  I do have the CCP codes that were given to me by our software vendor, WellSky, so eventually I will build them (after I finish the added PAS platelet build and my new reagent QC for our reagent switch).  ARC sent out information late last week with product codes as they will be collecting with the new codes.  

[Neil Blumberg 246]

Would suggest using only ABO identical plasma.  ABO mismatched plasma creates soluble immune complexes that, at least in vitro, damage endothelial cells, impair platelet function and cause dysfunction in the coagulation cascade (thrombin generation).  Probably not a good thing in patients who already have these problems ongoing.

[Johnv 19]

In regards to Neil Blumberg's comment about using ABO identical plasma:  can I assume that ABO compatible plasma acceptable?  ie. Transfusing A plasma to an O patient?  thanks. John V

[Neil Blumberg 246]

No, I meant ABO identical. Giving A plasma to O patients is not a good idea, despite 100 years of practice, give or take.  A plasma contains soluble A antigen glycolipids and glycoproteins, and these interact with the anti-A in the group O recipient, forming huge immune complexes.  We and others have observed that patients receiving "compatible plasma" have increased bleeding, increased lung injury and increased risks of infection.  The studies that suggest this isn't true are fatally flawed by characterizing the patients receiving platelets or plasma by their first transfusion (ABO identical or not), regardless of what subsequent transfusions they received. Stick with ABO identical if at all possible.

[Johnv 19]

Thanks Dr. Blumberg.   I have passed your comments to the physician  

[Mabel Adams 1,069]

On 3/27/2020 at 8:07 AM, Neil Blumberg said:

Transfusing platelets (and plasma)prophylactically to patients without serious bleeding, based solely upon laboratory abnormalities of hemostasis/platelet count,  is a serious clinical error in my opinion.  Platelets and plasma impair host defenses against viral and bacterial infection, promote inflammation and thrombosis, and likely increase the risk of multi-organ failure.  Thus I would reserve these products for situations where these serious toxicities are outweighed by the potential for treating life-threatening bleeding.  This opinion is shared by one of the world's experts on hemostasis and thrombosis, the London based hematologist Beverly Hunt, who has tweeted her recommendations for these patients.   See this link for her four pager on the subject.

https://twitter.com/bhwords?ref_src=twsrc^google|twcamp^serp|twgr^author

This seems particularly pertinent now that they are finding so many of these patients have VTE.  Their clotting system is already pretty messed up by the disease.  They seem to have DIC but with clotting more than bleeding.